教育、家戶所得與社會地位之健康效益的跨國以較研究

Health Effects of Education, Family Income and Social Standing: A Comparative Study of Four East Asian Countries

相關文獻將社會經濟地位定位為健康不平等之根源，本文以這個理論脈絡為起點，視客觀資源和相對地位為兩股影響健康的重要因素，提出健康資源論和地位症候論，檢驗教育、家戶所得、和社會地位，對個人健康之相對重要性。本文首先分析2011年臺灣社會變遷基本調查資料，發現絕大部分教育和家戶所得的健康效益都是透過社會地位的中介作用，且社會地位是理解臺灣民眾健康最重要的因素，所得其次，教育則沒有直接影響。進一步使用2010年東亞社會調查之資料，以同樣之分析架構分析中國、韓國和日本的態樣。分析發現，四個國家都觀察到教育、家戶所得和社會地位的粗健康效益。但是，（1）臺灣、中國和日本都觀察到社會地位比客觀資源重要，韓國則無此一現象。（2）在中國，且觀察到教育的健康效益，但於臺灣和日本則只觀察到家戶所得的健康效益。（3）教育的健康效益在韓國至為強烈。整體而言，文化因素和社會經濟發展等鉅觀環境，似乎難以有系統地理解各國間的歧異，對健康不平等的理論文獻形成相當大的挑戰。

This study examines the pathways through which education, family income, and subjective social standing affect health statuses. Data from the 2011 Taiwan Social Change Survey were used to test the health-enhancing resource hypothesis and the status syndrome hypothesis. Results indicate that social standing affects health and mediates most of the effects of education and income on health. We also compared country-specific patterns based on East Asia Social Surveys, and found that in all countries, education, income and social standing exert significant effects on health. After adjusting for education and income, social standing effects were found to be significant for all nations except South Korea. The effects of education were statistically significant for China and South Korea, and income effects were significant for Taiwan and Japan. We discuss how cross-country variation in the effects of education, income and social standing on health are hard to reconcile with existing health inequality theories.