scholarly journals From income inequality to social inequity: impact on health levels in an international efficiency comparison panel

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Simone Schenkman ◽  
Aylene Bousquat
Keyword(s):  
Comparative Analysis ◽  
Infant Mortality ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Health Equity ◽  
Fixed Effects ◽  
Health Production ◽  
Social Inequity ◽  
Life Expectancy At Birth ◽  
Capita Health Expenditure

Abstract Background Health equity, although addressed in several publications dealing with health efficiency analysis, is not easily translated into the operationalization of variables, mainly due to technical difficulties. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems. Method Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequity was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks. Results Both methods demonstrated that countries with higher inequity levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth exhibited, in the final model, the following variables: social inequity and per capita health expenditure. The outcome infant mortality comprehended the level of education variable, in association with the following healthcare variabels: care seeking due to diarrhea in children under five, births attended by skilled health professionals and the reduction in the incidence of HIV. Conclusion The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it is associated with high levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequties affect society altogether, generating mistrust and reduced social cohesion.

scholarly journals From income inequality to social corrosion: impact on health levels in an international efficiency comparison panel

2020 ◽  
Author(s):  
Simone Schenkman ◽  
Aylene Bousquat
Keyword(s):  
Comparative Analysis ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Health Equity ◽  
Fixed Effects ◽  
Care Seeking ◽  
Health Production ◽  
Fixed Effects Model ◽  
Life Expectancy At Birth ◽  
Capita Health Expenditure

Abstract Background Health equity, although addressed in several publications dealing with health efficiency analysis, usually does not usually remain as a relevant result in empirical studies, due to the difficulty in its operationalization. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems. Method Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequality was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks. Results Both methods demonstrated that countries with higher inequality levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth showed inequality and per capita health expenditure in the final model. The variable linfant mortality comprehended education, in association with care seeking due to diarrhea, births attended by skilled health professionals and the reduction in the incidence of HIV. Conclusion The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it increases the levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequalities affect society altogether, generating mistrust and reduced social cohesion.

Globalization and women’s and girls’ health in 192 UN-member countries

2016 ◽  
Vol 43 (7) ◽  
pp. 692-721 ◽  
Author(s):  
Deniz Gevrek ◽  
Karen Middleton
Keyword(s):  
Mortality Rate ◽  
Infant Mortality ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Fixed Effects ◽  
Content Type ◽  
Life Expectancy At Birth ◽  
Adolescent Fertility ◽  
The Impact ◽  
The Relationship

Purpose – The purpose of this paper is to explore the relationship between the ratification of the United Nations’ (UN’s) Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and women’s and girls’ health outcomes using a unique longitudinal data set of 192 UN-member countries that encompasses the years from 1980 to 2011. Design/methodology/approach – The authors focus on the impact of CEDAW ratification, number of reports submitted after ratification, years passed since ratification, and the dynamic impact of CEDAW ratification by utilizing ordinary least squares (OLS) and panel fixed effects methods. The study investigates the following women’s and girls’ health outcomes: total fertility rate, adolescent fertility rate, infant mortality rate, maternal mortality ratio, neonatal mortality rate, female life expectancy at birth (FLEB), and female to male life expectancy at birth. Findings – The OLS and panel country and year fixed effects models provide evidence that the impact of CEDAW ratification on women’s and girls’ health outcomes varies by global regions. While the authors find no significant gains in health outcomes in European and North-American countries, the countries in the Northern Africa, sub-Saharan Africa, Southern Africa, Caribbean and Central America, South America, Middle-East, Eastern Asia, and Oceania regions experienced the biggest gains from CEDAW ratification, exhibiting reductions in total fertility, adolescent fertility, infant mortality, maternal mortality, and neonatal mortality while also showing improvements in FLEB. The results provide evidence that both early commitment to CEDAW as measured by the total number of years of engagement after the UN’s 1980 ratification and the timely submission of mandatory CEDAW reports have positive impacts on women’ and girls’ health outcomes. Several sensitivity tests confirm the robustness of main findings. Originality/value – This study is the first comprehensive attempt to explore the multifaceted relationships between CEDAW ratification and female health outcomes. The study significantly expands on the methods of earlier research and presents novel methods and findings on the relationship between CEDAW ratification and women’s health outcomes. The findings suggest that the impact of CEDAW ratification significantly depends on the country’s region. Furthermore, stronger engagement with CEDAW (as indicated by the total number of years following country ratification) and the submission of the required CEDAW reports (as outlined in the Convention’s guidelines) have positive impacts on women’s and girls’ health outcomes.

