贫困是否影响农村中老年人的精神健康——基于CHARLS数据的实证研究

农村老年人在经济上是最为弱势的群体,他们的贫困发生率远远高于城市老人。贫困不仅体现为物质上的剥夺,更会引起认知退化和抑郁等精神健康上的问题。文章使用中国健康与养老追踪调查数据,实证考察经济状况对农村中老年人精神健康的影响。多层线性模型估计结果表明：家庭人均年收入每提高一千元,反映认知状况的情景记忆显著提高0.132分、精神状态显著提高0.121分,而反映抑郁程度的CES-D则显著下降0.293分。进一步分析表明,收入对精神健康的促进作用对高收入者更大。考虑到农村更加严重的老龄化程度,通过减贫实现农村中老年人精神健康状况的改善将具有重要的现实意义。     

健康扶贫政策提升农村贫困老人主观幸福感了吗？

随着我国脱贫攻坚结束进入过渡期，健康扶贫政策对巩固脱贫攻坚提高农村贫困人口健康水平具有重要的意义。基于2015年和2018年中国健康与养老追踪调查（CHARLS）数据，运用倾向得分匹配和双重差分模型（PSM-DID），分析健康扶贫政策对农村贫困老人幸福感的影响及作用机制。研究结果表明，健康扶贫政策在5%的显著水平下提升了农村贫困老人的积极情感，并在1%的显著水平下降低了其消极情感；机制检验发现，健康扶贫政策通过提升农村贫困老人实际健康状况、降低医疗费用支出的路径提升了农村贫困老人主观幸福感；通过异质性分析发现，健康扶贫政策在5%的显著性水平下提升了健康状况较差的农村贫困老人积极情绪。最后提出逐步完善医疗保障体系、拓宽健康帮扶边界、提升医疗服务水平、树立大健康理念等建议。     

“新农合”缓解了农村居民的贫困程度吗?

为考察新农合对农村居民贫困缓解的效果,使用中国健康营养调查(CHNS)2004 年、 2006 年、2009 年和 2011 年的数据,首先采用两阶段最小二乘法(2SLS)分别对个人收入水平和 贫困状况进行多变量回归和分析。然后,为了进一步探讨新农合缓解农村居民贫困程度的作用机制, 对健康支出和健康水平分别进行了回归分析。结果表明:参加新农合能显著降低健康支出,并在 一定程度上促进农村居民就医。总体上,新农合明显缓解了我国农村居民的贫困程度,但仍未达 到理想水平。     

Overweight Adolescents and On-time High School Graduation: Racial and Gender Disparities

Obesity among U.S. adolescents ages 12–19 rose from 4.6% in 1963–1965 to 17.4% in 2003–2004. This paper contributes to the literature on the impact of unhealthy body mass index (BMI) on health (e.g., obesity) and human capital (e.g., schooling) investments of adolescents. We use the propensity score method to study 8,388 individuals who responded to survey Waves I through III of the National Longitudinal Study of Adolescent Health (Add Health), for students in grades 7–12. We estimate an economic model that captures longer-term effects of BMI categories (obesity and overweight separately) on on-time (dichotomous) high school graduation. We control for characteristics at the individual, household, and community levels. Baseline probit regression estimates were improved upon by using matching estimators (propensity scores yield consistent estimate of the average treatment on the treated) based on the nearest neighbor and the more robust kernel density weighting schemes. Results from both full and reduced models suggest no adverse impact of overweight or obesity on timely high school completion for males, but a significant average negative effect on females. Investigating disparities in effects across both gender and race, we isolate the adverse effects primarily to white and Asian females. No significant effects were found for African-Americans. One of the novel contributions of our research is that the significant effects of gender- and race- specific adolescent obesity and overweight conditions reach beyond high school GPA standing to also impact on-time high school graduation status.     

The world economic crisis and the children: A United States case study

This is a review of the United States experience with issues of child health and services, as they relate to changes in economic trends. No existing data systems are entirely adequate for reporting on the current health status of children, an important consideration for the monitoring of children's health in the United States is the focus on subgroups such as those who are disadvantaged for reasons of poverty, discrimination or geographic isolation. Ample evidence exists that children living in poverty suffer adverse health consequences and that the proportion of children living in poverty in the United States has increased steadily since 1975 and dramatically since 1981. Most measures of health status and health risks for children show steady improvements througout the 1970s. The exercise of public responsibility for financing and providing essential services and supports held constant or improved during this recession period, especially during the recession of 1974–1975. The health status and risks for children since 1981 appear to be adversely affected which must be attributed to a combination of circumstances that include serious recession, increased poverty rates for households with children and diminished health benefits and social support services. These findings suggest that when either local or widespread economic reversals are anticipated, health services and social supports for children need to be expanded rather than contracted.     

