Article(id=1322589990798868806, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202406252, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1718380800000, receivedDateStr=2024-06-15, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793259626339, onlineDateStr=2026-10-29, pubDate=1736438400000, pubDateStr=2025-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793259626339, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793259626339, creator=13701087609, updateTime=1793259626339, updator=13701087609, issue=Issue{id=1322589954702688372, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='1736438400000', pubDateStr='2025-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793259617734, creator='13701087609', updateTime=1793260023378, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322591656147276425, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322591656147276426, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=114, endPage=119, ext={EN=ArticleExt(id=1322589991990051143, articleId=1322589990798868806, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research on the mediating effect of ecological environment quality between economic development level and residents’ health level, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the relationship between economic development level, ecological environment quality, and residents’ health level, and to explore the mediating effect of ecological environment quality between the two.

Methods

Based on provincial panel data from China from 2012 to 2022, a baseline regression model was established to analyze the relationship between economic development level and residents’ health level. The mediating effect of ecological environment quality was examined using the three-step method and Bootstrap testing.

Results

There is a positive correlation between economic development level and residents’ health level (β=0.01, P<0.05). Environmental governance investment has a mediating effect on residents’ health level (β=-0.005, P<0.01). The quality of urban living environment did not show a significant indirect effect on residents’ health level through the non-parametric percentile Bootstrap test (95%CI: -0.001 to 0.004). The mediating effect of environmental governance pressure on residents’ health level was 0.003, accounting for 13.64% of the total effect, as verified by the non-parametric percentile Bootstrap test.

Conclusion

Economic development level has a significant positive impact on residents’ health level, and it can enhance residents’health level through the indirect effects generated by environmental governance pressure and investment.

, authors=Xin-yuan WANG1, 2, 3, Hui-wen YE1, 2, 3, Yi JIANG1, 2, 3, En-ping WEN4, authorsList=Xin-yuan WANG, Hui-wen YE, Yi JIANG, En-ping WEN, authorCompany=null, correspAuthors=En-ping WEN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322589995014144334, articleId=1322589990798868806, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=生态环境质量在经济发展水平与居民健康水平之间的中介效应研究, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

分析经济发展水平、生态环境质量与居民健康水平之间的关系,并探究生态环境质量在二者之间的中介效应。

方法

基于中国2012—2022年省级面板数据,通过建立基准回归模型分析经济发展水平与居民健康水平之间的关系。并采用中介效应检验三步法与bootstrap检验对生态环境质量的中介效应进行探究。

结果

经济发展水平与居民健康水平间呈正相关(β=0.01,P<0.05)。环境治理投资对居民健康水平存在中介作用(β=-0.005,P<0.01)。城市生活环境质量未通过非参数百分位bootstrap检验(95%CI:-0.001~0.004),对居民健康水平间接效应不显著。环境治理压力对居民健康水平的中介效应值为0.003,占总效应值的13.64%,通过非参数百分位bootstrap检验。

结论

经济发展水平对居民健康水平有显著的促进作用,经济发展水平可以通过对环境治理压力、环境治理投资产生的间接效应来提升居民健康水平。

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王鑫缘(2002—),女,本科在读,研究方向:公共事业管理

