人均预期寿命差距的健康决定因素贡献度研究

目的:系统性分解健康决定因素不平等对人均预期寿命差距的贡献度,探索公共政策可干预的优先领域,提出缩小国家或地区间健康差距的政策建议.方法:利用1990—2017年跨国面板数据,在分组构建宏观健康生产方程和回归分析的基础上,利用Oaxaca-Blinder分解技术对高、低寿命国家组间差距进行分解,计算出各因素对寿命差距的贡献度.结果:总体人均预期寿命差距绝大部分(92.8%)可由健康决定因素不平等解释(可干预的资源型差异),不可解释部分(难以干预的结构型差异)仅占7.2%;在可解释部分,受教育程度贡献度最高(34.4%),其次是人均GDP(26.8%)和安全饮水覆盖率(26.2%),三者共占87.4%;在因素分类贡献度中,社会经济地位因素对于寿命差距贡献度最高(60.9%),医疗卫生体系因素贡献度为6.5%.结论:健康弱势国家应主动建立以健康为导向的资源可持续发展路径,必要时采取国家内部跨地区资源转移战略;明确健康发展的优先领域,兼顾跨领域资源统筹协调;加强发达国家对弱势国家资源发展的国际投资与援助,协作构建人类卫生健康共同体.

Study on the Contribution of Health Determinants to the Gap in Life Expectancy

Objective:To systematically decompose the contribution of health determinants to the gap in life expectancy,explore priority areas for public policy interventions,and put forward policy suggestions to narrow the health gap among countries or regions.Methods:According to transnational panel data from 1990 to 2017 and Oaxaca-Blinder decomposition technique,it decomposes the life expectancy gap between high-life expectancy and low-life expectancy countries on the basis of constructing macro health production equation and regression analysis by group,and calculates the contribution of each factor to the gap in life expectancy.Results:The vast majority(92.8%)of the overall life expectancy gap can be explained by inequalities in health determinants on which resource-based interventions can act,while the unexplainable part which is structural-based gap accounts for only 7.2%.In the explicable part,education contributes the most(34.4%),followed by per capita GDP(26.8%)and safe drinking water coverage(26.2%),all three accounting for a total of 87.4%.When the factors are categorized,the socio-economic status factor contributes the most to the gap(60.9%),and the health system factor contributes 6.5%.Conclusion:The vulnerable countries with relatively poor health should take the initiative to establish a health-oriented sustainable resource development path and adopt sub-national resources diversion strategies when necessary;identify priority areas for health development and give consideration to the overall coordination of cross-sectorial resources;strengthen international investment and assistance by developed countries in the development of resources in vulnerable countries,and cooperatively build a community of common health for mankind.