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“一胎化”政策对健康状况影响机制的实证研究
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摘要
经过几十年的努力,在中国经济还不发达的情况下,能将人口增长控制在目前的水平,极大程度上要归功于我国多年来实施的计划生育政策,尤其是近些年来推行的“一胎化”政策。然而,任何事物都有它的两面性。随着计划生育基本国策的逐步推进,它给整个社会和经济的发展带来的负面影响也日益显露出来,如人口老龄化、“失独老人”等社会现象越来越明显,而且,强制性的“一胎化”政策也饱受人性化发展的争议。因此,对于“一胎化”政策的认识说法不统一,存在着两个极端。有些人认为,“一胎化”政策在很大程度上缓解了中国的人口压力,在控制人口膨胀、提高经济发展速度方面发挥了不可磨灭的作用,应当继续严格执行“一胎化”政策;但还有些人认为,随着中国社会的发展和国力的强盛,“一胎化”政策的实施给整个社会带来的利益效用已经处于严重边际递减的状态,甚至就某些方面而言已经走向了另一个极端,因此它也是近来人们一直诟病的一项措施,认为应当放宽甚至取缔“一胎化”政策。事实上我们可以发现,在最近几年的“两会”上,呼吁放开“一胎化”政策的提案也是层出不穷。
     不可否认,在“一胎化”政策实施之后,其对整个社会的发展都产生了很大的影响。表现最为明显的是,在这项基本国策推行之后,“独生子女”问题已经成为了一个社会的典型问题,涉及到社会的方方面面。
     就健康而言,它既是人类生活追求的本质,也是人类生产必要的人力资本,是人类全面发展的基础。也就是说,身体健康已经不仅仅只是微观个体所应关注的议题了,同时也是宏观社会进步的动力和源泉。无论是从个人层面还是国家、世界层面,都应该就这一问题进行深入探讨。
     在“一胎化”政策实施前后出生的人群,现在所处的年龄段为35岁左右,他们正是目前中国社会经济建设的中坚力量。换个角度来说,其身体健康状况决定了健康人力资本的积累情况,影响着劳动市场的供求均衡状况,不仅关系着个人的收入和家庭的正常运转,还直接关系着宏观经济的发展和经济增长。然而,在“一胎化”政策全面推行的大环境下,所倡导的“少生”是否一定意味着“优生”?“质量-数量替代”的关系是否存在?本研究通过将“一胎化”政策实施前和实施后的独生子女与非独生子女进行比较,对其健康水平的差异进行系统分析,以期能够找出令人信服的证据。
     对于独生子女健康问题的研究,不同的学者往往基于不同的方法和角度。并且,就现有的研究情况来看,由于种种限制,导致所选样本范围较小,因而结论也可能存在着较大差异,甚至可能与事实相悖。本文在研究过程中,通过对不同的指标进行比较,得出较为稳健的结论,为计划生育政策的制定提供可靠依据。
     本文计划从以下方面对“一胎化”政策对健康状况的影响机制进行研究:
     第一章是绪论。本章主要阐述本论文的研究背景及论文的研究目的、研究意义、研究框架以及研究的价值所在,对论文采用的研究方法、研究内容和论文的研究思路等进行简单介绍,最后提出本论文的主要创新点。
     第二章是世界各国的人口政策与我国的计划生育政策演变。这里主要是对世界各国的人口政策与中国计划生育政策的实施背景、发展历程及实施情况进行归纳总结。本章首先对世界主要国家的人口政策进行一个简单的梳理,然后主要对中国计划生育政策的发展、“一胎化”政策的提出背景和发展历程、实施情况,以及由此导致的独生子女的总体现状做一个系统的介绍。
     第三章是研究综述及相关概念。本章主要介绍国内外学者对于独生子女的生理健康、心理健康及健康行为的研究成果的综述,并对现有研究的不足之处做一个简短评述,然后提出本文将要进一步研究的问题。本章的另一个重点是对生理健康、心理健康和健康行为各个概念的理清和界定。由于目前对于身体健康的标准尚无统一的认识,因此本文从各个不同的角度进行了综合阐述。
     第四章是“一胎化”政策对独生子女心理健康状况的影响——基于中印农民工调查数据的实证研究。本章内容将“一胎化”政策实施前后(1979年前后)的独生子女与非独生子女进行比较,选取自我肯定指标(包括是否经常对自己缺乏信心、是否经常觉得自己没价值、是否逃避困难和问题),精神压力和抑郁指标(包括精力集中程度、精神压力情况、是否觉得郁闷和抑郁),以及其他指标(包括幸福感、对别人的信任程度、风险偏好性等)作为心理健康状况的主要衡量指标,构建相应的计量经济学模型,在控制相关变量后,根据实证模型得出的回归结果,对主要变量的结果进行详细分析,检验独生子女与非独生子女在心理健康方面的差异,并得出相关结论。
     第五章是“一胎化”政策对独生子女生理健康状况的影响——基于国务院城镇居民基本医疗保险入户调查数据的实证研究。在此部分研究中,首先选取不同的生理健康衡量指标,包括身高、BMI、慢性病患病情况、两周患病情况、年住院情况、自评健康状况等,对这些指标进行细化研究,分别从不同的角度对“一胎化”政策实施前后(1979年前后)的两组人群的生理健康状况进行比较,并得出最终结论提出合理的政策建议。
     第六章是“一胎化”政策对独生子女健康行为的影响——基于国务院城镇居民基本医疗保险入户调查数据的实证研究。根据研究需要与实际情况,此部分以抽烟情况、喝酒情况、身体锻炼情况、年体检次数以及主动了解医疗保健知识的情况作为健康行为的衡量指标,对独生子女和非独生子女进行比较分析。
     第七章是“一胎化”政策对健康的影响机制探讨。本章通过对前面实证分析和国内外文献综述的总结,对“一胎化”政策对独生子女健康和健康行为的影响机制进行分析。
     第八章是结论和政策建议。本章首先对本文的研究结论做一总结,通过对以上心理健康、生理健康及健康行为指标的实证研究,得出可靠有效的结论。然后,基于本文的研究发现对目前我国实施的“一胎化”政策进行评价,提出合理的政策建议。最后,对本论文的研究不足做出说明,并指出下一步的研究方向。
     本文的创新与实际价值:
     本研究首次用实证的方法将“一胎化”政策对人们健康状况的长期影响进行了细化研究,加入了具体患病情况、医疗服务使用、心理健康状况、健康行为等各项指标。除此之外,本文还结合了健康人力资本理论,探讨了“一胎化”政策对健康、健康人力资本、经济增长、社会发展的层级影响。
     本研究从健康视角出发,试图用计量经济学的方法来估计“一胎化”政策对人们生理健康、心理健康及健康行为的影响,通过对实证结果进行分析最终得出结论,并在此基础上为政策制定者提供合理有效的建议。本文拟采用的主要数据为全国范围的微观数据,选取的样本为“一胎化”政策实施前后五年的样本,而不是目前通常使用的少年儿童的样本,从这个层面上来说,更能看出“一胎化”政策对身体健康的长期影响。此外,本文所使用的数据中的各项关键指标均为受访者本人回答,而此前一些关于少年儿童的研究中,许多指标均由目标人群的家长或者老师代为回答,这在一定程度上弱化了目标人群自身的感受,精确性不高。综合这些因素来看,本文的研究可以为政策的制定提供更多可靠的事实依据。
