Government Spending and the Two-Way Causation between Socioeconomic Status and Health in the UK: A Multilevel Structural Equations Modelling Approach

英国政府支出以及社会经济状况与健康之间的双向因果关系：多级结构方程建模方法

• 批准号: 2575929
• 金额: --
• 依托单位: University of Bristol
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2575929
• 关键词: Government; Spending; Two; Way; Causation

Policies are critical in contouring patterns of health and mitigating health inequalities. Evidence shows that different policy regimes based on different ideologies have dissimilar impacts on individual and population health. For example, countries adhered to liberal policies are found to entail aggravated health disparities and greater mortality rates compared to countries that implemented less neoliberal policies (Coburn 2004; Navarro et al. 2006; Beckfield and Krieger 2009; Stuckler, King, and McKee 2009; McCartney et al. 2012; Walsh et al. 2017). The fiscal component of policies is central in the materialist explanations of health inequalities. Such explanations are favoured by many researchers since the release of the government-commissioned Black Report in the UK (Black 1980). Particularly, the literature focuses on how the financing of the health system determines an array of population health outcomes (Drastichová and Filzmoser 2020; Rahman and Alam 2020), including those related to the recent COVID-19 pandemic outbreak (Luonga 2020).However, the literature is relatively scarce in investigating the health benefits of government investments in different sectors than those directly related to health. The existing literature that looks into the implications of policies in non-health sectors on health remains largely theoretical and descriptive (e.g., Smith and Kandlik Eltanani 2015). Yet, investigating the health implications of non-health expenditure is crucial given the potential of policy initiatives in alleviating health disparities by tackling the fundamental causes of such disparities, viz. inequalities in socioeconomic status (SES) (Link and Phelan 1995; Adler and Newman 2002). Indicators of SES are thought to serve as markers of the underlying dimension of social ordering, which determines the distribution of resources including those that enable avoiding risks of illness (Cutler, Lleras-Muney, and Vogl 2011). On the other hand, health conditions may over time also affect SES through social mobility processes (Hoffmann, Kröger, and Geyer 2019). Therefore, taking into account this dynamic simultaneity between SES and health, it is important to assess how government policies shape health inequalities through both (1) public health expenditure and policies which may influence directly individuals' health status, and (2) spending and policies in non-health-related areas such as education, labour, income and taxation which alter individuals' socioeconomic circumstances and in turn may affect health.The proposed research aims to compare longitudinally the effects of public health and non-health policy domains on indicators of health and SES. The research aims to address the following questions. What are the relative effects of investing directly in people's health versus in policies that improve their socioeconomic position on health? Do these effects of policies change over time, and if so, do they depend on a person's age, ethnicity, and other socio-demographic characteristics? As a general hypothesis, I expect that public health policies will exert a greater short-run effect on health, whereas non-health policies will manifest themselves in the long run. I select the UK to answer the research questions above because of the availability of a wealth of high-quality individual and population level longitudinal data.

政策对于勾画健康模式和减少健康不平等至关重要。有证据表明，基于不同意识形态的不同政策制度对个人和人口健康的影响不同。例如，与实施较少新自由主义政策的国家相比，坚持自由主义政策的国家导致健康差距加剧，死亡率更高（Coburn 2004; Navarro et al. 2006; Beckfield and Krieger 2009; Stuckler，King，and McKee 2009; McCartney et al. 2012;沃尔什et al. 2017）。政策的财政组成部分是对健康不平等的唯物主义解释的核心。自英国政府委托发布的《黑色报告》（Black 1980）以来，许多研究人员都倾向于这样的解释。特别是，文献集中于卫生系统的筹资如何决定一系列人口健康结果（Drastichová和Filzmoser 2020; Rahman and Alam 2020），包括与最近COVID-19疫情爆发有关的数据（Luonga 2020）。然而，在调查政府在不同部门投资的健康效益方面，文献相对较少，而不是直接与以下方面有关的文献：健康现有的研究非卫生部门的政策对卫生的影响的文献仍然主要是理论性和描述性的（例如，Smith和Kandlik Eltanani 2015）。然而，考虑到政策举措通过解决造成健康差距的根本原因，即社会经济地位的不平等，有可能缓解这种差距，因此调查非健康支出对健康的影响至关重要（Link and Einstein 1995; Adler and纽曼2002）。社会经济地位指标被认为是社会秩序的基本维度的标志，社会秩序决定了资源的分配，包括那些能够避免疾病风险的资源（Cutler，Lleras-Muney和Vogl 2011）。另一方面，随着时间的推移，健康状况也可能通过社会流动过程影响SES（Hoffmann，Kröger和盖耶2019）。因此，考虑到社会经济地位与健康之间的这种动态一致性，重要的是评估政府政策如何通过以下两方面形成健康不平等：（1）公共卫生支出和可能直接影响个人健康状况的政策，以及（2）教育、劳动、卫生和其他非健康相关领域的支出和政策。收入和税收，改变个人的社会经济状况，反过来可能会影响health.The拟议的研究旨在纵向比较公共卫生和非卫生政策领域的健康和社会经济地位的指标的影响。该研究旨在解决以下问题。直接投资于人民健康与投资于改善其社会经济地位的政策对健康的相对影响是什么？政策的这些影响是否会随着时间的推移而改变？如果是，它们是否取决于一个人的年龄、种族和其他社会人口特征？作为一个一般性假设，我预计公共卫生政策将对健康产生更大的短期影响，而非卫生政策将在长期内表现出来。我之所以选择英国来回答上述研究问题，是因为英国拥有大量高质量的个人和人口水平的纵向数据。