Older adults often suffer from multiple health problems. Social pensions, i.e., income transfers paid regularly to older people, are the key to alleviating old age poverty, reducing income insecurity, and investing in health. The roll-out of social pension programs in 106 countries has raised income of an ever-increasing body of older persons. However, existing evidence is inconclusive on if and to what extent social pensions may help to improve the health and health trajectory of the elderly. There is mixed evidence on the impact of pension income on mortality, subjective measures of health and physical health. Evaluating multidimensional health conditions and identifying pathways through which pension benefits affect health and domains of healthy aging may inform how and when to intervene to achieve desirable health objectives. Utilizing rich information on self-reported health, coexisting diseases, and blood/non-blood biomarkers in a HRS-sister survey sponsored by the NIH/NIA, i.e., China Health and Retirement Longitudinal Study (CHARLS), we study the New Social Pension Scheme (NSPS), the newest and largest social pension program in the world that will soon cover 1 billion individuals. We examine how health and health trajectory of seniors respond to pension benefits (Aim 1), through what mechanisms or pathways (e.g. nutrition, financial strain, health services utilization, health behavior, lifestyle, and labor supply) (Aim 2), and how multiple (e.g. family demographic, social environmental) factors mediate the relationship between pension and health domains (Aim 3). We analyze the recent implementation and expansion of the largest pension program in the world that will enroll 1 billion population, i.e., China's New Social Pension Scheme (NSPS), which is similar to the U.S. Social Security benefits in many aspects. Implementing cutting-edge and rigorous quasi-experimental research designs to examine the causal impact of social pensions on health using a nationally representative sample of biomarkers, we validate reporting bias of self-rated health and medical history, pay more adequate attention to morbidity than just focusing on mortality, and identify early signals of pre-disease pathways that are below the individual's threshold of perception. The rich meanings of biomarkers allow us to clarify the ambiguity in the literature by disentangling the multiple underlying pathways and mechanisms of the impact of pension on health. We are also able to explore mediating factors in the relationship between pension and health. We advance studies of social pensions and health via innovatively integrating economic methods and biomarker epidemiology into our research design to isolate the causal impact of pensions from confounding factors to offer novel evidence to the question ? how social security income may affect health and its trajectory. We also aim to offer insights into income support programs and health of the elderly, which holds general and important implications for the 20 million Asian population in the United States and its Social Security program.

Public Health Relevance

Social pensions are key to health in old age. Integrating economic methods and biomarker epidemiology into rigorous causal research designs to evaluate multidimensional health conditions and identifying pathways, mechanisms and mediating factors through which pension affect health and domains of healthy aging, this career development research plan aims to provide the knowledge base to improve social pension programs and achieve desirable health objectives.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Scientist Development Award - Research & Training (K01)
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Behavior and Social Science of Aging Review Committee (NIA)
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Phillips, John
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Yale University
Public Health & Prev Medicine
Schools of Medicine
New Haven
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