| China has prioritized the protection of people’s health in its development strategy.Under the promotion of economic development and advancements in medical technology,China has seen a steady increase in life expectancy and a continuous decline in mortality rates.The health level of the Chinese people has made significant progress.However,behind the progress,there are also some significant health issues that cannot be ignored.First,the degree of aging continues to deepen,with disability and dementia becoming the biggest obstacles to achieving healthy aging for the elderly;Second,the prevalence of chronic diseases is continuously rising,becoming a major threat to public health;Third,health inequality is deepening,not only evident between urban and rural areas and regions but also among different social strata with unequal access to resources.Therefore,driven by the realities of the country,the exploration of health has become a focal point of empirical research and a crucial matter in advancing the construction of Healthy China and achieving healthy aging.Ensuring the health of the people relies on the support of public financial policies such as education finance,healthcare finance,and social security.To enhance the level of public health,it is essential to incorporate the concept of health into public financial policies.Research on health also helps clarify the scope of public financial policy intervention in the field of health.The Fundamental Cause Theory and the Status Syndrome posit that socioeconomic status is a crucial factor influencing health.Health levels tend to improve in a descending order of socioeconomic status,with individuals of higher socioeconomic status often having an absolute health advantage.Conversely,those with lower socioeconomic status,due to poor nutritional conditions,adverse living environments,and limited access to medical resources,typically experience higher disease incidence and mortality rates.Numerous studies have separately examined the impact of single dimensions of socioeconomic status,such as income,education,and occupation,on health.These studies generally show a significant positive correlation between income,education,occupation,and health.However,the primary limitation of this body of research is that it typically examines the static impact of socioeconomic status on health at a single stage in the life course.Individual life trajectories span from birth to death,and the influence of socioeconomic status on health permeates all stages of development.Static research at a single stage often struggles to capture the associations and changes in socioeconomic status throughout the entire life course.To overcome this limitation,some research has started to incorporate life course theory.This approach explores the dynamic relationship between childhood socioeconomic status and elderly health,moving from static research at a single stage to dynamic analyses across multiple life stages,representing an innovative path in this field.This article is inspired by the life course theory and divides the individual’s developmental trajectory into childhood,adulthood,and old age.Considering the health fragility of middle-aged people,it also introduces the age of 45 as a significant point and further incorporates the middle-aged and elderly period.Through the research lineage spanning childhood,adulthood,middle age,and old age,it connects the socioeconomic factors influencing health throughout the entire life course.This approach takes into account the dynamic relationships from childhood to middle and old age,such as the long-term impact of childhood socioeconomic status on middle-aged and elderly health,as well as the dynamic changes from childhood to adulthood,such as the impact of upward socioeconomic mobility on health.It also analyzes the dynamic transmission from adulthood to old age,such as the influence of income disparities in retirement pensions from adulthood to old age on health.Through a multidimensional and dynamic analysis perspective,this study reevaluates the impact of socioeconomic status on health,offering valuable insights to inform the development of public fiscal policies for health interventions.At the level of theoretical research,this paper combines the life course theory,equality of opportunity,health demand theory to construct the logical framework of this study.First,the life course theory suggests that childhood,adulthood,and old age connect the entire developmental trajectory,and the experiences of this stage will affect the results of the next stage.Childhood,which is at the starting point,is a crucial period in the developmental trajectory.The advantages or disadvantages of childhood can trigger a chain reaction of subsequent socioeconomic status,thus having a long-term impact on the health of middle-aged and elderly.This paper takes the life course theory as the guide,and also adds the perspective of equality of opportunity.This perspective categorizes factors into circumstances and individual effort.Circumstances,which are beyond individual control,are deemed as sources of unjust health inequalities.Meanwhile,health inequalities related to individual effort are seen as the individual’s full responsibility.Parental or family resources,which reflect the socioeconomic status of childhood,are considered a morally arbitrary factor that can be categorized as circumstances.Therefore,with regard to childhood,this article adopts a dual perspective of life course theory and equality of opportunity theory.On one hand,it analyzes the impact of childhood socioeconomic status,which is transmitted to middle and old age through factors such as education and lifestyle as effort.On the other hand,it measures and decomposes both ex-ante and ex-post inequality of opportunity.Second,the social mobility model suggests that changes in socioeconomic status can lead to changes in health conditions.As individuals