儿童期家庭社会经济地位对中老年健康状况的路径分析

The Pathways of Childhood Family Socioeconomic Status on the Health of the Elderly

以“健康中国2030”建设中提出“全方位全周期”促进人群健康为出发点,结合综合环境医学模式,从全生命周期的视角,关注儿童期家庭社会经济地位(SES)对中老年时期健康状况的影响及其作用路径,以期为提高人群整体健康水平提供借鉴。基于中国健康与养老调查(CHARLS)数据,结合生命历程理论,构建了儿童期家庭SES影响中老年健康状况的理论分析框架。研究发现,第一,儿童期的家庭SES对健康的影响会持续到中老年时期,良好的儿童家庭SES对中老年健康具有保护效应;第二,儿童期家庭SES对中老人健康的影响主要通过中老年期的SES、医疗卫生服务利用、生活方式等中介变量实现;第三,儿童期家庭SES极大地决定了中老年时期的家庭SES,进而影响个体的健康状况,这是产生影响的关键路径。由此,从全生命周期的视角来说,儿童期是促进生命后期健康公平、减少健康差异的最佳时期。需要将在儿童期处于低SES的人群作为健康中国战略实施中的重点干预人群,重视儿童的成长环境;以提高个体社会经济地位为重要抓手,着力提高低家庭SES儿童的受教育程度,促进构建人群向上流动的体制机制;社会公共政策也应向利好于该部分人群家庭的发展倾斜,以降低生命后期的健康差异,促进人群整体健康水平的提高,实现健康效益最大化。

This study takes the“comprehensive and life cycle”in the construction of“Healthy China 2030”to promote human health as a starting point, combined with the comprehensive environmental medicine model, from the perspective of whole life cycle, focus on childhood family socioeconomic status(SES)impact on the health of middle-aged and path, in order to offer refe-rence to improve the health level people.Based on the data of the China Health and Elderly Survey( CHARLS) and the life course theory,this study constructed a theoretical analysis framework for the influence of childhood family SES on the health status of middle-aged and elderly people. The results showed that:( 1) The health impact of family SES in childhood will continue to the middle and elderly age,and has a protection effect on the health in later life.( 2) The influence of childhood family SES on the health of middle-aged and elderly people was mainly realized through mediating variables such as SES in middle-aged and elderly people,utilization of medical and health services,and lifestyle.( 3) Family SES in childhood greatly determines family SES in middle and old age,and thus affects individual health status,which is the critical path of influence( normalized path coefficients are 0. 73 and 0. 64,respectively). From a life cycle perspective,childhood is the best time to promote health equity and reduce health disparities at the later of life. Lower childhood SES population should be taken as the key intervention group in the implementation of the Healthy China strategy,the growing environment of children should be attached importance to,the improvement of individual social and economic status should be taken as the important starting point,and the education level of children from low childhood SES families should be improved,so as to promote the establishment of the system and mechanism of the upward mobility of the population. Social and public policies should also be favorable to the development of the families of this group,so as to reduce the health differences in the later life,promote the improvement of the overall health level of the population,and realize the maximum health benefits.