Economic Shocks and Health Resilience - Lessons from the Russian Federation

该项目是在欧洲自大萧条以来最严重的经济危机背景下进行的。这已经对联合王国和其他地方的健康产生了影响，有证据表明经济危机与更糟糕的健康之间存在很强的相关性(Stuckler、Basu等人)。2011年)。人们担心，鉴于持续缺乏经济增长、就业机会稀缺以及国家服务和支持的缩减，这种影响将会加剧。这个项目试图了解一些人为什么比其他人更有能力生存并保持良好的健康，尽管在个人和家庭一级经历了类似程度的经济冲击。虽然有大量文献研究了让人们在困难时期容易受到疾病影响的因素，但关于可能保护健康和福祉的因素的文献要少得多。为了解决这个问题，我们应用了复原力的概念。这被定义为“个人、社区和社会在重大逆境中积极适应的动态过程”(Luthar 2000)。它侧重于一次冲击(例如经济冲击)对个人的影响(即反弹的能力)。虽然有相当多关于韧性的研究(Rutter 2006；Castleden，McKee等人)。经济冲击和复原力研究面临的一个挑战是，在大多数情况下，受重大外部冲击影响的个人在人口中所占比例相对较小。然而，我们已经确定了一个现有的数据源来克服这一挑战。俄罗斯纵向监测调查(RLMS)由1994至2010年间4,000户家庭的面板数据组成，其中包含有关健康、经济状况和复原力的变量。俄罗斯人口面临着一系列重大经济危机，因此与其他国家的数据集相比，俄罗斯人受到冲击的程度和复原力因素的变化要大得多，从而使我们能够确定在英国和其他地方可能更难观察到的影响。我们项目的目的是通过使用后苏联时期俄罗斯联邦的定量案例研究(使用RLMS数据集)来了解促进或削弱人们对经济冲击的复原力的因素。第一个目标是找出提高或削弱抵御经济冲击的韧性的因素。第二个目标是使用多层次模型评估个人、家庭、社区和人口层面的复原力因素。我们将首先进行系统的回顾，以确定在经济危机时期影响健康的因素，以确定影响复原力的潜在因素，以指导RLMS数据分析。对于数据分析，我们将跟踪1994年受雇人员的回溯队列，并跟踪他们在2011年之前的经历，以评估个人和家庭特征以及对类似经济冲击(例如失业)的反应以及对他们健康结果的影响(例如死亡率、精神健康不良)。潜在的复原力因素包括教育水平、婚姻状况、伴侣特征、社会和政治态度、社会网络、劳动力市场特征和社会福利支持。我们相信，该项目将为英国、欧洲、俄罗斯和其他经历经济危机的国家的政策制定者提供证据，帮助他们制定政策，支持个人和家庭对经济冲击的复原力，从而减轻社会痛苦，改善健康。该项目在概念、方法和经验方面的贡献也将使公共卫生、经济学和社会学学科的研究人员受益。我们将通过与相关政策和学术界的积极接触，最大限度地提高项目的效益。

The project takes place in the context of the worst economic crisis in Europe since the Great Depression. This has already had an impact on health in the United Kingdom and elsewhere, with evidence showing the strong correlation between economic crises and worse health (Stuckler, Basu et al. 2011). There are fears this impact will increase given the persisting lack of economic growth, scarcity of job opportunities, and retrenchments of state services and support. This project seeks to understand how some people are better able than others to survive and maintain good health despite experiencing similar levels of economic shock at the individual and household level. While there is a large literature on the factors that leave people vulnerable to ill health during hard times, there is much less on the factors that may protect health and wellbeing. In order to address this, we apply the concept of resilience. This has been defined as a 'dynamic process by which individuals, communities and societies positively adapt in a context of significant adversity'(Luthar 2000). It focuses on the effect that a shock (e.g. economic shock) has on the individual (i.e. the ability to bounce back). While there is a considerable body of research on resilience (Rutter 2006; Castleden, McKee et al. 2011), it has yet to be applied specifically to the relationship of economic shocks and health.A challenge to the study of economic shock and resilience is that in most circumstances individuals exposed to significant external shocks comprise a relatively small proportion of the population. We have, however, identified an existing data source that overcomes this challenge. The Russian Longitudinal Monitoring Survey (RLMS) consists of panel data from 4,000 households between 1994 and 2010 which contains variables on health, economic status and resilience. The Russian population has faced a series of major economic crises and so has a much greater degree of exposure to shocks and variation of resilience factors than found in datasets in other countries, thus enabling us to ascertain effects which may be more difficult to observe in the United Kingdom and elsewhere.The aim of our project is to understand the factors that promote or diminish people's resilience to economic shocks, using a quantitative case-study of the Russian Federation in the post-Soviet period (using the RLMS dataset). The first objective is to identify the factors that promote or diminish resilience to economic shocks. The second objective is to evaluate resilience factors at individual, household, community, and population levels using multi-level modelling. We will firstly perform a systematic review to identify factors that modify health in times of economic crisis to identify potential factors influencing resilience to guide the RLMS data analysis. For the data analysis we will follow a retrospective cohort of persons who were employed in 1994 and follow their experiences until 2011 to evaluate individual and household characteristics and responses to comparable economic shocks (e.g. loss of a job) and the influence on their health outcomes (e.g. mortality, poor mental health). Potential resilience factors include education level, marital status, partner characteristics, social and political attitudes, social networks, labour market characteristics and social welfare support.We believe the project will benefit policymakers in the United Kingdom, Europe, Russia and other countries experiencing economic crises by providing evidence to develop policies that support individual and household resilience to economic shock and so alleviating social suffering and improving health. The conceptual, methodological and empirical contributions of the project will also benefit researchers from the disciplines of public health, economics and sociology. We will maximise the project benefits through active engagement with the relevant policy and academic communities.