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Wealth, health and equity: Convergence to divergence in late 20th century globalization
Abstract
Debate over relationships between economic growth, wealth, health and health inequity is long-standing and ongoing. The main message of this paper is that economic growth, while necessary, is not a sufficient condition in itself for achieving equitable health.
This review surveys and draws on research into principal factors commonly linked with improving health-income, health care, individual behavior-suggesting, using work from the Commission on Social Determinants of Health, that these are better understood in a broader social determinants of health framework.
The paper acknowledges that post-war globalization has seen significant growth, poverty reduction and greater economic resources at individual and household levels all of which can contribute to better health. But it also highlights renewing inequity in global health during the period.
It argues that over-reliance on market-driven growth, which fails to address deep-rooted social inequalities in economic resources key to accessing social determinants of health, and in the key determinants of health themselves have contributed to increasing inequity in health outcomes.
Commitment to market-driven growth remains evident in national policy-making worldwide.
With increasing health inequity, and calamitous global economic events in 2008-09, the centrality of this commitment needs urgently to be reviewed.
... These results are supported by McMichael et al (2004). A trend from convergence to divergence in the late 20th century is also noted by Taylor (2009). Ram (2006) shows that, instead of the sharp convergence before the 1980's, after 1980 there is lack of convergence and an indication of "divergence," that is particularly marked during the 1990s. ...
... Results on income divergence and on life expectancy convergence turning to divergence were already mentioned above (Bloom, Canning & Sevilla, 2003b;Castellacci, 2006Castellacci, , 2008Mayer-Foulkes, 2006;Moser, Shkolnikov & Leon, 2005;McMichael et al, 2004;Taylor, 2009;Ram, 2006;Edwards, 2010). ...
I conduct a cross-country analysis of the human development index (HDI) components, income, life expectancy, literacy and gross enrolment ratios, using Gray and PurserÕs 1970-2005 quinquennial database for 111 countries. 1) A descriptive analysis uncovers a complex pattern of divergence and convergence for these componentsÕ evolution. Development is not a smooth process but consists of a series of superposed transitions each taking off with increasing divergence and then converging. 2) Absolute divergence/convergence for the HDI components is decomposed using simultaneous growth regressions including a full set of quadratic interactions between the HDI components, and indicators of urbanization, trade, institutions, foreign direct investment and physical geography. These are implemented, first, using three stage least squares, all of the non-exogenous independent variables fully instrumented, and second, as independent regressions with errors clustered by countries, again all non-exogenous variables instrumented. 3) A set of quantile regressions is run for the HDI component levels on the same variables (just the linear terms), again fully instrumented. Urbanization is a leading significant variable for human development indicators in both sets of estimates, stronger than trade, FDI and institutional indicators. These indicators act with ambiguous signs that may result from their distributive impacts, reducing their effectiveness. The results indicate that improving markets will have smaller returns than complementing them with institutions that can coordinate urbanization as well as investment in human capital. Urbanization itself can provide a concrete agenda for development involving all aspects of economic, political and social life as well as human development.
... methodology in demography and public health (e.g. Wilson, 2001Wilson, , 2011McMichael et al., 2004;Moser et al., 2004;Dorius, 2008Dorius, , 2010Taylor, 2009). Theoretically, following homogeneous pre-transition phase of health transition, progressive transition generates multidimensional geographic and socioeconomic heterogeneity, until the reappearance of a homogeneous post-transition phase. ...
... Given the importance of this question, recently few research studies have attempted to address the issue, but all of them focused typically on worldwide mortality [LEB and infant mortality rate (IMR)] trends or developed world context (e.g. Bloom and Canning, 2007;Montero-Granados et al., 2007;Taylor, 2009;Dorius, 2010;Clark, 2011;Gächter and Theurl, 2011;Wilson, 2011). In the developing countries, despite considerable progress in health, there is hardly any evidence-based testing of convergence models for various health indicators, especially at the sub-national or local level. ...
