From understanding to reducing health disparities: a model-based evaluation

从理解到减少健康差异：基于模型的评估

基本信息

批准号：
8301628
负责人：
Titus Johannes Galama
金额：
$ 47.05万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-07-01 至 2013-03-17
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8301628
关键词：
Accounting Address Affect Age Alcohol Nutrition American Behavior Behavioral Biology Capital Caring Cessation of life Complex Consumption Country Data Data Sources Demography Deterioration Development Dimensions Disabled Persons Discipline Economics Education Effectiveness Empirical Research Employment Epidemiology Etiology Europe European European Union Evaluation Exercise Health Health Food Health Insurance Health Policy Health Services Accessibility Health Status Health Surveys Healthcare Heavy Drinking Household Human Income Individual Induced Labor Inequality Institution International Internet Intervention Investments Knowledge Labor Forces Life Life Cycle Stages Life Style Link Longitudinal Studies Marketing Measurement Measures Medical Modeling Netherlands Occupational Occupations Outcome Pathway interactions Patient Self-Report Phase Play Policies Preventive Psychology Public Policy Regulation Relative (related person)Research Retirement Review Literature Role Safety Smoking Social Sciences Social status Socioeconomic Status Sociology Solutions Sports Stress Structural Models Surveys System Taxation Taxes Testing Time Tobacco Variant Wages Withdrawal Work Workplace base disability health disparity improved indexing insight interest life history lifestyle factors mortality neglect protective effect psychosocial public health relevance socioeconomics statistics theories

项目摘要

DESCRIPTION (provided by applicant): Addressing the substantial disparity in health between low and high socioeconomic status (SES) groups requires a detailed understanding of the complex interaction between dimensions of SES (such as, education, income and wealth) and those of health (including disability and mortality). Progress has been made in recent years in characterizing the relationships between the various dimensions of SES and health over the lifecycle and in understanding the relative importance and directions of causal pathways. Yet, despite these advances in knowledge little is known about many of the mechanisms that produce the observed causal relations. Progress is hampered by the lack of a comprehensive theoretical framework to interpret empirical facts. It is no surprise then that recent reviews of the literature point to the absence of such a unifying theory and emphasize the importance of developing one. We have recently made substantial efforts toward the development of a unified theoretical framework for analyzing health and socioeconomic status trajectories over the lifecycle. Our theoretical framework aims to understand the SES-health gradient as the outcome of rational (but constrained) individual behavior. The structural model contains many potential mechanisms that could explain disparities in health by SES. Of particular importance appear to be lifestyle factors (preventive care, healthy and unhealthy consumption), work conditions (job-related health stress)1, curative care and the constraining effect of health on work. Empirical testing is needed to distinguish important from less important mechanisms. The objectives of this research are (i) to derive new, testable predictions from this framework; (ii) to test these predictions using existing panel data from the US and European countries. The aim of these tests is not only to establish plausible causality but to evaluate the underlying mechanisms that produce the causal relationships; and (iii) to couple the estimated models with international variation in institutions to inform policy and decision makers about the relative effectiveness of alternative public policies to reduce disparities in health. The specific aims of the proposed research are to: 1) improve our understanding of mechanisms responsible for socioeconomic disparities in health using a structural model of lifestyle and work; 2) use the structural model to empirically assess the importance of lifestyle and job-related health stress with the richest panel data available to date; 3) evaluate the contribution of health-induced labor-force withdrawal to health disparities; and 4) assess the effects of institutions and public policies on creating/moderating health disparities. 1 The concept of job-related health stress can be interpreted broadly and can range from physical working conditions (e.g., hard labor) to psychosocial aspects of work (e.g., low status, limited control, repetitive work, etc). The notion here is that it can include any aspect of work that is detrimental to health and as such is associated with a wage premium (relative to an imaginary situation where there would not be a detrimental affect on health). PUBLIC HEALTH RELEVANCE: Without a detailed understanding of the causes of the substantial disparities in health between low and high socioeconomic status groups, policies aimed at reducing such disparities are likely to be ineffective. We have recently made substantial efforts toward the development of a structural model that allows for many potential mechanisms that could explain disparities in health by SES over the lifecycle. The objectives of this research are (i) to derive new, testable predictions from this framework, (ii) to test these predictions using existing panel data from the US and European countries, and (iii) to use the estimated models and international variation to inform policy and decision makers about the relative effectiveness of alternative public policies to reduce disparities in health.

描述（由申请人提供）：要解决低社会经济地位 (SES) 群体和高社会经济地位 (SES) 群体之间在健康方面的巨大差异，需要详细了解 SES 维度（例如教育、收入和财富）与健康维度（例如，教育、收入和财富）之间复杂的相互作用（包括残疾和死亡率）。近年来，在描述生命周期中社会经济地位各个维度与健康之间的关系以及理解因果路径的相对重要性和方向方面取得了进展。然而，尽管知识取得了这些进步，但人们对产生观察到的因果关系的许多机制知之甚少。由于缺乏解释经验事实的综合理论框架，进展受到阻碍。因此，最近的文献评论指出缺乏这种统一的理论并强调发展一个理论的重要性也就不足为奇了。我们最近为开发一个统一的理论框架来分析生命周期中的健康和社会经济地位轨迹做出了巨大的努力。我们的理论框架旨在将社会经济地位健康梯度理解为理性（但受限）个人行为的结果。该结构模型包含许多潜在机制，可以解释 SES 造成的健康差异。特别重要的似乎是生活方式因素（预防保健、健康和不健康的消费）、工作条件（与工作相关的健康压力）1、治疗护理以及健康对工作的限制作用。需要进行实证测试来区分重要机制和不太重要的机制。这项研究的目标是（i）从这个框架中得出新的、可测试的预测； (ii) 使用美国和欧洲国家的现有面板数据来测试这些预测。这些测试的目的不仅是为了建立合理的因果关系，而且是为了评估产生因果关系的潜在机制； (iii) 将估计模型与机构的国际差异相结合，以便政策和决策者了解替代性公共政策在减少健康差距方面的相对有效性。拟议研究的具体目标是：1）利用生活方式和工作的结构模型，提高我们对造成健康方面社会经济差异的机制的理解； 2）利用结构模型，利用迄今为止最丰富的面板数据，实证评估生活方式和工作相关健康压力的重要性； 3) 评估健康引起的劳动力退出对健康差异的贡献； 4) 评估机构和公共政策对造成/缓解健康差异的影响。 1 与工作相关的健康压力的概念可以广义地解释，范围可以从体力工作条件（例如，艰苦劳动）到工作的社会心理方面（例如，地位低下、控制有限、重复性工作等）。这里的概念是，它可以包括对健康有害的工作的任何方面，因此与工资溢价相关（相对于不会对健康产生不利影响的想象情况）。公共卫生相关性：如果不详细了解低社会经济地位群体和高社会经济地位群体之间健康状况巨大差异的原因，旨在减少这种差异的政策可能会无效。我们最近为开发一个结构模型做出了巨大的努力，该模型允许许多潜在的机制来解释 SES 在生命周期中的健康差异。本研究的目标是 (i) 从该框架中得出新的、可测试的预测，(ii) 使用美国和欧洲国家的现有面板数据测试这些预测，以及 (iii) 使用估计模型和国际变化来向政策和决策者通报替代公共政策在减少健康差距方面的相对有效性。