空气污染、健康折旧与医疗成本——基于生理、心理及社会适应能力三重视角的研究

Air Pollution,Health Depreciation and Medical Costs:Research Based on the Three Perspectives of Physical Health,Mental Health and Social Adaptability

本文基于Grossman健康需求理论厘清空气污染对健康资本与医疗成本的影响机理,并以2015年中国健康与养老追踪调查(CHARLS)为样本,从生理、心理、社会适应能力三重健康视角全面考察了空气污染的健康折旧效应与医疗成本效应。研究发现:空气污染加速了健康资本折旧,年均空气质量指数(AQI)增加1个标准差,生理健康、心理健康与社会适应能力分别降低3.12个标准差、1.87个标准差和1.30个标准差;空气污染会导致医疗成本提升,年均AQI指数增加1单位,全国45岁以上中老年人口的医疗费用将增加642.29亿元。进一步研究发现,不同种类污染物的影响存在差异,PM2.5、PM10与NO2具有显著的健康折旧效应或医疗成本效应;空气污染的长期效应与短期效应并存,对生理健康的负面影响主要集中在9个月以上的中长期,而对心理健康与社会适应能力的折旧分别在0—9个月内、0—15个月内十分显著。此外,空气污染对健康资本与医疗成本的影响具有人群差异与区域差异,个人性别、年龄、健康状态及区域经济发展、医疗资源状况等不同,空气污染的健康效应也会具有差异。本文结论对于有重点、分阶段、分人群、分区域地推进环境健康工作,完善相关治理措施,促进公共健康发展具有重要政策含义。

As the largest developing country in the world,China has experienced rapid industrialization and urbanization during its 40 years of reform and opening-up.This has created a remarkable growth miracle.China's intensive development has caused a series of environmental problems,however,among which air pollution is the most serious.Severe air pollution hinders the social economy's sustainable development and poses a major threat to public health.This paper comprehensively evaluates the impact of air pollution on health depreciation and medical costs.It conducts a heterogeneity analysis for different types of pollutants,different time windows,different population groups,and different regions.The analysis has important policy implications for promoting public governance policies,reducing air pollution,and promoting public health in a focused,phased,population-based,and regional manner.The health depreciation effect of air pollution refers to the loss of health capital that air pollution causes.Economic analysis in this field begins with the Grossman model of health demand.In recent years,scholars have studied the health effects of air pollution from the perspectives of life expectancy,disease prevalence,cognition,depression,and economic costs.This paper first clarifies the impact mechanism of air pollution on health capital and medical costs based on Grossman's framework of health demand.The paper then takes the China Health and Retirement Longitudinal Study(CHARLS)from 2015 as its sample to measure physical health,mental health,and social adaptability.It uses air pollution data from the Air Quality Index(AQI)and the AQI's six main pollutants to comprehensively study the health depreciation effect and effect on medical costs of air pollution based on the two-stage least squares(2SLS).The main conclusions are as follows.This paper shows that air pollution can accelerate the depreciation of health capital.For each standard deviation increase in annual AQI,physical health,mental health,and social adaptability decrease by 3.12 standard deviations,1.87 standard deviations,and 1.30 standard deviations,respectively.Air pollution also leads to higher medical costs.For every unit increase in annual AQI,the medical expenses of middle-aged and elderly people over 45 years old increase by 64.229 billion yuan.Further research shows that different pollutants have different effects on health depreciation and medical costs.PM2.5,PM10,and NO2 have significant effects on health depreciation or medical costs and should be the current focus of pollution prevention and control work.Air pollution's long-term and short-term effects coexist.The negative effects on physical health mainly occur in the medium and long term over 9 months,while the depreciation of mental health and social adaptability is very significant over 0-9 months and 0-15 months,respectively.The impact of air pollution on health depreciation and medical costs also varies among different population groups and different regions.Gender,age,health status,regional economic development status,and regional medical resource status all cause the effects of air pollution to vary.This paper's conclusions have policy implications for taking practical and effective measures to reduce air pollution and promote public health.The paper's main contributions are as follows.First,the paper evaluates the health effects of air pollution from the three perspectives of physical health,mental health,and social adaptability.This research perspective is novel and comprehensive.Second,this paper follows up on research progress in the field of environmental science and medicine by using the entropy weight method to construct comprehensive indices for systematically evaluating residents'health.This method can reveal the relationship between air pollution and health more specifically and accurately.Third,heterogeneity analysis based on different pollutants,different time windows,different population groups,and different regions will help promote environmental health work in a focused,phased,population-based,and regional manner.