transition from childhood to adulthood,the way we measure socioeconomic status changes.It shifts from the parental socioeconomic status during childhood to the offspring’s socioeconomic status during adulthood.This transition essentially represents intergenerational mobility in socioeconomic status from one generation(parental)to another(offspring).Intergenerational mobility not only captures the longitudinal changes in socioeconomic status but also reflects psychological adaptation and social integration when transitioning from one position to another.It is closely related to health status.Therefore,with regard to adulthood,this article focuses on intergenerational mobility in socioeconomic status from childhood to adulthood,particularly the impact of upward mobility on health.It puts forward different research hypotheses through dissociative theory and cultural adaptation theory.Finally,the Health Demand Theory holds that income is a crucial variable influencing budget constraints.Pensions become a major source of income for the elderly,pension gap is also related to elderly health.The disparity in pension during old age essentially represents the dynamic transmission of socioeconomic status from adulthood.Because in China’s multi-tiered basic pension insurance system,the nature of one’s occupation and income level before retirement determine the type of insurance and the ability to make contributions.The stratification of pension corresponds to the stratification of socioeconomic status in adulthood.Therefore,in the context of old age,this article analyzes the impact of the pension gap,which is transmitted from the socioeconomic status in adulthood,on health.It presents corresponding theoretical expectations through the absolute income hypothesis and the income inequality hypothesis.This article also follows the logical framework of childhood,adulthood,and old age in empirical study.Based on CHARLS and CGSS,this article uses various econometric methods to validate the hypothesis in theoretical research,divided into three parts.First,estimating the effects of socioeconomic status during childhood on the health of individuals in their middle-aged and elderly years.This paper uses CHARLS 2011-2018 data to test the direct influence of childhood socioeconomic status on the health of middle-aged and elderly individuals,as well as the biased effects on education and lifestyle.Building upon this foundation,regression parameter methods,Shapley value decomposition,non-linear Oaxaca-Blinder models,and variance decomposition are employed to measure and decompose both ex-ante and ex-post inequality of opportunity.The results show that,the impact of childhood socioeconomic status persists into middle and old age.Those who experienced a more favorable socioeconomic environment during childhood tend to have better self-rated health in middle and old age.They also exhibit advantages in activities of daily living,instrumental activities of daily living,physical activity ability,cognitive levels,and mental health.A favorable socioeconomic environment during childhood also contributes to individuals adopting healthier lifestyles and attaining higher levels of education.Healthy lifestyles and educational attainment are also positively associated with self-rated health in the full model.In the measurement and decomposition section,the absolute level of ex-ante inequality of opportunity measured by the regression parameter method is 0.105.The Shapley decomposition indicates that the economic situation of the family,the education of parents,and the health of parents during childhood are the main factors leading to inequality of opportunity.The nonlinear Oaxaca-Blinder decomposition results that the heterogeneity among gender,urban-rural,and birth cohort derived from the coefficient effect.In the context of ex-post approach,once relative effort is taken into account,lifestyle and education contribute to 12.17%of the total inequality.Second,estimating the impact of intergenerational upward mobility on health.Based on the mixed cross-sectional data of CGSS from 2017 to 2018,this article employs the Probit model to examine the baseline impact of upward mobility on health.Additionally,it utilizes the Conditional Mixed Process(CMP)and instrumental variables to address endogeneity and conduct robustness test.This article further analyzes the heterogeneity of mobility distance,mobility trajectory,and individual characteristics.Finally it explores the channels through which upward mobility affects health.The results indicate that the CGSS data supports cultural adaptation theory in China.This means that compared to their parents,upward mobility in socioeconomic status is beneficial for self-rated health and mental health of the younger generation.After endogeneity processing and robustness testing,the results are still significantly positive.These positive effects vary depending on mobility distance,with the longer the mobility distance,the greater the effect.This article also reveals that the estimated coefficient for inflow from the agricultural to any non-agricultural is statistically significant.the positive impact of upward mobility on health is more pronounced in the male population,rural areas,and cohorts born in the 1960s and 1970s.The estimated results regarding the pathways of influence indicate that upward mobility primarily affects health by increasing income levels,improving lifestyle,and enhancing happiness.Third,estimating the impact of pension gap on health.On one hand,based on CHARLS data from 2013～2018,this article uses Theil index,Gini coefficient,and Kakwani index to measure the disparities in benefits among Public Sector Retirement Insurance,Enterprise Pension Insurance,Urban Resident Pension Insurance and New Rural Social Pension Insurance.It empirically examines the impact of the overall gap and inter-group gap in pension on health.On the other hand,in response