In the case of China's economy is not developed, thanks to great extent on the implementation of family planning policy,especially the "one-child" policy, for years in our country, we can control population growth at present levels through decades' efforts. However, every coin has its two sides. As the basic state policy of family planning gradually, it also brought some negative effects on the whole social and economic development, such as an ageing population,"the old man alone" and other social phenomenon, and the mandatory "one-child" policy also suffered controversy of human development. Therefore, there are to extremely different versions for the understanding of the "one-child" policy. Some people think that "one-child" policy alleviated the pressure of China's population to a great extent, and played an important part in controlling the population expansion and increasing the speed of economic development, so we should continue to strictly implement the "one-child" policy. While the others think that, with the development of the Chinese society, the implementation of the "one-child" policy is bringing the benefits to the society in the condition of seriously diminishing marginal utility, and even in some way has been to the other extreme. So it is also a measure that the people have criticized, and should be relaxed and even banned "one-child" policy. In fact, we can find that, in recent years on the "two sessions", many proposals are calling for loosening the "one-child" policy.
     In fact, the implement of the "one-child" policy has produced many effects to the development of the society. The most obvious is that, after implementing the basic national policy, the "only child" problem has become a social problem that involves all aspects of the society.
     As the nature of human life and the necessary human capital, health is the foundation of human all-round development. That is to say, health is not only the individual problem, but also the motivation and source of macro social progress. Both from the individual level and the country level, we should discuss deeply on this issue.
     People that born before and after the "one-child" policy are now about35years old, and they are the backbone of China's social and economic construction. From another perspective, the physical health determines the human capital accumulation, and affects the labor market supply and demand equilibrium conditions, which will not only influence the personal income and family functioning, but also directly influence the macro economic development and economic growth. However, under the circumstances of fully implementing "one-child" policy,"have fewer" whether must means "eugenics"? Does the "Quality-Quantity Offset" exist? We try to compare the people without siblings with the people with siblings on their health to find convinced evidence.
