University of Connecticut.
University at Albany, State University of New York.
J Health Polit Policy Law. 2024 Oct 1;49(5):855-884. doi: 10.1215/03616878-11257040.
Social determinants of health are finally getting much-needed policy attention, but their political origins remain underexplored. In this article, the authors advance a theory of political determinants as accruing along three pathways of welfare state effects (redistribution, poverty reduction, and status preservation), and they test these assumptions by examining impacts of policy generosity on life expectancy (LE) over the last 40 years.
The authors merge new and existing welfare policy generosity data from the Comparative Welfare Entitlement Project with data on LE spanning 1980-2018 across 21 countries in the Organization for Economic Cooperation and Development. They then examine relationships between five welfare policy generosity measures and LE using cross-sectional differencing and autoregressive lag models.
The authors find consistent and positive effects for total generosity (an existing measure of social insurance generosity) on LE at birth across different model specifications in the magnitude of an increase in LE at birth of 0.10-0.15 years (p < 0.05) as well as for a measure of status preservation (0.11, p < 0.05). They find less consistent support for redistribution and poverty reduction measures.
The authors conclude that in addition to generalized effects of policy generosity on health, status-preserving social insurance may be an important, and relatively overlooked, mechanism in increasing LE over time in advanced democracies.
健康的社会决定因素终于引起了人们的关注，但是它们的政治起源仍未得到充分探索。本文作者提出了一种政治决定因素理论，认为这些因素可以通过三种福利国家效应的途径（再分配、减贫和维护地位）产生，并通过检验政策宽松度对过去 40 年来预期寿命的影响来验证这些假设。
作者将来自比较福利权益项目的新的和现有的福利政策宽松度数据与经济合作与发展组织 21 个国家 1980 年至 2018 年的预期寿命数据相结合。然后，他们使用横截面差异和自回归滞后模型检验了五种福利政策宽松度措施与预期寿命之间的关系。
作者发现，在不同模型中，总宽松度（一种现有的社会保险宽松度衡量标准）对出生时预期寿命的影响是一致且积极的，出生时预期寿命的增加幅度在 0.10 至 0.15 岁之间（p<0.05），并且对于维护地位的措施（0.11，p<0.05）也是如此。他们发现，对再分配和减贫措施的支持不太一致。
作者的结论是，除了政策宽松度对健康的普遍影响外，维护地位的社会保险可能是一个重要的、相对被忽视的机制，可以随着时间的推移增加先进民主国家的预期寿命。
