Cheng Lanyan, Zhou Deshui, Liao Zangyi
School of Humanities, Southeast University, No. 2, Southeast University Road, Jiangning District, Nanjing, Jiangsu Province, China.
School of Finance and Public Management, Anhui University of Finance & Economics, No. 962, CaoShan Road, Bengbu, Anhui Province, China.
BMC Health Serv Res. 2025 Aug 13;25(1):1071. doi: 10.1186/s12913-025-13123-8.
BACKGROUND: As an essential component of public health infrastructure, public health education plays an important role in advancing health equity. In China, the large migrant population, while contributing substantially to socioeconomic development, continues to face significant health risks and inequalities due to frequent rural-to-urban mobility and occupational transitions. These issues not only undermine the well-being of migrants but also impede balanced social and economic progress. In this context, the present study systematically investigated the impact of public health education on health inequalities among the migrant population and explored the underlying mechanisms through which it exerts its influence. METHODS: Based on data from the China Migrants Dynamic Survey, this study employed the Recentred Influence Function regression method-a two-dimensional decomposition technique-combined with Instrumental Variable approaches to examine how public health education influences health inequality and to explore the underlying mechanisms. RESULTS: The findings indicated that health inequality among migrants followed a pro-rich socioeconomic gradient, with substantial regional heterogeneity. Participation in public health education programs was associated with a significant reduction in health inequality. After accounting for endogeneity, receiving two or more types of public health education was linked to a 0.102-unit decline in the Wagstaff-Erreygers Index (p < 0.001), implying that the income-related health concentration curve might have narrowed by approximately 47.4% relative to the equality line. Heterogeneity analysis showed that these effects were more pronounced among non-interprovincial migrants and self-employed individuals. Further analysis suggested that the inequality-reducing effect of public health education was mediated primarily through improved healthcare availability, which exerted stronger mediating effects than enhanced healthcare accessibility. CONCLUSION: Enhancing the provision and effectiveness of public health education and safeguarding the health rights of vulnerable groups are vital to narrowing health disparities. Accelerating the development of an inclusive public health system tailored to the migrant population will support the reduction of health inequality and contribute to the coordinated advancement of the Healthy China initiative.
背景:作为公共卫生基础设施的重要组成部分,公共卫生教育在促进健康公平方面发挥着重要作用。在中国,庞大的流动人口在为社会经济发展做出重大贡献的同时,由于频繁的城乡流动和职业转变,仍面临着重大的健康风险和不平等问题。这些问题不仅损害了流动人口的福祉,也阻碍了社会经济的平衡发展。在此背景下,本研究系统地调查了公共卫生教育对流动人口健康不平等的影响,并探讨了其发挥作用的潜在机制。 方法:基于中国流动人口动态监测调查的数据,本研究采用重新中心化影响函数回归方法(一种二维分解技术)并结合工具变量法,以检验公共卫生教育如何影响健康不平等并探索潜在机制。 结果:研究结果表明,流动人口中的健康不平等呈现出有利于富人的社会经济梯度,且存在显著的区域异质性。参与公共卫生教育项目与健康不平等的显著降低相关。在考虑内生性后,接受两种或更多类型的公共卫生教育与瓦格斯塔夫 - 埃雷格斯指数下降0.102个单位相关(p < 0.001),这意味着与收入相关的健康集中曲线相对于平等线可能缩小了约47.4%。异质性分析表明,这些影响在非省际流动人口和个体经营者中更为明显。进一步分析表明,公共卫生教育减少不平等的效果主要通过改善医疗服务可及性来介导,其介导作用比增强医疗服务可获得性更强。 结论:加强公共卫生教育的提供和效果,保障弱势群体的健康权利,对于缩小健康差距至关重要。加快发展适合流动人口的包容性公共卫生体系,将有助于减少健康不平等,并为健康中国行动的协调推进做出贡献。
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