to the merger reform of Public Sector Retirement Insurance and Enterprise Pension Insurance implemented in 2015,this article utilizes panel data from CHARLS covering the period from 2011 to 2018 to construct a DID model and evaluate the impact of the merger reform on health.The results show that during the period from 2013 to 2018,pension was extremely unequal,and the disparity between different systems was the main reason for pension inequality.The estimations indicate that this pension gap has a negative impact on self-rated health and activities of daily living,as well as on instrumental activities of daily living,physical functioning,cognitive ability,and psychological health in robustness tests.This negative impact is more pronounced in female groups,rural areas,younger elderly groups,and low personal asset groups.The DID model shows that the merger reform is beneficial for the self-rated health and activities of daily living of government agencies and public institutions’ staff.It has not led to a significant reduction in the pension disparity between different systems.This study has the following innovative points:First,the expansion of the research perspective.Existing research has separately examined the effects of income,education,and occupation on health,as well as the role of early-life socioeconomic status in elderly health.However,within the life course paradigm,there are still two shortcomings.Firstly,the role of socioeconomic status in old age has been overlooked.Secondly,the close connections between stages have not been fully explored.These connections are not only seen in the dynamic associations from childhood to old age but also involve dynamic changes and transmissions between stages.This paper tries to do further expansion.On one hand,on the basis of analyzing childhood and adulthood,it incorporates old age to examine the impact of pension gap on health.Ultimately,by dividing life trajectories into childhood,adulthood,and old age,it aims to connect different life stages,offering a more comprehensive perspective to identify socioeconomic risks across the entire life course.On the other hand,by adopting a perspective of dynamic changes and transmission,this article not only examines the dynamic relationship between childhood and middle-to-old age but also investigates the dynamic changes in socioeconomic status from childhood to adulthood,as well as the dynamic transmission of socioeconomic status from adulthood to old age.By examining the associations,changes,and transmissions between different life stages,this study dynamically analyzes the influence of socioeconomic status on health.Second,the advancement of measurement methods.This article goes beyond estimating the impact of childhood socioeconomic status on middle-aged and elderly health under the guidance of life course theory.It also integrates the theory of equality of opportunity to measure and decompose health opportunity inequality.On one hand,most of the existing studies focus on ex-ante inequality of opportunity.Considering the partial effect of circumstance on effort,this article obtains the relative effort which excludes the influence of circumstance,and measure the contribution of relative effort by using variance decomposition from the perspective of ex-post inequality of opportunity.On the other hand,most of the existing studies use Shapley to decompose the contribution of circumstance.The heterogeneity between gender,urban and rural,and birth cohorts may be derived both from differences in the circumstance itself or from coefficient effect.Few studies have broken down this heterogeneous source,this article uses the nonlinear Oaxaca-Blinder method to further explore.Third,the expansion of research content.Regarding the impact of upward mobility,existing studies have not reached consistent conclusions.The possible reason is that existing studies often use single dimensional indicators such as income,education,and occupation to measure different dimensions of socioeconomic status.This article employs the International Socioeconomic Index(ISEI),which takes into account the positions of both parents and offspring in social stratification.It not only examines the health effects of upward mobility but also categorizes mobility into five classes:farmers,industrial workers,service personnel and clerical workers,professional and technical personnel,and managers.This approach allows for a more detailed analysis of the heterogeneity in mobility distances and trajectories,which has been less explored in previous research.In addition,this paper also examines the channels through which upward mobility operates,including income,lifestyle,and happiness,which represents an extension of empirical research.In terms of pension income,existing studies mainly focus on whether pension insurance systems such as the New Rural Insurance can improve the quality of life for elderly.Unlike previous studies,this article shifts the focus to the disparities in benefits between pension systems.On one hand,it examines the deprivation of elderly health due to disparities in pension income.On the other hand,it constructs a DID model to test the impact of the merger reform on the health of government agency employees.Based on the conclusions drawn from theoretical analysis and empirical testing,this article puts forward policy recommendations from the perspectives of promoting fair health opportunities,facilitating upward mobility channels,and strengthening the pension insurance system.For example,increasing financial assistance for children from disadvantaged families,ensuring financial investments in education for vulnerable households,enhancing financial support for agricultural and rural development,improving the redistributive system through tax reforms,and providing fiscal support for the development of the pension insurance system. |
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