Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
J Health Econ. 2013 Jan;32(1):1-11. doi: 10.1016/j.jhealeco.2012.09.010. Epub 2012 Oct 11.
Using a rich Italian cross-sectional dataset, we estimate the effect of a neighborhood problems aggregate (including pollution, crime, and noise) on self-assessed health, presence of chronic conditions and limitations in daily activities. We address the self-selection of the residents in their neighborhoods, as well as the possible endogeneity of income with respect to health, through instrumental variable methods and several endogeneity tests. The main novelty is the sound estimation of the neighborhood effect on health using observational data, which has the advantage of providing general results that are not dependent on any experimental design. This allows us to fully compare the neighborhood effect with the traditional socioeconomic determinants of health. Our main findings are that low quality neighborhoods are strongly health damaging. This effect is comparable to the primary/upper secondary education health differential and is even higher than the impact that poor economic circumstances have on health.
利用一个丰富的意大利横截面数据集，我们估计了一个邻里问题综合指数（包括污染、犯罪和噪音）对自我评估健康、慢性病存在情况以及日常活动受限的影响。我们通过工具变量方法和几种内生性检验来解决居民在其邻里中的自选择问题，以及收入对健康的可能内生性问题。主要的新颖之处在于使用观察数据对健康的邻里效应进行了合理的估计，这一方法具有提供不依赖于任何实验设计的一般性结果的优势。这使我们能够将邻里效应与传统的健康的社会经济决定因素进行全面比较。我们的主要发现是，低质量的邻里环境对健康有严重的损害。这种影响与小学/中学后教育的健康差异相当，甚至高于贫困经济状况对健康的影响。
