相对剥夺对农村中老年人健康状况的影响——基于中国健康与养老追踪调查数据的分析
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摘要
中国农村地区的收入不平等程度和人口老龄化程度都高于城市地区,收入不平等会增加个体遭受到的相对剥夺,而人口老龄化是否会给社会经济带来严重负面影响取决于中老年人群体的健康状况。本文使用中国健康与养老追踪调查2015年数据,以村内其他居民为参照组构建相对剥夺测量指标,考察相对剥夺对中国农村中老年人健康状况的影响。多层模型的估计结果表明,收入的相对剥夺对农村中老年人的健康状况具有显著的负向影响:受较强程度相对剥夺的农村中老年人的自评健康状况较差,精神抑郁程度较高,且这种影响在以不同指标来测量相对剥夺的情况下均存在。进一步地,本文发现,相对剥夺对农村中老年人的客观健康状况并无显著影响,且相对剥夺对健康状况的不利影响主要作用于45～60岁的中年人、男性和来自收入不平等程度较高地区的农村中老年人。收入不平等引致的相对剥夺给农村中老年人的健康状况带来了不利影响,因此,改善农村地区的收入分配格局,有利于农村中老年人保持良好的健康状况。本文研究为深化农村地区的收入分配制度改革提供了相对剥夺和农村居民健康状况关系视角的经验证据。
Both the degree of income inequality and population ageing are more pronounced in rural China than in urban areas.On the one hand,the more unequal a society is economically,the higher the degree of relative deprivation people can feel.On the other hand,whether population ageing has a negative impact on the society depends on the health condition of middle and old-aged persons.Based on those facts,this article uses the recent round of CHARLS data to test relative deprivation hypotheses among Chinese rural middle and old-aged persons.The study uses sample individuals from the same villages as benchmark reference groups to construct three different relative deprivation indexes.The results from multilevel model regressions consistently show that relative deprivation has a significant negative effect on rural elderly's self-rated health condition and mental health condition.But relative deprivation seems to have little effect on objective heath measures,such as the incidence of functional limitations and chronic diseases.The analysis shows that the negative health effects of relative deprivation are mainly applied to middle-aged persons,male villagers and those coming from provinces with higher income inequality index.The relative deprivation induced by income inequality has caused a huge public health concern in rural societies with population ageing.The study suggests that deepening the income distribution policy reform may improve the health condition of rural population and relieve health burden in ruralareas.
Both the degree of income inequality and population ageing are more pronounced in rural China than in urban areas.On the one hand,the more unequal a society is economically,the higher the degree of relative deprivation people can feel.On the other hand,whether population ageing has a negative impact on the society depends on the health condition of middle and old-aged persons.Based on those facts,this article uses the recent round of CHARLS data to test relative deprivation hypotheses among Chinese rural middle and old-aged persons.The study uses sample individuals from the same villages as benchmark reference groups to construct three different relative deprivation indexes.The results from multilevel model regressions consistently show that relative deprivation has a significant negative effect on rural elderly's self-rated health condition and mental health condition.But relative deprivation seems to have little effect on objective heath measures,such as the incidence of functional limitations and chronic diseases.The analysis shows that the negative health effects of relative deprivation are mainly applied to middle-aged persons,male villagers and those coming from provinces with higher income inequality index.The relative deprivation induced by income inequality has caused a huge public health concern in rural societies with population ageing.The study suggests that deepening the income distribution policy reform may improve the health condition of rural population and relieve health burden in ruralareas.
