中国大众健康水平的社会决定因素及路径选择——基于31个省数据的组态分析

Social determinants of population health in China and pathway selection——Configuration analysis based on data from 31 provinces

目的分析大众健康水平的社会决定因素,优化资源配置,推动人口健康水平。方法基于健康社会决定因素理论,以31个省(自治区、直辖市)数据为样本,运用模糊集定性比较分析(fuzzy-Set qualitative comparative analysis,fsQCA)方法,探讨经济发展、教育水平、收入差距、医疗配置、空气质量对人口健康水平的联动效应及路径选择。结果单一条件(一致性均<0.9)并不构成高健康水平的必要条件,前因条件多重并发形成驱动高健康水平的多样化组态;存在高水平的经济、教育、环境治理与卫生系统,且不存在高度的收入不平等可以产生高健康水平(一致性0.9752、覆盖度0.7825),驱动高健康水平的3条路径,分别是高教育水平、高经济发展、收入公平性的组态(一致性0.9826、覆盖度0.6681、唯一覆盖度0.2100);高经济发展、收入公平性、高医疗配置、高空气质量的组态(一致性0.9834、覆盖度0.4812、唯一覆盖度0.0231);高教育水平、低经济发展、收入公平性、高医疗配置、高空气质量的组态(一致性0.9819、覆盖度0.3381、唯一覆盖度0.0912)。结论健康公平性强调跨部门行动对健康的重要性,通过指定条件配置,可以解释不同地区健康水平的高低,不仅有助于深化对健康背后社会因素间复杂互动机制的理解,也能够实践指导如何依据区域特征推动人口健康水平。

Objective To analyze the social determinants of population health,so as to optimize resource allocation and to promote population health.Methods Based on the theory of social determinants of health,data from 31 provinces,autonomous regions and municipalities were taken as samples and analyzed using fuzzy-set qualitative analysis(fsQCA)to explore the linkage effect of economic development,education level,income gap,medical resources allocation,and air quality on population health level and the pathways.Results The results showed that a single condition(consistency<0.9)did not constitute the necessary condition for high health level,and multiple antecedent conditions formed a diversified configuration that drove high health level.The co-existence of high level of economy,education,environmental governance and health system combined with the absence of high income inequality might produce high health level(consistency 0.9752,coverage 0.7825).Three pathways to high level of health were identified,including the configuration of high education level,high economic development,income equity(consistency 0.9826,coverage 0.6681,unique coverage 0.2100),the configuration of high economic development,income equity,high medical resources allocation,high air quality(consistency 0.9834,coverage 0.4812,unique coverage 0.0231),and the configuration of high education level,low economic development,income equity,high medical resources allocation,high air quality(consistency 0.9819,coverage 0.3381,unique coverage 0.0912).Conclusions Health equity emphasizes the importance of cross-sectoral collaboration for health.The regional disparity in health level may be explained by varying configuration of certain conditions.The findings may not only help to deepen the understanding of the complex interaction mechanism of social factors underlying population health,but also provide practical guidance regarding how to promote the population health level according to regional characteristics.