В ответе ли мы за свое здоровье? Неравенство возможностей в здоровье взрослого населения России
Аннотация
В работе проанализирован вклад неравенства возможностей в неравенство в здоровье населения России в возрасте от 25 до 74 лет. Эмпирической основой исследования являются национально репрезентативные данные РМЭЗ НИУ ВШЭ за 2018 г.
В качестве индикатора здоровья использована самооценка состояния здоровья (пятибалльная шкала). Стартовые возможности индивида в работе охарактеризованы образованием родителей и местом рождения (страна, тип поселения). Вектор собственных усилий человека по сохранению здоровья включает уровень образования, отказ от курения и занятия физкультурой.
Для анализа влияния стартовых возможностей на состояние здоровья индивида используется методика, предложенная в работе (Trannoy et al. 2010), которая позволяет учесть как прямой, так и посреднический (через влияние на усилия) эффекты. С помощью регрессионного анализа показано, что при прочих равных стартовые возможности оказывают значимое влияние на здоровье индивидов. В частности, образование родителей положительно отражается на самооценке здоровья. Рождение в другой стране, другом населенном пункте и рождение в городской местности, наоборот, снижают показатель самооценки здоровья. Данное наблюдение позволяет сделать вывод о наличии несправедливого неравенства в здоровье, т. е. неравенства, обусловленного факторами, независящими от собственных усилий человека.
Количественная оценка неравенства возможностей в здоровье сделана с помощью непараметрического подхода (Checchi, Peragine 2010; Lazar 2013). По нашим расчетам вклад неравенства возможностей в неравенство в здоровье составляет 72-74% для населения в целом, будучи несколько выше для женщин (62-74 и 60-69% для мужчин и женщин соответственно) и для лиц старшей возрастной группы (59-62 и 67-75% для групп 25-44 и 45-74 года соответственно). Полученные оценки сопоставимы с результатами для других стран и свидетельствуют о значимости проблемы неравенства возможностей в здоровье в России.
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