引文
1.白志远、亓寿伟,2017:《收入门槛、相对剥夺与老年人幸福感》,《财贸经济》第5期。
2.程令国、张晔,2012:《新农合:经济绩效还是健康绩效?》,《经济研究》第1期。
3.程令国、张晔、沈可,2014:《教育如何影响了人们的健康?》,《经济学(季刊)》第1期。
4.顾大男,2003:《婚姻对中国高龄老人健康长寿影响的性别差异分析》,《中国人口科学》第3期。
5.雷晓燕、谭力、赵耀辉,2010:《退休会影响健康吗?》,《经济学(季刊)》第4期。
6.李实、杨穗,2011:《养老金收入与收入不平等对老年人健康的影响》,《中国人口科学》第3期。
7.林宝,2018:《人口老龄化城乡倒置:普遍性与阶段性》,《人口研究》第3期。
8.任国强、王福珍、罗玉辉,2016:《收入、个体收入剥夺对城乡居民健康的影响--基于CGSS2010数据的实证分析》,《南开经济研究》第6期。
9.王湘红、孙文凯、任继球,2012:《相对收入对外出务工的影响:来自中国农村的证据》,《世界经济》第5期。
10.张川川、John Giles、赵耀辉,2014:《新型农村社会养老保险政策效果评估--收入、贫困、消费、主观福利和劳动供给》,《经济学(季刊)》第1期。
11.Aberg-Yngwe,M.,J.Fritzell,O.Lundberg,F.Diderichsen,and B.Burstr?m,2003,“Exploring Relative Deprivation:Is SocialComparison a Mechanism in theRelation between Income and Health?”,SocialScience and Medicine,57(8):1463-1473.
12.Adda,J.,J.Banks,and H.M.Gaudecker,2009,“The Impact of Income Shocks on Health:Evidence from Cohort Data",TheJournal ofthe European EconomicAssociation,7(6):1361-1399.
13.Adjaye-Gbewonyo,K.,and I.Kawachi,2012,“Use of the Yitzhaki Index as a Test of Relative Deprivation for Health Outcomes:AReviewofRecent Literature”,SocialScience and Medicine,75(1):129-137.
14.Baird,S.,J.Friedman,and N.Schady,2011,“Aggregate Income Shocks and Infant Mortality in the Developing World”,TheReview ofEconomicsand Statistics,93(3):847-856.
15.Barbosa,A.R.,J.M.P.Souza,M.L.Lebr?o,R.Laurenti and M.F.Marucci,2005,“Functional Limitations of Brazilian Elderly byAgeand GenderDifferences:Data fromSABE Survey”,Cadernos De Saúde Pública,21(4):1177-1185.
16.Braveman,P.A.,C.Cubbin,S.Egerter,S.Chideya,K.S.Marchi,M.Metzler,and S.Posner,2005,“Socioeconomic Status in Health Research:One Size DoesNot FitAll”,Jama,294(22):2879-2888.
17.Cai,F.,J.Giles,P.O’Keefe,and D.Wang,2012,The Elderly and Old Age Support in Rural China,Washington:World Bank PublicationsPress.
18.Cheng,L.,H.Liu,Y.Zhang,and Z.Zhao,2018,“The Health Implications of Social Pensions:Evidence from China’s New RuralPension Scheme”,TheJournal ofComparative Economics,46(1):53-77.
19.Currie,J.,2009,“Healthy,Wealthy,and Wise:Socioeconomic Status,Poor Health in Childhood,and Human Capital Development”,The Journalof Economic Literature,47(1):87-117.
20.Deaton,A.,2001,“Relative Deprivation,Inequality,and Mortality”,NBER Working Paper No.8099,http://www.nber.org/papers/w8099.
21.Eibner,C.,and W.N.Evans,2005,“Relative Deprivation,Poor Health Habits,and Mortality”,The Journal of Human Resources,52(3):591-620.
22.Gravelle,H.,and M.Sutton,2009,“Income,Relative Income,and Self-reported Health in Britain 1979-2000”,Health Economics,18(2):125-145.
23.Idler,E.L.,and Y.Benyamini,1997,“Self-rated Health and Mortality:A Review of Twenty-seven Community Studies”,Journalof Health and Social Behavior,38(1):21-37.