Multidimensional Poverty and Perceived Happiness: Evidence from China,Japan and Korea*

We compare multidimensional poverty and its associations with perceived happiness in China, Japan and Korea. Using largely comparable nationwide survey data, we focus on multidimensional poverty in terms of income, schooling, health and social protection. We find multidimensional poverty to be more prevalent in China than in Japan or Korea; sex and age‐based differences are largest in Korea. We further confirm significant associations between multidimensional poverty and perceived happiness. For all three countries, the aggregated poverty dimensions could largely identify unhappy individuals, with both wider coverage and higher odds than is possible through unidimensional analyses.     

Identifying income heterogeneity determinants using the method of moments quantile regression

Prior studies have typically concentrated on poverty status to determine anti-poverty measures; however, this approach cannot sufficiently detect income heterogeneity. This study employs quantile regression for panel data to investigate the Korean Labour and Income Panel Study 2003–2020. Moreover, it adopts both household- and community-level variables and separates demographic groups as working-age and older adults, considering Korea's severe old-age poverty. The findings indicate that household-level characteristics, such as householder's gender, physical health, and employment status, present heterogeneous effects across the income distribution. Second, low-income households are more vulnerable to regional economic and labour market downturns than high-income neighbours. Lastly, although the National Pension, a backbone of the public pension system, provides limited supports for retirees because it was introduced much later than other countries, it assists low-income old adults more effectively. Therefore, this study suggests more tailored redistribution measures, considering heterogeneous effects of household- and community-level environments, and a further expansion of the National Pension to mitigate old-age poverty.     

The determinants of poverty dynamics in Indonesia: evidence from panel data

We use the ‘spell’ approach to identifying poverty and apply an ordered logit model to examine the determinants of poverty dynamics in Indonesia, categorising households as poor, transient poor (–), transient poor (+) or non-poor. Observing the National Socio-Economic Survey (Susenas) balanced-panel data sets of 2005 and 2007, we found that 28% of poor households are classified as chronically poor (that is, remaining poor in two periods) while 7% of non-poor households are vulnerable to being transient poor (–). Our estimations confirmed that the determinants of poverty dynamics in Indonesia are educational attainment, the number of household members, physical assets, employment status, health shocks, the microcredit program, access to electricity, and changes in employment sector, employment status and the number of household members. We also found that households in Java–Bali are more vulnerable to negative shocks than those outside Java–Bali.     

If You Build It Nearby and Keep the Price Low,Will They Come? Large-Scale Evidence on the Relative Roles of Access and Quality in Use of Healthcare in Low-and Middle-Income Countries

Health policy reform often emphasises improving access to healthcare. Recent studies highlight the role healthcare quality plays in determining which health providers individuals use and health outcomes. Yet, there is little standardised large-scale evidence on the importance of quality of care relative to access in determining healthcare use. This paper examines the relative roles of access and quality in whether individuals seek healthcare and how these vary with socioeconomic status in a sample of over 250,000 national household survey respondents from low- and middle-income countries. My results suggest that quality is as large a barrier as access. Among quality barriers, drug availability is as large a barrier as provider availability. Analyses of the barriers-socioeconomic status gradients indicate that the quality-SES gradient is much less steep than the access-SES gradient, highlighting that increasing incomes may not be sufficient to address quality barriers and that supply-side interventions may be necessary.     

Beyond Income: What Else Predicts Very Low Food Security Among Children?

We examine characteristics and correlates of households in the United States that are most likely to have children at risk of inadequate nutrition—those that report very low food security (VLFS) among their children. Using 11 years of the Current Population Survey, plus data from the National Health and Nutrition Examination Survey (NHANES), we describe these households in great detail with the goal of trying to understand how these households differ from households without such severe food insecurity. While household income certainly plays an important role in determining VLFS among children, we find that even after flexibly controlling for income‐to‐poverty rates some household characteristics and patterns of program participation have important additional explanatory power. Finally, our examination of the NHANES data suggests an important role for both mental and physical health of adults in the household in determining the food security status of children.     

