Beckfield Jason, Morris Katherine Ann, Bambra Clare
1 Department of Sociology, Harvard University, Cambridge, MA, USA.
2 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
Scand J Public Health. 2018 Feb;46(1):6-17. doi: 10.1177/1403494817715954. Epub 2017 Jul 4.
In this study we aimed to analyze gender health equity as a case of how social policy contributes to population health. We analyzed three sets of social-investment policies implemented in Europe and previously hypothesized to reduce gender inequity in labor market outcomes: childcare; active labor market programs; and long-term care.
We use 12 indicators of social-investment policies from the OECD Social Expenditure Database, the OECD Family Database, and the Social Policy Indicators' Parental Leave Benefit Dataset. We draw outcome data from the 2015 Global Burden of Disease for years lived with disability and all-cause mortality among men and women ages 25-54 for 18 European nations over the 1995-2010 period. We estimate 12 linear regression models each for mortality and morbidity (i.e. years lived with disability), one per social-investment indicator. All models use country fixed-effects and cluster-robust standard errors.
For years lived with disability, women benefit more from social investment for most indicators. The only exception is the percentage of young children in publicly funded childcare or schooling, which equally benefits men. For all-cause mortality, men benefit more or equally from social investment for most indicators, while women benefit more from government spending on direct job creation through civil employment.
Social policy contributes to the distribution of population health. Social-investment advocates argue such policies in particular enhance economic gender equity. Our results show that these polices have ambiguous effects on gender health equity and even differential improvements among men for some outcomes.
在本研究中，我们旨在分析性别健康公平，以此作为社会政策如何促进人口健康的一个案例。我们分析了在欧洲实施的三组社会投资政策，这些政策先前被假定可减少劳动力市场结果中的性别不平等：儿童保育；积极的劳动力市场计划；以及长期护理。
我们使用了经合组织社会支出数据库、经合组织家庭数据库以及社会政策指标育儿假福利数据集里的12项社会投资政策指标。我们从1995 - 2010年期间18个欧洲国家25 - 54岁男性和女性的2015年全球疾病负担中提取残疾生存年数和全因死亡率的结果数据。我们针对死亡率和发病率（即残疾生存年数）分别估计12个线性回归模型，每个社会投资指标对应一个模型。所有模型均使用国家固定效应和聚类稳健标准误差。
对于残疾生存年数，在大多数指标上女性从社会投资中受益更多。唯一的例外是接受公共资助儿童保育或教育的幼儿比例，这对男性和女性的受益程度相同。对于全因死亡率，在大多数指标上男性从社会投资中受益更多或相同，而女性从政府通过民事就业直接创造就业机会的支出中受益更多。
社会政策有助于人口健康的分配。社会投资倡导者认为此类政策尤其能增强经济性别公平。我们的结果表明，这些政策对性别健康公平的影响不明确，甚至在某些结果上男性之间的改善也存在差异。
