Economic Shocks and Health Resilience - Lessons from the Russian Federation

该项目发生在大萧条以来欧洲最严重的经济危机的背景下。这已经对英国和其他地方的健康产生了影响，有证据表明经济危机与健康状况恶化之间存在很强的相关性（Stuckler, Basu et al. 2011）。鉴于经济增长持续乏力，就业机会稀缺，以及国家服务和支持的缩减，人们担心这种影响会加剧。该项目旨在了解，尽管个人和家庭遭受了类似程度的经济冲击，但有些人如何能比其他人更好地生存和保持健康。虽然关于在困难时期使人们易患疾病的因素有大量文献，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，我们应用了弹性的概念。这被定义为“个人、社区和社会积极适应重大逆境的动态过程”（Luthar 2000）。它关注的是冲击（如经济冲击）对个人的影响（即反弹的能力）。虽然有大量关于弹性的研究（Rutter 2006; Castleden, McKee et al. 2011），但还没有专门应用于经济冲击与健康之间的关系。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，遭受重大外部冲击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，可以克服这一挑战。俄罗斯纵向监测调查（RLMS）包括1994年至2010年期间来自4 000户家庭的面板数据，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的经济危机，因此，与其他国家的数据集相比，俄罗斯人口受到冲击和弹性因素变化的影响程度要大得多，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对后苏联时期俄罗斯联邦的定量案例研究（使用RLMS数据集），了解促进或削弱人们对经济冲击的抵御能力的因素。第一个目标是确定促进或削弱抵御经济冲击能力的因素。第二个目标是利用多层次模型评估个人、家庭、社区和人口水平的复原力因素。我们将首先对经济危机时期影响健康的因素进行系统回顾，以确定影响弹性的潜在因素，以指导RLMS数据分析。为了进行数据分析，我们将跟踪1994年就业人员的回顾性队列，并跟踪他们直到2011年的经历，以评估个人和家庭特征以及对可比经济冲击（例如失业）的反应及其对健康结果的影响（例如死亡率、精神健康状况不佳）。潜在弹性因素包括教育水平、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。我们认为，该项目将为制定支持个人和家庭抵御经济冲击的政策提供证据，从而减轻社会痛苦和改善健康状况，从而使英国、欧洲、俄罗斯和其他经历经济危机的国家的决策者受益。该项目的概念、方法和经验贡献也将使公共卫生、经济学和社会学等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.