Convergence in health and health inequalities reflects not only a sense of equity, but also provides a critical assessment tool for monitoring the health progress of differently placed individuals. This study examines convergence hypothesis for health and health inequalities across major Indian states, using both standard and cutting-edge convergence metrics. The findings lend support to the convergence in average health status among the states and the socioeconomic group of India, examined through select health indicators. However, results also suggest a setback in convergence in decline of health inequalities in recent times, particularly in life expectancy at birth, child immunization and underweight. Evidence signals that from the late 1990s, convergence in decline of health inequalities are replaced by emerging divergence. This paper contributes to health policy and planning by identifying areas where, India needs to work to achieve efficiency with equity in health status across geographical divisions and social groups.
... Public health in the 21st century is faced with major global challenges and transformations, including persisting and increasing social inequalities and injustice [1][2][3], the climate and planetary health crises [4,5], war and conflict [6], as well as the burden of both communicable and non-communicable diseases (NCDs) [7]. ...
In light of the current public health challenges, calls for more inter- and transdisciplinarity in the public health workforce are increasing, particularly to respond to complex and intersecting health challenges, such as those presented by the climate crisis, emerging infectious diseases, or military conflict. Although widely used, it is unclear how the concepts of multi-, inter-, and transdisciplinarity are applied with respect to the public health workforce. We conducted a scoping review and qualitative content analysis to provide an overview of how the concepts of multi-, inter-, and transdisciplinarity are defined and applied in the academic literature about the public health workforce. Of the 1957 records identified, 324 articles were included in the review. Of those, 193, 176, and 53 mentioned the concepts of multi-, inter-, and transdisciplinarity, respectively. Overall, 44 articles provided a definition. Whilst definitions of multidisciplinarity were scarce, definitions of inter- and transdisciplinarity were more common and richer, highlighting the aim of the collaboration and the blurring and dissolution of disciplinary boundaries. A better understanding of the application of multi-, inter-, and transdisciplinarity is an important step to implementing these concepts in practice, including in institutional structures, academic curricula, and approaches in tackling public health challenges.
... Nonetheless the operational hypothesis that underpins the study is that convergence in gender indicators is mainly due to the international policy learning and adoption of the gender empowerment agenda, while the impediments to and the slack in the convergence are the result of institutional and cultural rigidities at the national level in individual countries. ii While a number of the studies of inequality convergence were conducted, specifically for the income or wealth inequality (Taylor, 2009;Apergis et al, 2018), this present study is the first of its kind for the analysis of global gender indicators' convergence using econometric and statistical techniques. The two studies on gender convergence across the countries have been principally descriptive (Barnat et al, 2019;EIGE, 2019). ...
The paper examined convergence process and outcomes in gender indicators (gender inequality and development indexes) for two global panels of 106 and 75 economies over the 1990-2013 period. The five convergence dimensions were considered: beta, sigma, gamma, stochastic, and club convergence. The statistical methods included cross-sectional regression, kernel density plots, panel unit root tests, the rank correlation, and Phillips-Sul club convergence algorithm. While there reduction in gender inequality and improvement in gender development across the panel, the convergence in most dimensions was observed only for the gender development. Formation of the clubs and the absence of convergence to a single level was common for gender inequality. Overall, the findings indicate that improvement in gender development indicators did not translate into higher gender equality, thereby suggesting corrective policy action at national and international levels. JEL Classification: C14, C23, J16
... At the same time, this group often is deprived of quality goods, creating a negative impact on human health and welfare and ultimately limiting productive opportunities. Thus, economic growth, while necessary, is not a sufficient condition in itself for achieving equitable health (Taylor, 2009). To have a decentralised, sustainable, and equitable production system, which are the promised advantages of a successful model based on renewable feedstocks and cleaner energetic matrices, it is necessary to avoid lock-ins influenced by the classical linear system, implementing smart policies to pull a truthful paradigm change. ...
