Research Of The Health Inequality And Determinants Based On Multidimensional Poverty And Intersectionality Theory

BackgroundHealth inequality refers to the health disparity caused by social disadvantages or advantages of individuals or groups.Previous studies usually focused on income inequality,which was a part of the cause to health inequality,while other forms of inequality were also verified to affect health.In the post poverty alleviation era of eliminating absolute income poverty,expansion of health social disadvantage from single income poverty to multi-dimensional poverty can avoid the neglect of multi-dimensional poverty disadvantaged groups.Health behavior is an important path for external conditions to affect individual health,and thus Multidimensional poverty may affect health status through health behavior.The inequality of health behavior is an important cause of health inequality.Therefore,this study also pays attention to the inequality of health behavior.Previous studies deeply explained the impact of single dimension or level of multi-dimensional poverty on health,but few studies explore its multilevel impact on health and health behavior and thus leading to health inequality from combination or intersectionality perspective.This study will address these shortcomings.Objectives and ContentsResearch objective:to measure the health inequality based on multidimensional poverty,identify the characteristics and inequality of extremely disadvantaged groups of health behavior and health through intersectionality research,and solve the heterogeneity of social disadvantage.Research contents:(1)Combined with China’s actual conditions and social development phase,improve the multi-dimensional poverty index system,measure the multi-dimensional poverty of families,and health inequality on this basis;(2)Conduct mechanistic studies of the impact of Multidimensional Poverty on health inequalities,including causal inference,estimation of the indirect effect of Multidimensional Poverty on health through health behaviors;(3)Develop Multidimensional Poverty intersectionality studies,identify characteristics and inequality of extreme social disadvantage groups of health and health behaviours,and address heterogeneity of social disadvantage.SignificanceIntersectionality studies more specifically document intersectional population inequalities,so that individuals in doubling marginalised intersectional positions were not ignored,making up for the shortcomings of previous studies.Intersectionality study of Multidimensional Poverty allows precise estimation of individual health inequality for extreme Multidimensional Poverty,addresses heterogeneity of social disadvantage,and has practical implications for locking healthy high-risk individuals and eliminating health inequalities.Data and methodsThe subjects of this study were 16 years and older in China,and the data source was the 2010-2018 data from the China Family Panel Studies(CFPS).CFPS has follow-up surveys at 2-year intervals that facilitate exploration of mechanisms underlying the health effects of Multidimensional Poverty;The sample coverage was representative across 25 provinces,and the sample size met the requirements for intersectionality studies;Questionnaires containing variables and scales required for Multidimensional Poverty,health,health behavior,and measurement are effective in reducing outcome bias resulting from a single measurement of health or socioeconomic variables.The Multidimensional poverty index system was refined using the literature review,and the family multidimensional poverty score was calculated using the Alkire-foster method,based on which centralization index method was uesed to measure inequalities in health(self-rated health,mental health,ability of daily living(ADL)).Fixed effect models were used to make causal inferences about Multidimensional Poverty and health,and the KHB method was used to estimate the indirect effect of Multidimensional Poverty on health through health behaviors.Multilevel models and Generalized Estimating Equation estimated the impact of multidimensional poverty on individual health and health behaviors.Intersectional multilevel models were constructed to estimate the health risks of each Multidimensional Poverty intersectional group compared to the dominant group.Main findings(1)The multidimensional poverty indicator system(including six dimensions of economy,education,health,information,living conditions,social security and poverty and 13 secondary indicators)was relatively robust.There was a significant negative S-shaped nonlinear correlation between family multidimensional poverty and per capita income,and thus treating the people with the lowest economic income as the health disadvantaged group may ignore the individuals with the most serious multidimensional poverty.(2)On the basis of family multidimensional poverty score,self-rated health(CI=-0.188),mental health(CI=-0.287)and ADL(CI=-0.313)showed significant pro-rich effect.The members of multidimensional poverty families were at a systematic social disadvantage,but with heterogeneity.The inequality of self-rated health improved from 2014 to 2018,and the inequality of mental health and ADL deepened.(3)There may be a causal relationship between family Multidimensional Poverty and individual health in young people and elderly people.Family multidimensional poverty indirectly influenced health through health behavior,and community multidimensional poverty indirectly affected mental health through health behavior,which verified the theoretical framework.(4)Compared with the non-deprived group,the characteristics of extremely disadvantaged groups in health:the self-rated extremely disadvantaged groups were family members with economic,information poverty and either health or living condition poverty(β>2.00);The extremely disadvantaged groups of mental health were female family members with economic,information and social security poverty(β=1.87),and male family members with information and social security poverty but non-deprived in economic dimention(β=1.90);The extremely disadvantaged groups of ADL were elderly members of families with education,health,information poverty(β=5.44).Those who were most likely to lack exercise were family members whose education,living condition and social security in poverty(β=2.19).Women with highest possibility of smoking behavior was the elderly women in social security and health poverty families(β=3.19),men were middle-aged men in families with social security and living condition poverty(β=2.39).Conclusions(1)Multidimensional poverty families were at a systematic social disadvantage,and inequality of mental health and ADL based on multi dimensional poverty score deepened over time;(2)Family multidimensional poverty score was relatively stable as a socio-economic proxy variable of health inequality,and its endogeneity was smaller than family economic income;(3)The intersectionality study of multidimensional poverty avoided the heterogeneity of social disadvantage,and identifieed the characteristics of extreme social disadvantage groups caused by the superposition multiplication property of multidimensional poverty;(4)Community multidimensional poverty affected individual exersice behavior and led to ADL inequality.Policy recommendations(1)Identify multidimensional poverty groups and formulate health promotion strategies and reduce health inequality;(2)Based on the characteristic of multidimensional poverty intersectional groups,focus on people with extreme health disadvantages and improve the cost-effectiveness of health intervention;(3)Address partial dimension deprivation could help to narrowing health inequalities;(4)Health policy makers need to pay more attention to mental health and ADL inequality.Innovation(1)Extending economic income basis of health inequality measurement to multidimensional poverty basis,multidimensional poverty was less endogenous with wider coverage of social disadvantages to health than single economic income.(2)Integrating multidimensional poverty theory with intersectionality theory,this study identified characteristics of health extreme social disadvantages on the basis of multidimensional poverty intersectional groups,addressed heterogeneity of social disadvantages.