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

• 批准号: 8486349
• 负责人: Titus Johannes Galama
• 金额: $ 38.66万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8486349
• 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

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）：解决低社会经济地位（SES）群体之间健康的实质性差异，需要详细了解SES（例如，教育，收入和财富）与健康（包括残疾和死亡率）之间的复杂相互作用。近年来，在表征生命周期的各个方面与健康方面的关系以及了解因果途径的相对重要性和方向方面取得了进展。 然而，尽管知识方面的进展知之甚少，但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全面理论框架，进步受到了阻碍。毫不奇怪的是，最近对文献的评论表明缺乏这种统一的理论并强调了发展一种理论的重要性。 最近，我们为开发一个统一的理论框架做出了巨大的努力，以分析生命周期的健康和社会经济地位轨迹。我们的理论框架旨在将SES健康梯度理解为理性（但受约束）个人行为的结果。结构模型包含许多潜在的机制，可以解释SES健康差异。特别重要的是，似乎是生活方式因素（预防性护理，健康和不健康的消费），工作条件（与工作相关的健康压力）1，治愈性护理以及健康对工作的限制。需要经验测试来区分重要的重要机制。 这项研究的目的是（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。这些测试的目的不仅是建立合理的因果关系，而且是评估产生因果关系的基本机制。 （iii）将估计的模型与机构的国际差异相结合，以告知政策和决策者有关替代公共政策以减少健康差异的相对有效性。 拟议研究的具体目的是：1）通过使用生活方式和工作的结构模型来提高我们对负责健康社会经济差异的机制的理解； 2）使用结构模型与迄今为止可用的最丰富的面板数据一起经验评估生活方式和与工作相关的健康压力的重要性； 3）评估健康引起的劳动力撤出对健康差异的贡献； 4）评估机构和公共政策对造成/调节健康差异的影响。 1与工作相关的健康压力的概念可以广泛解释，从身体工作条件（例如，努力）到工作的心理社会方面（例如，状态低，有限的控制，重复性工作等）范围。这里的想法是，它可以包括对健康有害的工作的任何方面，因此与工资溢价有关（相对于虚构的情况，不会对健康造成不利影响）。 公共卫生相关性：如果不详细了解低和高社会经济地位群体之间健康差异的原因，旨在减少这种差异的政策可能是无效的。最近，我们为开发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在生命周期上的健康差异。这项研究的目标是（i）从该框架中得出新的可测试预测，（ii）使用来自美国和欧洲国家的现有面板数据测试这些预测，以及（iii）使用估计的模型和国际变化，以告知政策和决策者有关替代公共政策的相对有效性，以减少健康方面的差异。