Department of Community Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway.
Centre of Health Economics, University of York, York, United Kingdom.
BMC Public Health. 2022 Sep 6;22(1):1691. doi: 10.1186/s12889-022-14084-x.
The literature on Inequality of opportunity (IOp) in health distinguishes between circumstances that lie outside of own control vs. efforts that - to varying extents - are within one's control. From the perspective of IOp, this paper aims to explain variations in individuals' health-related quality of life (HRQoL) by focusing on two separate sets of variables that clearly lie outside of own control: Parents' health is measured by their experience of somatic diseases, psychological problems and any substance abuse, while parents' wealth is indicated by childhood financial conditions (CFC). We further include own educational attainment which may represent a circumstance, or an effort, and examine associations of IOp for different health outcomes. HRQoL are measured by EQ-5D-5L utility scores, as well as the probability of reporting limitations on specific HRQoL-dimensions (mobility, self-care, usual-activities, pain & discomfort, and anxiety and depression).
We use unique survey data (N = 20,150) from the egalitarian country of Norway to investigate if differences in circumstances produce unfair inequalities in health. We estimate cross-sectional regression models which include age and sex as covariates. We estimate two model specifications. The first represents a narrow IOp by estimating the contributions of parents' health and wealth on HRQoL, while the second includes own education and thus represents a broader IOp, alternatively it provides a comparison of the relative contributions of an effort variable and the two sets of circumstance variables.
We find strong associations between the circumstance variables and HRQoL. A more detailed examination showed particularly strong associations between parental psychological problems and respondents' anxiety and depression. Our Shapley decomposition analysis suggests that parents' health and wealth are each as important as own educational attainment for explaining inequalities in adult HRQoL.
We provide evidence for the presence of the lasting effect of early life circumstances on adult health that persists even in one of the most egalitarian countries in the world. This suggests that there may be an upper limit to how much a generous welfare state can contribute to equal opportunities.
关于健康机会不平等（IOp）的文献将无法控制的环境与在一定程度上可以控制的努力区分开来。从 IOp 的角度来看，本文旨在通过关注两组显然不受自身控制的单独变量来解释个体健康相关生活质量（HRQoL）的变化：父母的健康状况通过他们经历的躯体疾病、心理问题和任何物质滥用来衡量，而父母的财富则通过童年的财务状况（CFC）来表示。我们进一步纳入自身的教育程度，它可能代表一种环境或一种努力，并检查 IOp 对不同健康结果的关联。HRQoL 通过 EQ-5D-5L 效用得分以及报告特定 HRQoL 维度（移动、自我护理、日常活动、疼痛和不适以及焦虑和抑郁）受限的概率来衡量。
我们使用来自平等主义国家挪威的独特调查数据（N=20150）来研究环境差异是否导致健康方面的不公平不平等。我们估计了包括年龄和性别作为协变量的横截面回归模型。我们估计了两种模型规格。第一种规格通过估计父母健康和财富对 HRQoL 的贡献来表示狭义的 IOp，而第二种规格包括自身教育程度，因此表示更广泛的 IOp，或者它提供了努力变量和两组环境变量的相对贡献的比较。
我们发现环境变量与 HRQoL 之间存在很强的关联。更详细的检查显示，父母心理问题与受访者的焦虑和抑郁之间存在特别强的关联。我们的 Shapley 分解分析表明，父母的健康和财富对解释成人 HRQoL 不平等与自身教育程度同样重要。
我们提供了早期生活环境对成人健康的持久影响的证据，即使在世界上最平等的国家之一，这种影响也持续存在。这表明，慷慨的福利国家在实现机会均等方面可能存在上限。