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温恩萍,E-mail:
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Chinese Journal of Health Policy, 2023, 16(1): 42-51.(In Chinese), articleTitle=Effects of education level on health and its underlying mechanism: An empirical analysis based on China Family Panel Studies, refAbstract=null), Reference(id=1322590004497465770, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[23], rfOrder=40, authorNames=中共江西省委, journalName=null, refType=null, unstructuredReference=中共江西省委. 努力走出生态与经济协调发展新路[EB/OL].[2024-12-04]. http://www.qstheory.cn/dukan/qs/2017-08/15/c_1121478537.htm.Communist., articleTitle=努力走出生态与经济协调发展新路, refAbstract=null), Reference(id=1322590004577157547, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[23], rfOrder=41, authorNames=Communist Party of China Jiangxi Provincial Committee, journalName=null, refType=null, unstructuredReference=Communist Party of China Jiangxi Provincial Committee. 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Opinions of the central committee and state council of the communist party of China on accelerating comprehensive green transformation of economic and social development[EB/OL]. [2024-12-01]. https://www.gov.cn/gongbao/2024/issue_11546/202408/content_6970974.html.(In Chinese), articleTitle=Opinions of the central committee and state council of the communist party of China on accelerating comprehensive green transformation of economic and social development, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322589995735564623, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, xref=1., ext=[AuthorCompanyExt(id=1322589995739758928, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, companyId=1322589995735564623, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Chongqing Medical University, Chongqing 400000, China), AuthorCompanyExt(id=1322589995748147537, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, companyId=1322589995735564623, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.重庆医科大学公共卫生学院,重庆 400016)]), AuthorCompany(id=1322589995811062098, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, xref=2., ext=[AuthorCompanyExt(id=1322589995823645011, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, companyId=1322589995811062098, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.医学与社会发展研究中心,重庆 400000)]), AuthorCompany(id=1322589996163383636, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, xref=3., ext=[AuthorCompanyExt(id=1322589996171772245, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, companyId=1322589996163383636, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.公共卫生安全研究中心,重庆 400000)]), AuthorCompany(id=1322589996230492502, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, xref=4., ext=[AuthorCompanyExt(id=1322589996238881111, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, companyId=1322589996230492502, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.重庆大学附属沙坪坝医院,重庆 400030)])], figs=[ArticleFig(id=1322589998382170490, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, language=EN, label=Table 1, caption=

Variable description and descriptive statistics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类型变量名称变量符号变量定义均值标准差最小值最大值
因变量居民健康水平lnHeal平均期望寿命的自然对数4.340.034.244.43
核心解释变量经济发展水平lnEcon人均GDP的自然对数10.900.459.5212.16
中介变量城市生活环境质量lnGree人均公园绿地面积的自然对数2.580.211.963.13
环境治理压力lnGarb生活垃圾清运量的自然对数6.320.744.198.12
环境治理投入lnInve工业污染治理完成投资的自然对数11.781.156.1714.16
控制变量医疗水平lnMedi每千人口医疗卫生机构床位数的自然对数1.720.201.212.13
性别结构Wom同期同地区女性人口比重48.662.3010.7150.83
老龄化程度Agei65岁及以上人口比重11.593.236.3728.20
受教育程度lnScho6岁以上人口平均受教育年限的自然对数2.240.092.042.54
), ArticleFig(id=1322589998461862267, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, language=CN, label=表1, caption=

变量说明及描述性统计

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类型变量名称变量符号变量定义均值标准差最小值最大值
因变量居民健康水平lnHeal平均期望寿命的自然对数4.340.034.244.43
核心解释变量经济发展水平lnEcon人均GDP的自然对数10.900.459.5212.16
中介变量城市生活环境质量lnGree人均公园绿地面积的自然对数2.580.211.963.13
环境治理压力lnGarb生活垃圾清运量的自然对数6.320.744.198.12
环境治理投入lnInve工业污染治理完成投资的自然对数11.781.156.1714.16
控制变量医疗水平lnMedi每千人口医疗卫生机构床位数的自然对数1.720.201.212.13
性别结构Wom同期同地区女性人口比重48.662.3010.7150.83
老龄化程度Agei65岁及以上人口比重11.593.236.3728.20
受教育程度lnScho6岁以上人口平均受教育年限的自然对数2.240.092.042.54
), ArticleFig(id=1322589998533165436, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, language=EN, label=Table 2, caption=

