Department of International Public Health and Biostatistics, Nova University of Lisbon, Lisbon, Portugal; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
Soc Sci Med. 2015 Oct;142:241-8. doi: 10.1016/j.socscimed.2015.08.035. Epub 2015 Aug 22.
Health inequalities pose an important public health challenge in European countries, for which increased social mobility has been suggested as a cause. We sought to describe how the relationship between health inequalities and social mobility varies among welfare regime types in the European region. Data from six rounds of the European Social Survey was analyzed using multilevel statistical techniques, stratified by welfare regime type, including 237,535 individuals from 136 countries. Social mobility among individuals was defined according to the discrepancy between parental and offspring educational attainment. For each welfare regime type, the association between social mobility and self-rated health was examined using odds ratios and risk differences, controlling for parental education. Upwardly mobile individuals had between 23 and 44% lower odds of reporting bad or very bad self-rated health when compared to those who remained stable. On an absolute scale, former USSR countries showed the biggest and only significant differences for upward movement, while Scandinavian countries showed the smallest. Downward social mobility tended to be associated with worse health, but the results were less consistent. Upward social mobility is associated with worse health in all European welfare regime types. However, in Scandinavian countries the association of upward mobility was smaller, suggesting that the Nordic model is more effective in mitigating the impact of social mobility on health and/or of health on mobility.
健康不平等是欧洲国家面临的一个重要公共卫生挑战，有人认为提高社会流动性是造成这一问题的原因之一。本研究旨在描述在欧洲地区，不同福利制度类型下健康不平等与社会流动性之间的关系存在何种差异。本研究使用多水平统计技术，对来自 136 个国家的 237535 名个体在六个欧洲社会调查轮次的数据进行了分析，数据按照福利制度类型进行分层。根据父母和子女教育程度的差异来定义个体的社会流动性。对于每种福利制度类型，使用优势比和风险差异来检验社会流动性与自我报告健康之间的关联，同时控制父母的教育程度。与保持稳定的个体相比，向上流动的个体报告身体状况差或非常差的几率低 23%至 44%。从绝对水平来看，前苏联国家的上升流动差异最大且具有统计学意义，而斯堪的纳维亚国家的差异最小。向下的社会流动性往往与较差的健康状况相关，但结果不太一致。向上的社会流动性与所有欧洲福利制度类型下的较差健康状况相关。然而，在斯堪的纳维亚国家，向上流动的关联较小，这表明北欧模式在减轻社会流动性对健康的影响以及/或健康对流动性的影响方面更为有效。