持续灾难性卫生支出测度、城乡差异与医疗保险阻断效应评估

以往文献对持续灾难性卫生支出天然属性的研究匮乏,导致相对贫困治理和医疗保障政策长远靶向目标规划缺失。文章将家庭医疗支出连年增加,重复发生灾难性卫生支出的过程定义为持续灾难性卫生支出,并在此基础上构建反映持续灾难性卫生支出发生率、发生深度以及发生时间等指数综合刻画持续灾难性卫生支出程度,利用中国微观数据（CFPS）进行动态测度和城乡分解,最后实证分析基本医疗保险对城乡家庭持续灾难性卫生支出的政策效果。研究发现,家庭持续灾难性卫生支出发生具有较强黏性,持续时间越长,摆脱难度越大,且农村持续灾难性卫生支出程度高于城镇,但城乡差距随持续时间逐渐缩小;与此同时,基本医疗保险能够显著阻断持续灾难性卫生支出,但阻断效应呈现较大的城乡差异,农村基本医疗保险在当期的阻断效应更明显,而长期来看城镇基本医疗保险的阻断效应则更强。文章结论为我国相对贫困治理和医疗保险制度优化提供了实证参考。     

A conceptualisation of poverty in rural India

This paper investigates the different aspects of poverty in rural India. Based largely on data from a region of Bihar, the various characteristics and sources of poverty are enumerated and discussed, including food intake, other consumption, health, security, education and status as characteristics; and occupation, employment, wages, assets, organization and demographic factors as sources. It is argued that poverty must be seen as a multivariate phenomenon; policy to affect any one aspect of poverty is likely to be rendered ineffective by negative feedback from other variables in the poverty complex. Only a simultaneous attack on all aspects of poverty can be successful.     

Predicting Household Poverty: A Methodological Note with a Kenyan Example

Household surveys provide data that is used for identifying and measuring the poverty status of households and individuals. However, carrying out such surveys is expensive, especially in poor developing countries. Thus it is important to make maximum use of the available survey data in developing countries, especially in sub‐Saharan Africa, where such data are expensive to collect and analyse. This paper develops a simple method for using poverty indices derived from survey data for a given year, to predict poverty rates for subsequent periods without having to conduct a new household survey. We illustrate the workings of the method with data from Kenyan household surveys for 1994 and 1997.     

Unhealthy consumption behaviors and their intergenerational persistence: The role of education

As one of the countries sharing the world's largest population of smokers and drinkers, China has been facing serious health-related problems from smoking and drinking in recent decades. This paper attempts to investigate the impact of education on unhealthy consumption behaviors (smoking, binge drinking, and drinking) and their intergenerational persistence, using data from the China Health and Nutrition Survey (CHNS) for the period from 1991 to 2011. Estimation results suggest that there exists significantly positive intergenerational persistence of unhealthy consumption behaviors in China, and this persistence seems to be higher from the mother than from the father. After introducing two institutional changes as instruments to address the endogeneity problem of education in unhealthy consumption equations, we find that education has a significantly negative impact on smoking and binge drinking according to the results from instrumental variable estimation. Specifically, an additional year of education decreases the probability of smoking and binge drinking by 4.1% and 3.4%, respectively. Although the health effect of drinking is ambiguous, we also find that the likelihood of drinking decreases by 1.6% with one additional schooling year. Interestingly, an additional year of education could counteract intergenerational persistence of smoking and binge drinking from the father, but it has no impact on intergenerational persistence from the mother. Our results suggest that education might be an efficient way to control unhealthy consumption behaviors in China, but it might not be an efficient way to prevent intergenerational persistence of unhealthy consumption behavior from the mother.     

Are smokers too optimistic about their health status: Ex ante perception versus ex post observation

As the world has moved toward the era of non-communicable diseases, whether the individuals are in a capable position to accurately evaluate their own health status has an important implication on disease prevention in particularly and population health outcome in general. In this paper, we address four important questions surrounding the accuracy of health perception: (1) to what extent that individuals can make an accurate evaluation on their own health status; (2) what are the major factors influencing health misperception if any; (3) what are the causal directions between health behavior and health perception; and (4) whether individuals can learn and update their self-evaluation on health status over time and whether such learning is productive in that it mitigates the health misperception. Specifically, we use a longitudinal data set obtained from Taiwan that covers six waves of survey over about twenty-year period to compare the ex ante subjective perception on health and the ex post mortality hazards. Our results suggest that over one third of the survey respondents are not performing well in the evaluation of their own health status. We also find that smokers are more likely to have an optimistic bias on their own health assessment as compared to nonsmokers. After controlling for the simultaneous causality problem, we find a causal effect of individuals' misperceptions on continuing smoking, but not vice versa. In addition, our results show that individuals update their subjective perception on health over time through the learning from personal health shocks and the provision of public information on smoking hazards. Although the learning process tends to be overshooting among smokers, it is beneficial to mitigate the optimistic bias. We also find the evidence that personal health shock has a stronger impact on updating behavior than public information, indicating that personal experience is a more effective channel through which to correct the bias in health perception, compared to the provision of public information, such as anti-smoking campaign.     