scholarly journals Infant Mortality in Low- and Middle-income Countries: Does Government Health Spending Matter?

2020 ◽  
Vol 5 (1) ◽  
pp. 54-73
Author(s):  
Micheal Kofi Boachie ◽  
Tatjana Põlajeva ◽  
Albert Opoku Frimpong
Keyword(s):  
Infant Mortality ◽  
Health Outcomes ◽  
Health Expenditure ◽  
Fixed Effects ◽  
Health Sector ◽  
Health Spending ◽  
Middle Income ◽  
Government Health ◽  
Middle Income Countries ◽  
Low And Middle Income

The issue of whether government health spending improves health outcomes has been a matter of contention over the years. There have been calls for governments to reduce their financing role in the health sector since such funding do not produce better health. This article examines the effect of public (i.e., government) health expenditure on infant mortality, a proxy of health outcomes, in low- and middle-income countries. We use data from the World Bank’s World Development Indicators database and employ fixed effects estimation technique, with three-stage least squares as a robustness check. The data cover the period 1995–2014. We find that public health expenditure improves health outcomes significantly, as it reduces infant mortality. The results further show that rising income and access to safe water are some of the reasons for improved health outcomes in low- and middle-income countries. Based on these results and the expected redistributive impact of government spending, governments in low- and middle-income countries may consider increasing health spending for better healthcare systems and improved health.

OP134 Predictors Of Public Health Outcomes: A Case Study From Turkey

2017 ◽  
Vol 33 (S1) ◽  
pp. 62-63
Author(s):  
Songul Cinaroglu ◽  
Onur Baser
Keyword(s):  
Public Health ◽  
Health Outcome ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Outcome Indicators ◽  
Random Forest Classification ◽  
Life Expectancy At Birth ◽  
Forest Classification ◽  
Province Level ◽  
Public Health Outcome

INTRODUCTION:In Turkey, there is a scarcity of knowledge about the predictors of health outcomes at a national level, and it is well known that there is a gap between rural and urban parts of developing countries in terms of the level of health outcomes. This study aims to find out predictor factors of the public health outcomes at a province level in Turkey.METHODS:Life expectancy at birth and mortality are used as public health outcome indicators. Logistic regression and Random Forest classification generated by using 50, 100, and 150 trees were used to compare prediction performance of health outcomes. The results of different prediction methods were recorded changing the “k” parameter from 3 to 20 in k-fold cross validation. The Area Under the ROC Curve (AUC) was used as a measure of prediction accuracy. Prediction performance differences were tested using Kruskall-Wallis analysis and visualized on a heatmap. Finally, predictor variables of public health outcomes were shown on a decision tree.RESULTS:Study results revealed that Logistic regression outperformed Random Forest classification. The difference between all prediction methods to predict public health outcome indicators was statistically significant (p<.000). The heatmap shows that AUC values to predict mortality have superior performance when compared with life expectancy at birth. Decision tree graphs present that the most important predictor variables were total number of beds for mortality and percentage of higher education graduates for life expectancy at birth.CONCLUSIONS:The results of this study represent a preliminary attempt to determine public health outcome indicators. It is hoped that the results of this study serve as a basis to understand the determinants of health care outcomes at province level with focus on a developing country. This study illustrates that there is a need to spend extra effort for future studies to analyze public health outcomes to improve social welfare functions in health systems.

