刘瑞平，李建新

(北京大学 社会学系，北京 100871)

儿童期是个体生理功能形成的关键时期，最容易受到外部环境的积极或消极影响，(1)Perry, B. Childhood Experience and Expression of Genetic Potential: What Childhood Neglect Tells Us about Nature and Nurture. Brain and Mind, 2002, 3, 79-100.一次不利经历或风险环境暴露往往会导致后续的不良结果，形成“风险链”(或连锁反应)，不同生命阶段的风险因素随着时间的推移而累积，童年逆境的冲击主要通过生物学途径、社会途径、社会生物学途径、生物社会途径对中老年健康不平等产生直接或间接影响机制，(2)Ben-Shlomo, Y., Kuh, D. A Life Course Approach to Chronic Disease Epidemiology: Conceptual Models, Empirical Challenges and Interdisciplinary Perspectives. International Journal of Epidemiology,2002, 31(2), 285-293.被称为“童年的长臂(the long arm of childhood)”(3)Hayward M D, Gorman B K. The Long Arm of Childhood: The Influence of Early-Life Social Conditions on Men’s Mortality. Demography, 2004, 41(1): 87-107.。大量研究表明，童年逆境的数量、不同种类、不同组合等对成年期多种健康结果产生负面影响。(4)Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998,14(4):245-258. Chapman D P, Whitfield C L, Felitti V J, et al. Adverse Childhood Experiences and the Risk of Depressive Disorders in Adulthood. Journal of Affective Disorders. 2004,82(2):217-225.通过对欧洲和北美的数据分析发现，由童年逆境引起的疾病给个人和社会带来巨大的健康和经济负担，每年损失总计3750万残障调整生命年(disability adjusted life years)和1.3万亿美元(欧洲为5810亿美元，北美为7480亿美元)，超过75%的成本是由经历两种及以上童年逆境的人口所带来的。(5)Bellis MA, Hughes K, Leckenby N, et al. Adverse Childhood Experiences and Associations with Health-Harming Behaviours in Young Adults: Surveys in Eight Eastern European Countries.Bulletin of the World Health Organization. 2014,92(9):641-655.在人口老龄化背景下，童年逆境与中老年健康的研究在西方发达国家中越来越受到重视，然而童年逆境在发展中国家的存在更为普遍，(6)Soares AL, Howe LD, Matijasevich A, Wehrmeister FC, Menezes AM, Gonçalves H. Adverse Childhood Experiences: Prevalence and Related Factors in Adolescents of a Brazilian Birth Cohort.Child Abuse & Neglect,2016, 51:21-30.但在我国对童年逆境与中老年人健康关系的关注仍然不够。本文在以往理论和实证研究的基础上，分析我国中老年人经历童年逆境的基本状况，比较单一童年逆境对我国中老年人多维度健康的独特影响，以及童年逆境的累积效应和组合效应，这将有利于评估儿童期风险和成年健康状况，对于制定有效的政策干预儿童不利环境、减少童年逆境暴露风险、打破童年到晚年的健康风险链并最终实现改善成年健康状况等方面具有重要意义。……