Population and Poverty in Africa

This paper sets out the position in Sub-Saharan Africa [SSA] regarding poverty and population. Africa has as much danger of starvation and depopulation [due to Aids] as of over population. The paper sets out a model of poverty based on the twin concepts of capabilities and entitlements. This is micro level approach and points to the importance of health and education as well as physical assets in analysing poverty. Issues of gender are always kept central. Income, access to public goods, physical assets and human capital are the four determinants of the status of any individual visavis poverty. In terms of access to public goods the paper develops a new measure of poverty based on daily calorie supply, access to clean water and access to health care. It would seem that nearly 90% of the population in 25 SSA countries or as many as 350 million can be counted as poor. Poverty is influenced by population most significantly if the household cannot afford education and health for its children. Other effects of population on poverty are thought to be transient. Poverty affects population by the complex interaction of the desire for children as insurance but an inability to ensure their survival. Population problems are most acute in societies which are developing enough to cut death rates drastically but not yet adjusted to lower infant mortality to modify their child bearing behaviour. Policy issues are discussed in the last section which highlights once again the central importance of education, health and land reforms.     

Social capital as correlate,antecedent, and consequence of health service demand in China

Amid increasing interest in how social relationships play an important role in health and health behavior, it remains unclear whether social activities and social capital in general benefit individuals' health literacy and in turn affect their health care consumption. More specifically, this article proposes a research hypothesis to address the question: Do individuals who are strongly tied to other individuals within the social networks become more health conscious or literate and hence use more health services? This paper extends prior research on social support, health literacy and health care utilization to investigate the association between social interaction and health service demand. Using the China Health and Nutrition Survey, the paper provides cross-sectional evidence that people who are socially active and connected with their friends made more visits to health care providers. It also finds that people of male gender, being single, having more years of education, and no health insurance coverage tend to avoid seeking health services. The quasi-experimental study, which examines the events that exogenously intensified social interactions in some but not all Chinese provinces, indicates that social capital is more an antecedent than a consequence of health service needs.     

Population and Poverty in Africa

This paper sets out the position in Sub-Saharan Africa [SSA] regarding poverty and population. Africa has as much danger of starvation and depopulation [due to Aids] as of over population. The paper sets out a model of poverty based on the twin concepts of capabilities and entitlements. This is micro level approach and points to the importance of health and education as well as physical assets in analysing poverty. Issues of gender are always kept central. Income, access to public goods, physical assets and human capital are the four determinants of the status of any individual visavis poverty. In terms of access to public goods the paper develops a new measure of poverty based on daily calorie supply, access to clean water and access to health care. It would seem that nearly 90% of the population in 25 SSA countries or as many as 350 million can be counted as poor. Poverty is influenced by population most significantly if the household cannot afford education and health for its children. Other effects of population on poverty are thought to be transient. Poverty affects population by the complex interaction of the desire for children as insurance but an inability to ensure their survival. Population problems are most acute in societies which are developing enough to cut death rates drastically but not yet adjusted to lower infant mortality to modify their child bearing behaviour. Policy issues are discussed in the last section which highlights once again the central importance of education, health and land reforms.     

Poor health as a precursor to consumer debt distress in South Africa

While it is well documented that severe consumer indebtedness can lead to mental and physical health problems including unhealthy coping mechanisms, the pathways from poor health to financial strain is still an understudied area. Using the National Income Dynamics Study (NIDS) data, this study examines the relationship between poor health and debt distress while controlling for the possible endogeneity between these two conditions and some health-related variables. The results indicate that poor health significantly increases the probability of financial strain. Insofar as poor health is associated with catastrophic healthcare costs and income deprivation, for instance through inability to work, other factors affecting health such as socioeconomic status and insurance might shape the contours of consumers’ debt performances in the face of health risk. Ultimately, health may be creating a vicious circle in which poor health affects the capacity to earn income and accumulate assets, which limits access to quality healthcare.     

Does children’s marriage matter for parents' mental health？Evidence from China

How to effectively alleviate mental disorders among elderly individuals is an important issue. Children are important financial and spiritual supporters of parents. However, whether there are upward spillovers from children to parents remains understudied. Using the instrumental variable (IV) method and data from the China Health and Retirement Longitudinal Study, this paper estimates the causal effect of children's marriage on the mental health of older parents. The IV estimation results demonstrate that having unmarried children is associated with a significant deterioration in parental mental health, especially in older, less educated, poor and male groups. Further evidence suggests that having unmarried children leads to significant changes in parents' economic behaviors, including labor supply, consumption, and savings; this indicates that parents are more likely to actively respond to their children’s unmarried status by increasing labor supply, reducing consumption and increasing savings rather than by engaging in negative behaviors.