24.Kondo,N.,I.Kawachi,S.V.Subramanian,Y.Takeda,and Z.Yamagata,2008,“Do Social Comparisons Explain the Association between Income Inequality and Health?Relative Deprivation and Perceived Health among Male and Female Japanese Individuals”,SocialScience and Medicine,67(6):982-987.
25.Lei,X.,X.Sun,J.Strauss,Y.Zhao,G.Yang,P.Hu,Y.Hu,and X.Yin,2014a,“Health Outcomes and Socio-economic Status among the Mid-aged and Elderly in China:Evidence from The CHARLS National Baseline Data”,The Journal of the EconomicsofAgeing,3(2):29-43.
26.Lei,X.,X.Sun,J.Strauss,P.Zhang,and Y.Zhao,2014b,“Depressive Symptoms and SES among the Mid-aged and Elderly in China:Evidence from the China Health and Retirement Longitudinal Study National Baseline”,Social Science and Medicine,120(11):224-232.
27.Li,H.,and Y.Zhu,2006,“Income,Income Inequality,and Health:Evidence from China”,The Journal of Comparative Economics,34(4):668-693.
28.Mangyo,E.,and A.Park,2011,“Relative Deprivation and Health:Which Reference Groups Matter?”,The Journal of Human Resources,46(3):459-481.
29.Sapolsky,R.M.,2005,“The Influenceof Social Hierarchyon Primate Health”,Science,308(5722):648-652.
30.Strauss,J.,X.Lei,A.Park,Y.Shen,J.P.Smith,Z.Yang,and Y.Zhao,2010,“Health Outcomes and Socio-economic Status among the Elderly in China:Evidence from theCHARLS Pilot”,Journal ofPopulationAgeing,3(4):111-142.
31.Subramanyam,M.,I.Kawachi,L.Berkman,and S.V.Subramanian,2009,“Relative Deprivation in Income and Self-rated Health in the United States”,Social Science and Medicine,69(3):327-334.
32.Szumilas,M.,2010,“Explaining Odds Ratios”,Journal of the Canadian Academy of Child and Adolescent Psychiatry,19(3):227-229.
33.Wang,C.,G.Wan and D.Yang,2014,“Income Inequality in the People’s Republic of China:Trends,Determinants,and ProposedRemedies”,The Journalof Economic Surveys,28(4):686-708.
34.Wildman,J.,2003,“Income Related Inequalities in Mental Health in Great Britain:Analysing the Causes of Health InequalityoverTime”,TheJournal ofHealth Economics,22(2):295-312.
35.Xie,Y.,and X.Zhou,2014,“Income Inequality in Today’s China”,The Proceedings of the National Academy of Sciences,111(19):6928-6933.
36.Yang,G.,L.Kong,W.Zhao,X.Wan,Y.Zhai,L.C.Chen,and J.P.Koplan,2008,“Emergence of Chronic Non-communicableDiseases in China”,The Lancet,372(9650):1697-1705.
37.Yitzhaki,S.,1979,“Relative Deprivation and theGini Coefficient”,The Quarterly JournalofEconomics,93(2):321-324.
38.Yu,B.,Q.Meng,C.Collins,R.Tolhurst,S.Tang,F.Yan,L.Bogg,and X.Liu,2010,“How Does the New Cooperative Medical Scheme Influence Health Service Utilization?A Study in Two Provinces in Rural China”,BMC Health Services Research,10(1):116-125.
39.Zhang,J.,2012,“The Impact of Water Quality on Health:Evidence from the Drinking Water Infrastructure Program in RuralChina”,TheJournal ofHealth Economics,31(1):122-134.
