Borisova Liubov V
Department of Sociology, Uppsala Univerisity, Uppsala, Sweden.
Cent Eur J Public Health. 2019 Jun;27(2):145-152. doi: 10.21101/cejph.a5226.
Determinants of health in Central and Eastern Europe (CEE) have been discussed primarily in relation to the transition of the 1990's and early 2000's, citing lifestyles as the main culprit. This paper tries to draw a bigger picture of the health determinants in CEE in the first decade of the 21st century. To do so, the two main analytical approaches to health are united in one setting. One of them is based on the definition of health as a personal commodity relying mostly on micro-level subjective data. The other views health as a public commodity analysing objective societal characteristics and health care interventions with often a macro-level perspective. The current study incorporates these different approaches (subjective and objective) in a multi-level setting in CEE.
The analysis concentrates on health care, social, political, and economic factors as determinants of self-rated health. Multilevel analysis is carried out on a dataset of Life in Transition Survey (LiTS), conducted in 2006 and 2010, pooled cross-sectional data on 46,546 individuals in 27 CEE states. They are accompanied by macro-level data.
The findings demonstrate that a complex mix of determinants influences subjective health in CEE. There are clear differences in the way objective and subjective indicators influence self-rated health. While societal economic prosperity does not influence health, there are strong country-specific differences in the effect of individual prosperity on health.
The study adds to the recent literature on health in CEE by introducing an encompassing systematic approach to analysing health, as no leading cause for self-rated health variation was found. This paper also contributes to research on the determinants of health by fusing objective and subjective determinants in a hierarchical setting. Both subjective and objective determinants matter for health.
中东欧（CEE）地区健康的决定因素主要是在讨论20世纪90年代和21世纪初的转型时提及的，认为生活方式是主要原因。本文试图描绘21世纪第一个十年中东欧地区健康决定因素的更全面图景。为此，将两种主要的健康分析方法结合在一个框架内。其中一种基于将健康定义为一种主要依赖微观层面主观数据的个人商品。另一种则将健康视为一种公共商品，通常从宏观层面分析客观的社会特征和医疗保健干预措施。本研究在中东欧地区的多层次框架中纳入了这些不同的方法（主观和客观）。
分析集中于医疗保健、社会、政治和经济因素作为自评健康的决定因素。对2006年和2010年进行的转型期生活调查（LiTS）数据集进行多层次分析，该数据集为27个中东欧国家46546人的汇总横截面数据。同时还伴有宏观层面的数据。
研究结果表明，多种决定因素的复杂组合影响着中东欧地区的主观健康。客观和主观指标影响自评健康的方式存在明显差异。虽然社会经济繁荣并不影响健康，但个人繁荣对健康的影响在不同国家存在很大差异。
本研究通过引入一种全面系统的健康分析方法，为近期关于中东欧地区健康的文献增添了内容，因为未发现自评健康差异的主要原因。本文还通过在分层框架中融合客观和主观决定因素，为健康决定因素的研究做出了贡献。主观和客观决定因素对健康都很重要。
