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收入与免疫:社会保障管理改革对儿童感染风险的影响

Income and immunity: The consequences of social security administration reform for childhood infection risk
Journal of Health Economics · 2026 · Mary-Alice Doyle、Stefanie Schurer、Steven Guthridge

中文摘要

我们分析社会保障给付管理方式的改变——发生在胎儿期和婴儿早期——对幼儿期健康的影响。我们借助2007年澳大利亚北领地原住民社区逐步推行的所谓"收入管理"政策来识别这一影响。该政策改变了社会保障给付的发放方式,但未改变其金额;然而,实施中的困难意味着许多家庭未能按时收到给付。利用关联的行政数据,我们发现,在胎儿期或生命最初三个月("第四个三月期")暴露于该政策推行的儿童,因严重感染需要住院的风险更高。这些儿童从出生到8岁生日之间平均多住院4.7天。这一影响大部分集中于因感染住院,其增加了23%。这些住院由多种感染类型驱动:细菌性、病毒性和呼吸道感染。我们将研究结果与"免疫编程假说"联系起来,即在免疫系统发育的关键阶段,母亲的应激与营养不良可能永久性地削弱儿童的免疫系统。我们的发现凸显了在设计影响家庭财务资源(即便是暂时性影响)的政策时,关注儿童发育关键阶段的重要性。

Abstract

We analyse the impact of a change in the administration of social security payments, occurring in utero and early infancy, on health in early childhood. We identify this impact through the gradual rollout of the so-called 'income management' policy in Aboriginal communities in Australia's Northern Territory in 2007. This policy changed the delivery method of social security payments but not their value - however, implementation challenges meant that many families did not receive their payments on time. Using linked administrative data, we find that children who were exposed to the policy rollout in utero or in their first three months of life (the 'fourth trimester') were at higher risk of severe infection requiring hospitalisation. These children spent, on average, 4.7 more days in hospital between birth and their 8th birthday. Most of this impact is concentrated in hospitalisations for infection, which increased by 23 percent. These admissions are driven by a range of infection types: bacterial, viral and respiratory. We link our findings to the 'immune programming hypothesis', i.e. maternal stress and poor nutrition during key stages in immune system development can permanently weaken the child's immune system. Our findings highlight the importance of attention to key phases in child development when designing policies that affect households' financial resources, even temporarily.
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