Results of regression analysis of the level of economic development on the health level of the population based on the fixed effects model(β)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3模型4模型5
lnEcon0.048***0.016***0.016***0.015***0.010**
(18.681)(3.707)(3.698)(3.429)(2.368)
lnMedi—0.064***0.064***0.057***0.043***
(9.022)(9.006)(7.121)(5.249)
Wom——-0.005-0.0070.000
(-0.163)(-0.231)(0.016)
Agei———0.001*0.000
(1.886)(1.016)
lnScho————0.166***
(5.095)
Cons3.821***4.063***4.065***4.081***3.786***
(136.366)(111.244)(102.440)(101.045)(54.342)
固定效应控制控制控制控制控制
N330330330330330
r20.5390.6380.6380.6420.671
), ArticleFig(id=1322589998612857213, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, language=CN, label=表2, caption=

基于固定效应模型的经济发展水平对居民健康水平的回归分析结果(β)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3模型4模型5
lnEcon0.048***0.016***0.016***0.015***0.010**
(18.681)(3.707)(3.698)(3.429)(2.368)
lnMedi—0.064***0.064***0.057***0.043***
(9.022)(9.006)(7.121)(5.249)
Wom——-0.005-0.0070.000
(-0.163)(-0.231)(0.016)
Agei———0.001*0.000
(1.886)(1.016)
lnScho————0.166***
(5.095)
Cons3.821***4.063***4.065***4.081***3.786***
(136.366)(111.244)(102.440)(101.045)(54.342)
固定效应控制控制控制控制控制
N330330330330330
r20.5390.6380.6380.6420.671
), ArticleFig(id=1322589998675771774, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, language=EN, label=Table 3, caption=

Analysis of the mediating effect of ecological quality between the degree of economic development and the residents’ health levels(β)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量城市生活环境质量环境治理压力环境治理投资
模型1模型2模型3模型4模型5
模型6lnGreelnHeallnGarblnHeallnInvelnHeal
lnEcon0.049*
(1.747)
0.008**
(1.972)
0.078*
(1.829)
0.011**
(2.515)
-1.034***
(-4.272)
0.005
(1.239)
M—0.038***
(4.551)
—-0.009
(-1.480)
—-0.005***
(-4.722)
Cons1.270***
(2.717)
3.737***
(2.717)
1.717**
(2.717)
3.801***
(2.717)
32.333***
(2.717)
3.935***
(2.717)
控制变量控制控制控制控制控制控制
固定效应控制控制控制控制控制控制
N330330330330330330
r20.5230.6930.6260.6730.3170.694
), ArticleFig(id=1322589998738686335, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, language=CN, label=表3, caption=

生态环境质量在经济发展水平与居民健康水平间的中介效应分析(β)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量城市生活环境质量环境治理压力环境治理投资
模型1模型2模型3模型4模型5
模型6lnGreelnHeallnGarblnHeallnInvelnHeal
lnEcon0.049*
(1.747)
0.008**
(1.972)
0.078*
(1.829)
0.011**
(2.515)
-1.034***
(-4.272)
0.005
(1.239)
M—0.038***
(4.551)
—-0.009
(-1.480)
—-0.005***
(-4.722)
Cons1.270***
(2.717)
3.737***
(2.717)
1.717**
(2.717)
3.801***
(2.717)
32.333***
(2.717)
3.935***
(2.717)
控制变量控制控制控制控制控制控制
固定效应控制控制控制控制控制控制
N330330330330330330
r20.5230.6930.6260.6730.3170.694
), ArticleFig(id=1322589998814183808, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, language=EN, label=Table 4, caption=

Bootstrap mediation effect test of urban living environment quality, environmental governance pressure between the level of economic development and the health level of the population

, figureFileSmall=null, figureFileBig=null, tableContent=
变量效应类别效应值(95%CI)效应占比(%)
InGree间接效应0.001(-0.001~0.004)4.55
直接效应0.021(0.013~0.028)95.45
总效应0.022(0.015~0.029)100.00
lnGarb间接效应0.003(0.000~0.005)13.64
直接效应0.019(0.012~0.027)86.36
总效应0.022(0.015~0.029)100.00
), ArticleFig(id=1322589998893875585, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589990798868806, language=CN, label=表4, caption=