     The research on the health of people without siblings often base on different methods and different angles. Moreover, in the context of the existing research situation, the small sample leading to many different results, even may be inconsistent with the facts. In the process of research in this paper, we can get the solid conclusions by comparing different indicators, at last we can provide a reliable evidence for the establishment of family planning policy.
     This article plans to analyze the effects of "one-child" policy on the health from the following aspects:
     The first chapter is introduction. This chapter mainly elaborates the research background of this paper and the paper's research purpose, research significance, research framework and research value, and briefly introduce this paper's research method, research content and the research design, then put forward the main innovation points of this paper.
     The second chapter is the world's population policy and the evolution of family planning policy in China. We will mainly summarize the world's population policy and the implementation of China's family planning policy background. This chapter will first comb the population policy of main countries in the world, then will mainly elaborates the development of China's family planning policy, the background and development course of "one-child" policy, the implementation situation. At last, we will systematically introduce the latest situation of people without siblings.
     The third chapter is the literature review and related concepts. This chapter mainly introduces the domestic and foreign research for the only child's physical health, mental health and health behaviors, and gets the limitations of the existing literature, then we will find the points that we should focus on. In addition, we will analyze the concepts and indicators of physical health, mental health and health behaviors. Since there are no unified concepts for the body health, so we carry on the comprehensive elaboration from different angles.
     The fourth chapter is the research about the effect of "one-child" policy on the mental health status.Compared the people without siblings with the people with siblings, and the people born before and after the implement of "one-child" policy, and select some indicators,such as self-affirmation indicators (including whether one is self-confident, whether to affirm self value, whether to escape the difficulties and problems), mental stress and depression indicators (including the degree of concentration, mental pressure, whether often feel depressed), and other indicators (including happiness, degree of trust in others, risk preferences) as the main measure of mental health, then construct the corresponding econometric model. According to the results of the empirical model of regression, we can analyze the results of the main variables, and compare the difference between the only child and the people with siblings.
     The fifth chapter is the research about the effect of "one-child "on physical health status. In this study, firstly, we select some different physical health indicators, including height, BMI, chronic diseases, two weeks outpatient, inpatient and self-reported health status, then we will study the indicators in details, and compare the two different groups of physical health, and put forward reasonable suggestions to the final conclusion.
     The sixth chapter is the research about the effect of "one-child" on health behaviors. According to the research needs and actual situation, t we choose smoking, drinking, exercise situation, annual physical examination times and take the initiative to understand health care knowledge as a measure of health behaviors, the compare the people without siblings and the people with siblings by econometric methods.
     The seventh chapter is the discussion about the "one-child" policy's influence mechanism. On the basis of the empirical analysis and the conclusion, we will discuss the influence mechanism of "one-child" policy for health and health behavior.
     The eighth chapter is conclusion and policy suggestions. First we will make a summary of the empirical research conclusion of this paper, then come to the conclusion that reliable and efficient based on the above mental health, physical health and health behaviors index of empirical research. Besides, we will evaluate the "one-child" policy reasonably and put forward reasonable suggestions on the basis of the results. Finally, point out the shortcomings of this thesis and the further research direction.
     The innovation and the actual value of this paper are as follows:
     Firstly, this study is the first time to use empirical methods to analyze the long term effect of "one-child" policy on people's health, and choose the detailed indicators, such as BMI, height, mental health status, health behavior and so on. In addition, we also combine the results with the human capital theory, and discuss the effect of "one-child" policy to health, human capital and economic growth and social development level.
     Secondly, from the health perspective, this study tries to use the method of econometrics to estimate the effect of "one-child policy" on people's physical health, mental health and health behavior. Through the analysis of empirical results finally come to the conclusions, and provide reasonable and effective suggestions for policy makers on this basis. We decide to use the national micro data, compared the people that born five years before and after the "one-child" policy, which can get the long-term effects of "one-child" policy on the health, rather than the current commonly used samples of children. In addition, all of the questions of the data are answered by the respondents itself. While in the children's study, many questions are answered by the parents or teachers, to a certain extent, which weaken the target population's own feelings. Take all the factors account, our research can provide more reliable results for policy makers based on facts.
引文
① 数据来源于国务院发展研究中心信息网,http://www.drcnet.com.cn/eDRCnet.common.web/DocSummary.aspx?docid=1829781&leafid=4175。
    ② 数据来源于新华网,http://news.xinhuanet.com/politics/2013-11/20/c_125731840.htm。
    ① 数据来源于新华网,http://news.xinhuanet.com/politics/2013-11/20/c_125731840.htm。
    ① 资料来源于中新网,http://www.chinanews.com/cj/2011/10-08/3370778.shtml。
    ① 资料来源于凤凰财经,http://finance.ifeng.com/news/macro/20130112/7548966.shtml。
    ① 资料来源于新华网,http://www.sc.xinhuanet.com/content/2008-11/13/content_14906142.htm.
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