(1)中国农村老年人存在较严重的贫困问题,中国农村60岁以上老年人的贫困率为28.9%(参见《中国人口老龄化的挑战:中国健康与养老追踪调查全国基线报告》,http://www.doc88.com/p-0874648160403.html)。本文研究样本的家庭人均年收入水平与张川川等(2014)使用CHARLS2011年基线调查数据得到的这一指标值较为接近。
(2)Li and Zhu(2006)使用中国健康与营养调查(China Health and Nutrition Survey,CHNS)1993年数据,实证考察了收入不平等对健康状况的影响。在他们的分析中,也以村内其他成员为参照组构建相对剥夺变量。
(1)这10道题是:“我因一些小事而烦恼”,“我在做事时很难集中精力”,“我感到情绪低落”,“我觉得做任何事都很费劲”,“我对未来充满希望”,“我感到害怕”,“我的睡眠不好”,“我很愉快”,“我感到孤独”,“我觉得我无法继续我的生活”。
(1)参见《中国健康与养老追踪调查2011年全国基线调查用户使用手册》,http://charls.pku.edu.cn/uploads/document/2011-charls-wave1/application/CHARLS_nationalbaseline_users_guide.pdf。
(1)收入百分位排序变量的取值范围为[0, 100],数值越大,表明农村中老年人家庭人均年收入在所在村村民家庭人均年收入排序中的位次越靠前,相对收入越高。
(1)正文所描述的控制变量的系数估计值为表2中方程4至方程6对应系数估计值的平均数。
(2)从样本农村中老年人的自评健康状况结果看,73%的农村女性中老年人认为自己的健康状况“不好”,男性样本的这一比例为67%;从农村中老年人精神健康的性别差异看,农村女性中老年人的CES-D得分均值为19.57分,而农村男性中老年人的CES-D得分均值为17.1分。双样本t检验结果表明,男性和女性在自评健康状况和精神健康上存在显著差异。
(3)受篇幅所限,表3和后文表4中没有报告村级随机截距项方差、组内相关系数、对数似然值等结果,感兴趣的读者可通过编辑部向作者索取。
2.程令国、张晔,2012:《新农合:经济绩效还是健康绩效?》,《经济研究》第1期。
3.程令国、张晔、沈可,2014:《教育如何影响了人们的健康?》,《经济学(季刊)》第1期。
4.顾大男,2003:《婚姻对中国高龄老人健康长寿影响的性别差异分析》,《中国人口科学》第3期。
5.雷晓燕、谭力、赵耀辉,2010:《退休会影响健康吗?》,《经济学(季刊)》第4期。
6.李实、杨穗,2011:《养老金收入与收入不平等对老年人健康的影响》,《中国人口科学》第3期。
7.林宝,2018:《人口老龄化城乡倒置:普遍性与阶段性》,《人口研究》第3期。
8.任国强、王福珍、罗玉辉,2016:《收入、个体收入剥夺对城乡居民健康的影响--基于CGSS2010数据的实证分析》,《南开经济研究》第6期。
9.王湘红、孙文凯、任继球,2012:《相对收入对外出务工的影响:来自中国农村的证据》,《世界经济》第5期。
10.张川川、John Giles、赵耀辉,2014:《新型农村社会养老保险政策效果评估--收入、贫困、消费、主观福利和劳动供给》,《经济学(季刊)》第1期。
11.Aberg-Yngwe,M.,J.Fritzell,O.Lundberg,F.Diderichsen,and B.Burstr?m,2003,“Exploring Relative Deprivation:Is SocialComparison a Mechanism in theRelation between Income and Health?”,SocialScience and Medicine,57(8):1463-1473.
12.Adda,J.,J.Banks,and H.M.Gaudecker,2009,“The Impact of Income Shocks on Health:Evidence from Cohort Data",TheJournal ofthe European EconomicAssociation,7(6):1361-1399.
13.Adjaye-Gbewonyo,K.,and I.Kawachi,2012,“Use of the Yitzhaki Index as a Test of Relative Deprivation for Health Outcomes:AReviewofRecent Literature”,SocialScience and Medicine,75(1):129-137.
