社区环境互动作用下的健康公平实现机会及社会条件——基于追踪数据的分析

The Opportunity and Social Condition of Health Equity under People’s Interaction with Community Environment:An Empirical Analysis Based on Longitudinal Data

我国卫生健康事业的重心已从缩小健康不平等向实现健康公平转变,但存在哪些实现机会尚缺乏充分讨论,本文基于社会生态学理论衍生出环境互动视角加以探究。通过对中国劳动力动态调查(CLDS)2014年和2016年连续两轮追踪数据建立多层次混合效应模型进行分析,发现人们参与社区环境互动会对健康公平有重要促进作用,但这种作用更可能在健康公平状况相对较差的条件下产生,例如教育差异下的健康公平及农村地区的健康公平。这反映出我国社会的健康公平尚处于可初步改善状态,民众对环境互动的参与需继续加强才能扩大机会效用。进一步地,从浙江省相关政策实践案例中总结出不同层次的互动改善措施,综合考虑大众健康活动需求,加强环境设施的有效利用,应成为健康公平政策的重要发展方向。

The goal of health development in China has gradually transferred from alleviating inequality to promoting equity,but the opportunity in attainment of health equity has not been discussed specifically.In this study,the opportunity was explored from the perspective of people’s interaction with environment based on the theory of social ecology.Using the longitudinal data collected from China Labor Dynamics Survey(CLDS)in 2014 and 2016,this study set up the hierarchical mixed-effect model and find that people's participation in health environments of community played an important role in advancing health equity.However,such positive effects were significant in relatively poor status of health equity,such as health equity under educational disparities and in rural areas.The implication is that health equity could only get improved preliminarily and need broader social interaction with health facilities to expand the utility of opportunity.By analyzing exemplary policy implementations in Zhejiang Province,this article further summarized practical measures to boosting health interaction in different observatory levels.As thus,the direction of health equity policy should be stressed on comprehensive demand for health activities and effective utilization of health facilities.