城市生活环境质量、环境治理压力在经济发展水平与居民健康水平间的bootstrap中介效应检验

, figureFileSmall=null, figureFileBig=null, tableContent=
变量效应类别效应值(95%CI)效应占比(%)
InGree间接效应0.001(-0.001~0.004)4.55
直接效应0.021(0.013~0.028)95.45
总效应0.022(0.015~0.029)100.00
lnGarb间接效应0.003(0.000~0.005)13.64
直接效应0.019(0.012~0.027)86.36
总效应0.022(0.015~0.029)100.00
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生态环境质量在经济发展水平与居民健康水平之间的中介效应研究
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王鑫缘 1, 2, 3 , 叶惠雯 1, 2, 3 , 蒋祎 1, 2, 3 , 温恩萍 4
现代预防医学 | 卫生政策与管理 2025,52(1): 114-119
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现代预防医学 |卫生政策与管理 2025 , 52 (1) : 114 -119
生态环境质量在经济发展水平与居民健康水平之间的中介效应研究
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王鑫缘1, 2, 3, 叶惠雯1, 2, 3, 蒋祎1, 2, 3, 温恩萍4
作者信息
  • 1.重庆医科大学公共卫生学院,重庆 400016
  • 2.医学与社会发展研究中心,重庆 400000
  • 3.公共卫生安全研究中心,重庆 400000
  • 4.重庆大学附属沙坪坝医院,重庆 400030
通讯作者:
温恩萍,E-mail:
作者简介:

王鑫缘(2002—),女,本科在读,研究方向:公共事业管理

Research on the mediating effect of ecological environment quality between economic development level and residents’ health level
Xin-yuan WANG1, 2, 3, Hui-wen YE1, 2, 3, Yi JIANG1, 2, 3, En-ping WEN4
Affiliations
  • School of Public Health, Chongqing Medical University, Chongqing 400000, China
出版时间: 2025-01-10 doi: 10.20043/j.cnki.MPM.202406252
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目的

分析经济发展水平、生态环境质量与居民健康水平之间的关系,并探究生态环境质量在二者之间的中介效应。

方法

基于中国2012—2022年省级面板数据,通过建立基准回归模型分析经济发展水平与居民健康水平之间的关系。并采用中介效应检验三步法与bootstrap检验对生态环境质量的中介效应进行探究。

结果

经济发展水平与居民健康水平间呈正相关(β=0.01,P<0.05)。环境治理投资对居民健康水平存在中介作用(β=-0.005,P<0.01)。城市生活环境质量未通过非参数百分位bootstrap检验(95%CI:-0.001~0.004),对居民健康水平间接效应不显著。环境治理压力对居民健康水平的中介效应值为0.003,占总效应值的13.64%,通过非参数百分位bootstrap检验。

结论

经济发展水平对居民健康水平有显著的促进作用,经济发展水平可以通过对环境治理压力、环境治理投资产生的间接效应来提升居民健康水平。

经济发展  /  环境和公共卫生  /  健康状况  /  中介效应模型
Objective

To analyze the relationship between economic development level, ecological environment quality, and residents’ health level, and to explore the mediating effect of ecological environment quality between the two.

Methods

Based on provincial panel data from China from 2012 to 2022, a baseline regression model was established to analyze the relationship between economic development level and residents’ health level. The mediating effect of ecological environment quality was examined using the three-step method and Bootstrap testing.

Results

There is a positive correlation between economic development level and residents’ health level (β=0.01, P<0.05). Environmental governance investment has a mediating effect on residents’ health level (β=-0.005, P<0.01). The quality of urban living environment did not show a significant indirect effect on residents’ health level through the non-parametric percentile Bootstrap test (95%CI: -0.001 to 0.004). The mediating effect of environmental governance pressure on residents’ health level was 0.003, accounting for 13.64% of the total effect, as verified by the non-parametric percentile Bootstrap test.

Conclusion

Economic development level has a significant positive impact on residents’ health level, and it can enhance residents’health level through the indirect effects generated by environmental governance pressure and investment.