14.Baird,S.,J.Friedman,and N.Schady,2011,“Aggregate Income Shocks and Infant Mortality in the Developing World”,TheReview ofEconomicsand Statistics,93(3):847-856.
15.Barbosa,A.R.,J.M.P.Souza,M.L.Lebr?o,R.Laurenti and M.F.Marucci,2005,“Functional Limitations of Brazilian Elderly byAgeand GenderDifferences:Data fromSABE Survey”,Cadernos De Saúde Pública,21(4):1177-1185.
16.Braveman,P.A.,C.Cubbin,S.Egerter,S.Chideya,K.S.Marchi,M.Metzler,and S.Posner,2005,“Socioeconomic Status in Health Research:One Size DoesNot FitAll”,Jama,294(22):2879-2888.
17.Cai,F.,J.Giles,P.O’Keefe,and D.Wang,2012,The Elderly and Old Age Support in Rural China,Washington:World Bank PublicationsPress.
18.Cheng,L.,H.Liu,Y.Zhang,and Z.Zhao,2018,“The Health Implications of Social Pensions:Evidence from China’s New RuralPension Scheme”,TheJournal ofComparative Economics,46(1):53-77.
19.Currie,J.,2009,“Healthy,Wealthy,and Wise:Socioeconomic Status,Poor Health in Childhood,and Human Capital Development”,The Journalof Economic Literature,47(1):87-117.
20.Deaton,A.,2001,“Relative Deprivation,Inequality,and Mortality”,NBER Working Paper No.8099,http://www.nber.org/papers/w8099.
21.Eibner,C.,and W.N.Evans,2005,“Relative Deprivation,Poor Health Habits,and Mortality”,The Journal of Human Resources,52(3):591-620.
22.Gravelle,H.,and M.Sutton,2009,“Income,Relative Income,and Self-reported Health in Britain 1979-2000”,Health Economics,18(2):125-145.
23.Idler,E.L.,and Y.Benyamini,1997,“Self-rated Health and Mortality:A Review of Twenty-seven Community Studies”,Journalof Health and Social Behavior,38(1):21-37.
24.Kondo,N.,I.Kawachi,S.V.Subramanian,Y.Takeda,and Z.Yamagata,2008,“Do Social Comparisons Explain the Association between Income Inequality and Health?Relative Deprivation and Perceived Health among Male and Female Japanese Individuals”,SocialScience and Medicine,67(6):982-987.
25.Lei,X.,X.Sun,J.Strauss,Y.Zhao,G.Yang,P.Hu,Y.Hu,and X.Yin,2014a,“Health Outcomes and Socio-economic Status among the Mid-aged and Elderly in China:Evidence from The CHARLS National Baseline Data”,The Journal of the EconomicsofAgeing,3(2):29-43.
26.Lei,X.,X.Sun,J.Strauss,P.Zhang,and Y.Zhao,2014b,“Depressive Symptoms and SES among the Mid-aged and Elderly in China:Evidence from the China Health and Retirement Longitudinal Study National Baseline”,Social Science and Medicine,120(11):224-232.
27.Li,H.,and Y.Zhu,2006,“Income,Income Inequality,and Health:Evidence from China”,The Journal of Comparative Economics,34(4):668-693.
28.Mangyo,E.,and A.Park,2011,“Relative Deprivation and Health:Which Reference Groups Matter?”,The Journal of Human Resources,46(3):459-481.
29.Sapolsky,R.M.,2005,“The Influenceof Social Hierarchyon Primate Health”,Science,308(5722):648-652.
30.Strauss,J.,X.Lei,A.Park,Y.Shen,J.P.Smith,Z.Yang,and Y.Zhao,2010,“Health Outcomes and Socio-economic Status among the Elderly in China:Evidence from theCHARLS Pilot”,Journal ofPopulationAgeing,3(4):111-142.