DEMOGRAPHIC AND HEALTH PATTERNS IN A RURAL COMMUNITY FROM THE BASQUE AREA IN SPAIN (1800–1990)

2002 ◽  
Vol 34 (4) ◽  
pp. 541-558 ◽  
Author(s):  
MIGUEL A. ALFONSO SÁNCHEZ ◽  
VICTORIA PANERA MENDIETA ◽  
JOSÉ A. PEÑA ◽  
ROSARIO CALDERÓN
Keyword(s):  
Infant Mortality ◽  
Life Expectancy ◽  
Rural Community ◽  
Significant Proportion ◽  
Infant Mortality Rate ◽  
Effective Control ◽  
Malignant Neoplasms ◽  
Transitional Stage ◽  
Life Expectancy At Birth ◽  
Health Patterns

In this work, the evolution of demographic and health patterns in a Basque rural population from Spain is analysed, as they relate to progress in demographic and epidemiological transition. For this purpose, parochial record data on 13,298 births and 9215 deaths, registered during the 19th and 20th centuries (1800–1990), were examined. The study area is a rural community called Lanciego, which is located at the southern end of the Rioja Alavesa area (Alava Province, Basque Country). In Lanciego, demographic transition began in the final decade of the 19th century, when a definite, irreversible trend began towards a reduction in mortality. The decrease in the birth rate came later than that in the death rate, and did not start until the 1930s. The post-transitional stage seemed to be reached in the 1970s, when the birth and death rates showed values below 20 per 1000. Other characteristics observed for the post-transitional stage in Lanciego are: (i) very low rates of infant mortality achieved at the expense of effective control of exogenous mortality; (ii) the mortality curve by ages changes from a U-shape (typical of populations with a high infant mortality rate and low life expectancy at birth) to a J-shape more characteristic of modern societies where longevity and life expectancy are considerably higher; (iii) a certain level of over-mortality among women in the senior age group (>65); and (iv) a significant proportion of mortality in recent times (1970–90) resulting from cardiovascular diseases and malignant neoplasms (post-transition causes). This last point is in contrast with observations from the first four decades of the 20th century, when infectious diseases and respiratory ailments were determining factors in mortality among this population. The data provided by the study of the variation over time in demographic and health patterns indicate that reducing the risk of mortality is one of the most important preconditions for fertility decline.

scholarly journals Health disparities in Russia at the regional and global scales

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Natalia Shartova ◽  
Vladimir Tikunov ◽  
Olga Chereshnya
Keyword(s):  
Health Status ◽  
Infant Mortality ◽  
Life Expectancy ◽  
Principal Component ◽  
Well Being ◽  
Spatial Inequality ◽  
Infant Mortality Rate ◽  
High Income Group ◽  
Life Expectancy At Birth ◽  
Regions Of Russia

Abstract Background The capacity for health comparisons, including the accurate comparison of indicators, is necessary for a comprehensive evaluation of well-being in places where people live. An important issue is the assessment of within-country heterogeneity for geographically extensive countries. The aim of this study was to assess the spatial and temporal changes in health status in Russia and to compare these regional changes with global trends. Methods The index, which considers the infant mortality rate and the male and female life expectancy at birth, was used for this purpose. Homogeneous territorial groups were identified using principal component analysis and multivariate ranking procedures. Trend analysis of individual indicators included in the index was also performed to assess the changes over the past 20 years (1990–2017). Results The study indicated a trend towards convergence in health indicators worldwide, which is largely due to changes in infant mortality. It also revealed that the trend of increasing life expectancy in many regions of Russia is not statistically significant. Significant interregional heterogeneity of health status in Russia was identified according to the application of typological ranking. The regions were characterized by similar index values until the mid-1990s. Conclusions The strong spatial inequality in health of population was found in Russia. While many regions of Russia were comparable to the countries in the high-income group in terms of GDP, the progress in health was less pronounced. Perhaps this can be explained by intraregional inequality, expressed by significant fluctuations in income levels. Trial registration Not applicable.