Economic development  /  Environment and public health  /  Health status  /  Mediating effect model
王鑫缘, 叶惠雯, 蒋祎, 温恩萍. 生态环境质量在经济发展水平与居民健康水平之间的中介效应研究. 现代预防医学, 2025 , 52 (1) : 114 -119 . DOI: 10.20043/j.cnki.MPM.202406252
Xin-yuan WANG, Hui-wen YE, Yi JIANG, En-ping WEN. Research on the mediating effect of ecological environment quality between economic development level and residents’ health level[J]. Modern Preventive Medicine, 2025 , 52 (1) : 114 -119 . DOI: 10.20043/j.cnki.MPM.202406252
健康是促进人全面发展的必然要求,是经济社会发展的基础条件[1]。2024年政府工作报告指出,2023年全年国内生产总值(GDP)超过126万亿元,增长5.2%,增速居世界主要经济体前列。与此同时,随着健康中国战略的有效实施,我国居民的平均预期寿命明显上升,从2015年的76.34岁增长至2021年的78.2岁[2-3]。这些数据均表明,随着经济的持续增长,我国居民的健康状况也在稳步上升。两者相辅相成,同步增长。
经济发展不仅会影响居民健康水平,同时也会影响生态环境质量。党的十八大以来,以习近平同志为核心的党中央高度重视生态文明建设,将其置于国家发展全局的战略高度[4],全面提高经济发展和生态环境发展的“含金量”“含绿量”。2012—2021年,我国在城市绿化、污水处理和环境治理等方面均取得显著成效。城市建成区的绿化覆盖率由39.22%提高到42.06%,城市和县城污水处理能力达2.47亿立方米/日,城镇生活垃圾无害化处理率接近100%[5]。但另一方面,在我国经济快速增长的大潮中,生态环境却受到严重破坏,尤其是生态环境污染对居民的健康危害日益突出。据世卫组织统计,我国每年因空气污染而死亡的人数约为200万,其中,仅环境空气污染所导致的死亡人数就已超过百万[6]。因此,推进健康中国建设不能仅关注经济发展状况和医疗卫生服务的供给情况,而且还要关注生态环境质量在经济发展水平与居民健康水平之间发挥的重要作用。
从现实来看,生态文明建设关乎人民福祉、民族兴亡以及人类文明兴衰。且生态文明建设在“五位一体”中具有基础性作用,为经济建设提供了具有可持续性的节约资源和保护环境的产业结构[7]。另一方面,随着经济的快速增长,生态环境却受到严重破坏并对居民的健康危害日益突出。由此可见,生态环境既为我国社会经济带来了发展福利,又会在一定程度上对居民健康带来负面胁迫。从目前来看,国内外学者对经济发展水平、生态环境质量和居民健康水平之间的两两关系做了大量有益的讨论[8-14],但大多数学者侧重于采用耦合协调性模型、向量自回归(VAR)模型、向量误差修正(VEC)模型以及联立方程模型来分析两两之间的相互关系,相比之下,以生态环境质量为中介机制的研究比较少。基于此,本篇文章以生态环境质量为中介机制,目的是厘清生态环境质量在经济发展水平与居民健康水平之间的中介作用,并深入探究三者之间增长的内在规律及其相互关联,从而为制定更加精准有效的经济发展策略和生态环境保护政策提供参考依据。
本文研究数据来源于2012—2022年中国(港澳台、西藏地区除外)30个省(直辖市、自治区)的统计年鉴、《中国统计年鉴》、《中国环境统计公报》、国家统计局数据库、第七次全国人口普查公报、卫生健康事业发展统计公报、卫生健康统计年鉴,部分缺失数据采用线性插值法补齐。
因变量为居民健康水平(lnHeal)[15]。采用平均期望寿命的自然对数来衡量。
核心解释变量为经济发展水平(lnEcon)。参考钱海章、陶云清、曹松威[16]等的做法选取人均GDP来衡量经济发展水平,同时考虑到数据量级的差异,对其进行取对数处理。
