权力下放与地区卫生差距：对欧洲 14 个国家的纵向生态研究。

Devolution and the regional health divide: a longitudinal ecological study of 14 countries in Europe.

机构信息

Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, England.

Department of Public Health and Policy, University of Liverpool, Liverpool, England.

出版信息

J Public Health (Oxf). 2019 Mar 1;41(1):3-9. doi: 10.1093/pubmed/fdy014.

DOI:10.1093/pubmed/fdy014

PMID:29444304

Abstract

BACKGROUND

Greater regional devolution can reduce economic inequalities between regions; however, the impact on health inequalities is not clear. We investigated the association between changes over time in the level of devolution in European countries and regional economic and health inequalities.

METHODS

We used the proportion of government expenditure controlled by subnational levels of government as our measure of devolution in 14 European countries between 1995 and 2011. Fixed effects linear regression models were used to analyse trends in the level of devolution, trends in regional economic inequalities (Gini-coefficient) and trends in regional health inequalities (slope index) in life expectancy.

RESULTS

Each additional percentage of government expenditure managed at subnational level reduced the Gini-coefficient of regional GDP by -0.17 points (95% CI: -0.33 to -0.01; P = 0.04). However, it increased the slope index of regional life expectancy by 23 days (95% CI: -2 to 48; P = 0.07). When trends in regional economic inequalities were controlled for, as a potential mediator-increased devolution-was significantly associated with an increase in health inequalities between regions (P = 0.01).

CONCLUSIONS

Increased devolution does not appear to reduce regional health inequalities-even when it reduces regional economic inequalities-and it could be associated with increased health inequalities.

摘要

背景

更大程度的地区放权可以减少地区间的经济不平等；然而，其对健康不平等的影响尚不清楚。我们调查了欧洲国家放权水平随时间变化与区域经济和健康不平等之间的关联。

方法

我们使用 1995 年至 2011 年间 14 个欧洲国家的政府支出中由次国家政府控制的比例来衡量放权程度。采用固定效应线性回归模型分析放权水平、区域 GDP 不平等（基尼系数）和区域健康不平等（预期寿命斜率指数）的变化趋势。

结果

每增加 1%的政府支出由次国家政府管理，区域 GDP 的基尼系数就会降低 0.17 个点（95%置信区间：-0.33 至 -0.01；P=0.04）。然而，它使区域预期寿命斜率指数增加了 23 天（95%置信区间：-2 至 48；P=0.07）。当控制区域经济不平等的趋势时，作为潜在的中介因素——放权增加——与区域间健康不平等的增加显著相关（P=0.01）。