How Self-Rated is Self-Rated Health? Exploring the Role of Individual and Institutional Factors in Reporting Heterogeneity in Russia

Valerii Baidin,Christopher J Gerry,Maria Kaneva

doi:10.1007/s11205-020-02604-4

Abstract

In recent years the literature exploring the state dependent nature of individual self-rated health has grown rapidly. We contribute to this ‘reporting heterogeneity’ research field in two main ways. First, we are among the few studies to examine the determinants of reporting heterogeneity in self-rated health in the Russian context. Second, echoing the social determinants of health literature, we augment the standard battery of individual level socioeconomic and demographic characteristics with aggregated macro level variables serving as proxies for local environmental and social conditions. We are not aware of other heterogeneity studies that have incorporated this approach. Estimating a generalized ordered probit model we resolve the identification problem through the inclusion of an objective disease index. In terms of reporting heterogeneity, we find that response behaviour is systematically influenced by individual characteristics but also by aggregate regional socioeconomic characteristics. In particular, the finding that an individual’s relative standing in their local economy can condition their response to subjective health questionnaires is important and merits further examination. We argue that both a relative income mechanism and a mechanism that links the cognitive process of choice with the sense of optimism that individuals have for their institutional environment are plausible explanations for the observed aggregate level effects.

Highlights

Interest in understanding and explaining the nature and causes of comparative health outcomes across and within countries and by socioeconomic and demographic subgroup has expanded dramatically during the last three decades
Before turning to the results of estimating Eq (8), we briefly present the outcome of the bivariate random effects panel probit regressions used to generate the objective health index (Appendix 2)
Using an objective health index as a proxy for true health enables us to distinguish between explanatory variables which give rise to reporting heterogeneity in SRH

Summary

Introduction

Interest in understanding and explaining the nature and causes of comparative health outcomes across and within countries and by socioeconomic and demographic subgroup has expanded dramatically during the last three decades. In self-rating health in this ordinal manner, an individual’s response is informed by myriad factors, other than their true health, including education, environment, gender relations, social networks, labour market status, the presence or absence of longterm chronic conditions and culture. If this is so, SRH is as much a health-related social construct (Kaplan et al 1976) as it is a measure of ‘true’ underlying health. This is not to deny that SRH is linked in important ways to underlying physiological and psychological states but to contend that an individual’s comprehension of these states is itself a function of socioeconomic and demographic characteristics, health behaviours and expectations, and national, neighbourhood and peer comparisons

Methods

Results

Discussion

Conclusion