scholarly journals Military Expenditures and Health Outcomes: A Global Perspective

2019 ◽  
Vol 1 (1) ◽  
pp. 1-20
Author(s):  
Seemab Gillani ◽  
Muhammad Nouman Shafiq ◽  
Tusawar Iftikhar Ahmad
Keyword(s):  
Infant Mortality ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Spillover Effects ◽  
School Enrollment ◽  
Global Perspective ◽  
Determinants Of Health ◽  
Sensitivity Analyses ◽  
Drinking Water Source ◽  
Military Expenditures

Health has a major contribution in attaining better human capital and wellbeing both at the individual as well as at country levels. Although military spending may boost economic growth through multiplier and spillover effects, yet tradeoffs exist between military expenditures and health outcomes. Grossman (1972) explains health as output which depends on many input variables. By covering a panel of 156 countries ranging from the time period 1970 to 2014, this study incorporates military expenditures, GDP per capita, urbanization, access to the improved drinking water source, number of physicians, and secondary school enrollment as determinants of health (life expectancy and infant mortality). OLS, fixed effects, random effects, and system GMM have been used as estimation techniques. The study reveals that countries with low military expenditures have a comparatively high life expectancy and low infant mortality as compared to countries with high military expenditures. Robustness of results was checked through sensitivity analyses performed on the bases of determinants of health, international geopolitical scenario, and the development status of the country. The evidence of sensitivity analysis suggests that overall results are robust in life expectancy model but somehow sensitive in case of infant mortality. The study affirms the explicit tradeoff between military expenditures and welfare spending and concludes that hefty defense expenditures lower life expectancy and enhance infant mortality.

scholarly journals Health Outcomes And The Cost-Quality Trade-Off In Health Care: Empirical Study Of OECD Countries

2011 ◽  
Vol 3 (7) ◽  
Author(s):  
Adora D. Holstein
Keyword(s):  
Health Care ◽  
Infant Mortality ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Health System ◽  
Oecd Countries ◽  
World Health ◽  
Healthy Life Expectancy ◽  
Healthy Life ◽  
Trade Off

This study applies multivariate regression analysis to cross-section data of 30 OECD countries to determine if there is a trade-off between health care cost and the quality of the health system on one hand, and better health outcomes on the other. It also investigates whether a higher quality health system leads to superior health outcomes. The empirical results provide positive answers to the above two questions. Indices of responsiveness, fairness or accessibility, and overall efficiency of the health system developed by the World Health Organization were used in this study to measure health system quality. The rate of infant mortality and a disability-free or healthy life expectancy measure developed by the WHO are used as indicators of health outcomes. The empirical models control for the effects of cross-country differences in literacy level and health-risk or lifestyle. The study finds evidence that the more responsive and accessible the countrys health system is, the longer is the healthy life expectancy of its people. Moreover, the more accessible and efficient the countrys health system is, the lower is the rate of infant mortality.

scholarly journals A Panel Data Approach to the Measurement of Health Technical Efficiency of Sub-Saharan Africa

2015 ◽  
Vol 18 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Elham Torkian
Keyword(s):  
Panel Data ◽  
Environmental Factors ◽  
Life Expectancy ◽  
Technical Efficiency ◽  
Fixed Effects ◽  
Sub Saharan Africa ◽  
Stochastic Production Frontier ◽  
Life Expectancy At Birth ◽  
Sub Saharan ◽  
The Impact

Abstract This study investigates technical efficiency of health production function in Sub-Saharan Africa. For this purpose, a stochastic production frontier model is estimated using fixed-effects panel data method over the period of 2000-2007. More specifically the impact of economic, social, and environmental factors in determining life expectancy at birth, as the dependent variable, is measured and evaluated. Overall, the results justify the important role of policymakers, who their proactive approaches should be given to activities that go beyond the health system to influence the main determinants of health i.e. socioeconomic and environmental factors in preventing infectious diseases, improving life expectancy and aid populations to access available resources.

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