Morris J N, Wilkinson Paul, Dangour Alan D, Deeming Christopher, Fletcher Astrid
London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Int J Epidemiol. 2007 Dec;36(6):1300-7. doi: 10.1093/ije/dym129. Epub 2007 Jul 12.
Worldwide biomedical and social research is providing evidence on the personal requirements for health and well-being. Assessment of the minimum personal costs entailed in meeting these requirements is important for the definition of 'poverty'. Barriers to health must arise if income is below this level. We demonstrate the principle of such assessment for people aged 65 years plus without significant disability living independently in England.
Current best evidence on the needs for healthy living was derived for nutrition, physical activity, housing, psychosocial relations/social inclusion, getting about, medical care and hygiene. We used conclusions of expert reviews, published research and where necessary, our judgement. This knowledge was translated into presumptively acceptable ways of living for the specified population. Current corresponding minimal personal costs were assessed from familiar low cost retailers/suppliers or, where unavoidable, from national data on the expenditure of low-income older people.
Minimum income requirements for healthy living, MIHL, for this population in England is 50% greater than the state pension. It is also appreciably greater than the official minimum income safety floor (after means testing), the Pension Credit Guarantee; that will also have to meet any extra costs of disability.
Objective evidence-based assessment of MIHL now is practicable but not presently as a basis of health and social policy in the UK or elsewhere apparently. Such assessment could also be an operational criterion of poverty and society's minimum income standards. The results suggest that inadequate income currently could be a barrier to healthy living for older people in England.
全球范围内的生物医学和社会研究正在为健康和幸福的个人需求提供证据。评估满足这些需求所需的最低个人成本对于“贫困”的定义很重要。如果收入低于这一水平,就必然会出现健康障碍。我们证明了对英格兰65岁及以上无重大残疾且独立生活的人群进行此类评估的原则。
从营养、体育活动、住房、心理社会关系/社会包容、出行、医疗保健和卫生等方面得出当前关于健康生活需求的最佳证据。我们采用了专家评审的结论、已发表的研究成果,并在必要时运用了我们的判断。这些知识被转化为针对特定人群的假定可接受的生活方式。当前相应的最低个人成本是从熟悉的低成本零售商/供应商处评估得出的,或者在不可避免的情况下,从低收入老年人支出的国家数据中评估得出。
英格兰该人群健康生活的最低收入要求(MIHL)比国家养老金高出50%。它也明显高于官方最低收入保障(经过经济状况调查后),即养老金信贷担保;而养老金信贷担保还必须满足残疾带来的任何额外费用。
目前基于客观证据对MIHL进行评估是可行的,但显然目前在英国或其他地方都不作为健康和社会政策的基础。这样的评估也可以成为贫困和社会最低收入标准的操作标准。结果表明,目前收入不足可能成为英格兰老年人健康生活的障碍。