为深入探讨生态环境质量在其中的中介作用,本文选取城市生活环境质量(lnGree)、环境治理压力(lnGarb)、环境治理投入(lnInve)[17]作为中介变量。
主要为医疗水平(lnMedi)、老龄化程度(Agei)、受教育程度(lnScho)、性别结构(Wom)[18]。
首先,通过构建省级面板数据模型检验经济发展水平对居民健康水平的影响作用,基准回归模型1如下:
模型1中,lnHeali, t为因变量,表示i省(市)t时期的居民健康水平;lnEconi, t为核心解释变量,表示i省(市)t时期的经济发展水平;Controli, t表示可能影响被解释变量居民健康水平(lnHeali, t)的控制变量集合;α0是常数项,α1是自变量对因变量的回归系数,α2是控制变量的回归系数,μt为个体固定效应,εi, t为随机误差项。
其次,构建模型检验经济发展水平对中介变量(Mi, t)的影响,以此检验经济发展水平影响居民健康水平的间接机制,模型的具体形式如模型2所示:
模型2中,Mi, t为中介变量,根据前文的理论分析,主要包括人均公共绿地面积(lnGree)、生活垃圾清运量(lnGarb)和工业污染治理完成投资(lnInve)。其他变量设定均与模型1相同。
最后,在模型1中加入中介变量(Mi, t)以检验经济发展水平(lnEcon)和中介变量(Mi, t)对居民健康水平(lnHeal)的直接效应和中介效应,模型的具体形式如模型3所示:
本文参照温忠麟[19]提出的有关中介效应检验程序,用模型1中的系数α1,模型2中的系数β1和模型3中的系数γ1等指标来检验是否存在中介效应,并进一步阐释经济发展水平、生态环境质量和居民健康水平的相互关系。
使用STATA 17.0软件对省级面板数据进行处理和分析,首先对所选取的部分变量进行取对数处理并进行基准回归分析。其次采用线性回归三步法对中介效应进行分析,最后用bootstrap法对中介效应进行检验。检验水准α=0.05。
2012—2022年的年度分省数据计算得到。从研究对象的性别结构来看,同期同地区女性人口比重为48.66%;从老龄化程度来看,65岁及以上的人口占总人口的比重为11.59%。见表1。
表2为基准回归结果,模型1表示未加入控制变量,其回归结果显示经济发展水平与居民健康水平呈显著正相关(β=0.048, P<0.01)。模型2~5为逐步加入lnMedi、Wom、Agei、lnScho这四个控制变量,其回归分析结果显示,经济发展水平与居民健康水平均显著正相关(β=0.016, P<0.01; β=0.016, P <0.01; β=0.015, P<0.01;β=0.010, P<0.05)。
表3为生态环境质量在经济发展水平与居民健康水平间的中介效应回归结果,模型5说明经济发展水平显著负向影响环境治理投资(β=-1.034, P<0.01),模型6说明经济发展水平正向影响居民健康水平(β=0.005),环境治理投资显著负向影响居民健康水平(β=-0.005, P<0.01)。结合中介效应检验程序,可知环境治理投资在经济发展水平与居民健康水平间存在完全中介效应。
根据温忠麟的做法,因城市生活环境质量、环境治理压力未通过三步法检验,继而采取bootstrap法对其进行中介效应的假设检验。设置bootstrap随机抽样5 000次,置信区间为95%。结果显示城市生活环境质量boot置信区间包含0,即间接效应不显著,停止分析;环境治理压力boot置信区间均不包含0,说明其在经济发展水平与居民健康水平间起中介效应,中介效应值为0.003,占总效应值的13.64%。见表4。
根据前文实证分析结果可知,在逐步加入控制变量后,经济发展水平对居民健康水平有正向的促进作用。首先,从宏观层面来看,我国经济充满活力、动力、潜力,发展具有“五大战略优势”和新的战略机遇[20],这很大程度上为居民健康水平的提高提供了直接有利的经济保障。同时,随着健康中国战略的实施,我国人均预期寿命已提高到78.2岁,居民健康素养水平提升到29.70%[21],这项显著成绩使得我国在中高收入国家的关键健康指数中名列前茅。其次,国家经济实力逐渐加强,有助于构建一个以绿色、低碳为核心,注重可持续发展的循坏经济体系。这一体系的建立健全,不仅极大地改善了人们的生产生活环境,更促进了生态与经济的和谐共生,推动了可持续发展的深入实施。最后,经济发展还通过提升居民健康意识、提高居民物质生活水平、增加健康投资、提高教育水平等间接作用于居民健康。在基本生活得到保障后,人们开始更加注重对自身健康的保养,通过扩大自身预算约束从而增加对于健康的投入,以改善自身健康水平[22]。