31.Subramanyam,M.,I.Kawachi,L.Berkman,and S.V.Subramanian,2009,“Relative Deprivation in Income and Self-rated Health in the United States”,Social Science and Medicine,69(3):327-334.
32.Szumilas,M.,2010,“Explaining Odds Ratios”,Journal of the Canadian Academy of Child and Adolescent Psychiatry,19(3):227-229.
33.Wang,C.,G.Wan and D.Yang,2014,“Income Inequality in the People’s Republic of China:Trends,Determinants,and ProposedRemedies”,The Journalof Economic Surveys,28(4):686-708.
34.Wildman,J.,2003,“Income Related Inequalities in Mental Health in Great Britain:Analysing the Causes of Health InequalityoverTime”,TheJournal ofHealth Economics,22(2):295-312.
35.Xie,Y.,and X.Zhou,2014,“Income Inequality in Today’s China”,The Proceedings of the National Academy of Sciences,111(19):6928-6933.
36.Yang,G.,L.Kong,W.Zhao,X.Wan,Y.Zhai,L.C.Chen,and J.P.Koplan,2008,“Emergence of Chronic Non-communicableDiseases in China”,The Lancet,372(9650):1697-1705.
37.Yitzhaki,S.,1979,“Relative Deprivation and theGini Coefficient”,The Quarterly JournalofEconomics,93(2):321-324.
38.Yu,B.,Q.Meng,C.Collins,R.Tolhurst,S.Tang,F.Yan,L.Bogg,and X.Liu,2010,“How Does the New Cooperative Medical Scheme Influence Health Service Utilization?A Study in Two Provinces in Rural China”,BMC Health Services Research,10(1):116-125.
39.Zhang,J.,2012,“The Impact of Water Quality on Health:Evidence from the Drinking Water Infrastructure Program in RuralChina”,TheJournal ofHealth Economics,31(1):122-134.
(1)中国农村老年人存在较严重的贫困问题,中国农村60岁以上老年人的贫困率为28.9%(参见《中国人口老龄化的挑战:中国健康与养老追踪调查全国基线报告》,http://www.doc88.com/p-0874648160403.html)。本文研究样本的家庭人均年收入水平与张川川等(2014)使用CHARLS2011年基线调查数据得到的这一指标值较为接近。
(2)Li and Zhu(2006)使用中国健康与营养调查(China Health and Nutrition Survey,CHNS)1993年数据,实证考察了收入不平等对健康状况的影响。在他们的分析中,也以村内其他成员为参照组构建相对剥夺变量。
(1)这10道题是:“我因一些小事而烦恼”,“我在做事时很难集中精力”,“我感到情绪低落”,“我觉得做任何事都很费劲”,“我对未来充满希望”,“我感到害怕”,“我的睡眠不好”,“我很愉快”,“我感到孤独”,“我觉得我无法继续我的生活”。
(1)参见《中国健康与养老追踪调查2011年全国基线调查用户使用手册》,http://charls.pku.edu.cn/uploads/document/2011-charls-wave1/application/CHARLS_nationalbaseline_users_guide.pdf。
(1)收入百分位排序变量的取值范围为[0, 100],数值越大,表明农村中老年人家庭人均年收入在所在村村民家庭人均年收入排序中的位次越靠前,相对收入越高。
(1)正文所描述的控制变量的系数估计值为表2中方程4至方程6对应系数估计值的平均数。
(2)从样本农村中老年人的自评健康状况结果看,73%的农村女性中老年人认为自己的健康状况“不好”,男性样本的这一比例为67%;从农村中老年人精神健康的性别差异看,农村女性中老年人的CES-D得分均值为19.57分,而农村男性中老年人的CES-D得分均值为17.1分。双样本t检验结果表明,男性和女性在自评健康状况和精神健康上存在显著差异。
(3)受篇幅所限,表3和后文表4中没有报告村级随机截距项方差、组内相关系数、对数似然值等结果,感兴趣的读者可通过编辑部向作者索取。