根据回归分析结果可知,生态环境质量对于居民健康水平的提升产生间接效应。这表明,经济发展水平不仅可以直接影响居民健康水平,还可以通过生态环境质量的中介作用对居民健康水平产生影响。其中原因可能是生态环境质量的提升意味着环境中的健康危险因素减少、人居环境改善,这不仅可以在短期内降低急性疾病发病率,减少暴露人群不良反应发生率、急性中毒率、死亡率,还可以在长期阶段下改变地区疾病谱和死因谱,进而降低慢性疾病的患病率,全面提升居民的整体健康福祉。就环境治理压力而言,经济发展水平的提高意味着更大规模的生活生产需求量,促使人们的生活方式发生变化,引起生活垃圾清运量由2012年17 080.9万吨增加至2022年24 444.7万吨。环境治理压力增加在一定程度上为人们的环保意识敲响警钟,同时促使社会关注环境危害问题,有利于改善生态环境质量。对于环境治理投入而言,数据显示工业污染治理完成投资由2012年的5 004 573万元降至2022年的2 857 077万元。环境治理投入的降低提示环境危害问题在国家政策和人民的共同努力下大幅减少,生态环境持续改善,为构建宜美宜居社会奠定了坚实的生态基础。因此,可以看出生态环境质量对于居民健康水平虽然有多种影响,但是其总的作用还是有利影响大于不利影响。
综上,在经济快速发展的背景下,要把经济发展、生态环境与居民健康紧密结合起来,实现良性互动、持续共生、互利共赢,走出一条经济、生态与健康协调发展的新路[23]。我国应当坚持经济高质量发展,着力优化产业链与生产结构,确保经济增长和生态环境的共同繁荣;坚持以绿色发展为基调,着力减少高能耗高污染的生产方式;坚持推进生态文明建设工作并及时进行工作监测;完善生态环境治理体系,明确生态环境治理工作的分配,对环境污染问题做到减少发生、发生后及时发现、发现后及时干预,以减少生态环境质量损失对居民健康的不利影响;持续完善相关法律法规体系,确保对任何破坏生态环境的行为实现全面覆盖,并加大违法成本,强化处罚力度,从而为生态环境的持续发展提供强有力的法治基础;坚持协同转型,充分考虑不同地区、不同行业及生态环境的不同方面的发展实际;坚持统筹推进与重点突破相结合,有所侧重地、科学地设定绿色转型的时间表、路线图、施工图[24],以提高策略的可行性与针对性。以本研究为例,应当加大对环境治理压力的改善,因地制宜进行环境治理投入,最终提升居民健康水平;最后,强化人与自然和谐共生的理念,创造绿色发展的社会环境,在潜移默化中提升人民的环保意识,从多方面多渠道缓解生态环境压力,将经济发展引起的环境危害最小化,以提升生态环境质量,减少疾病危险因素,从而提升居民健康水平。

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doi: 10.20043/j.cnki.MPM.202406252
  • 接收时间:2024-06-15
  • 首发时间:2026-10-29
  • 出版时间:2025-01-10
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  • 收稿日期:2024-06-15
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    1.重庆医科大学公共卫生学院,重庆 400016
    2.医学与社会发展研究中心,重庆 400000
    3.公共卫生安全研究中心,重庆 400000
    4.重庆大学附属沙坪坝医院,重庆 400030

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
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