Lignin, a major component of lignocellulosic biomass, is the most abundant aromatic polymer on the planet. Thus, it represents a renewable and non-fossil source of aromatics, promising to positively impact the transition to a circular bioeconomy. Despite being a chemical treasure box, lignin is still widely underutilized. In the last years, there is an emerging paradigm change towards implementing new biorefineries based on chemo- and/or biocatalytic upgrading of lignin aromatics into valuable products. Especially, in the biocatalytic conversion, the native aromatic catabolic ability of many Pseudomomas promises to ease the inherent aromatic heterogeneity of lignin depolymerized mixtures. Simultaneously, some Pseudomomas strains can synthesize valuable molecules for the polymer industry like medium chain length polyhydroxyalkanoate (mcl-PHA) and cis,cis-muconic acid. While enormous progress is underway in metabolic engineering towards improving conversion of aromatics into mcl-PHA, there is a significant gap in detailed bioprocess understanding, especially from mixtures of lignin-derived aromatics. Analogously, despite important advances on strain engineering and bioprocess development, limitations related to product accumulation at toxic levels still prevents reaching industrially-relevant productivities of cis,cis-muconic acid from lignin substrates. Thus, through understanding the key factors for successful bioconversion and applying this knowledge to implement innovative bioprocess strategies, this thesis intended to increase production of mcl-PHA and cis,cis-muconic acid from lignin aromatics. After performing step-wise screenings and parallel cultivations of several known strains of the Pseudomonas family, this work clearly confirmed Pseudomonas putida KT24440 as the most robust, versatile, and well performing biocatalyst for mcl-PHA accumulation from a defined lignin aromatic mixture. In a next step, the detailed resolution of aromatics funneling and microbial metabolic activity was revealed during online measurements of the oxygen consumption. From this experience, oxygen and nitrogen availability were identified as the key factors for a successful biocatalytic upgrading. Overall, the accumulation of mcl-PHA was improved in the wild type strain under technically relevant conditions by up to 43% (polymer content in cell biomass, mg mcl-PHA mg-1 CDW). At this stage, the highest mcl-PHA concentration (582 mg L-1) was obtained for a C/N ratio of 60 for oxygen-unlimited conditions (oxygen transfer rate ≥ 20 mmol L-1 h-1). In contrast, aromatic intermediates accumulated under oxygen-limited conditions at oxygen transfer rates below 10 mmol L-1 h-1. Through this bioprocess characterization, the performance of the biocatalytic funneling in P. putida KT2440 became predictable and thus, the experimental conditions were scalable into a 1-L stirred tank bioreactor based on the oxygen transfer rate. Finally, the benefits of implementing simultaneous biocatalyst and bioprocess optimization strategies were demonstrated. A 1.9- fold increment in mcl-PHA concentration and a 1.5-fold increment in mcl-PHA content were obtained from lignin aromatics. To alleviate the negative effect of product accumulation at toxic levels, this thesis also implemented an innovative solution establishing an in-line extraction of cis,cis-muconate produced by a metabolically engineered strain of P. putida KT2240. The implementation followed a systematic approach of process development. First, an electrolytic extraction of cis,cis-muconate was characterized in terms of flux and Coulombic efficiency from a synthetic media. In parallel, cis,cis-muconic acid bioproduction rates were defined in a conventional process and the negative effect of cis,cis muconic acid on the culture was confirmed at a threshold concentration of 195 mM (27.7 g L-1). In the middle time, long term electrolytic extractions were performed at a higher scale using fermentation broths as approximation of the final process. This experience served to identify and solve relevant technical drawbacks related to muconic acid precipitation in the anodic chamber. The solution consisted of pH control at 3.5, which was a suitable pH where higher amounts of the muconate isomeric forms cis,cis- and cis,trans- were found in solution (i.e., not as precipitated form). This was essential to enable higher muconate accumulation in the anolyte. From all the process parameters (i.e., bioproduction rates and extractive electrolytic performance) obtained separately, a final integration was carried out. Through implementing the in-line extraction from a bioreactor, the volumetric productivity of cis,cis-muconate was increased 15.6 % in respect to a conventional bioprocess run in parallel. Overall, this study contributed to deepening our understanding of the biocatalytic capability of the promising bacterium P. putida KT2440 towards efficient conversions of lignin aromatics for future biorefinery applications. Additionally, the potential of selective removal of cis,cismuconic acid was demonstrated for the first time in a microbial cultivation, contributing as an important step towards implementing a cost-effective bioproduction system.
... Although there is growing interest in assessing the convergence in health status across populations, much research has focused on inter-country differences and has rarely been in the context of developing countries, where growth trajectories remain hidden (Neumayer, 2003;McMichael et al., 2004;Moser et al., 2005;Taylor, 2009;Dorius & Firebaugh, 2010;Wilson, 2011;Goli et al., 2019). The dissimilar rates of progress in health status across different countries make it difficult to achieve SDG-3 and -10. ...
The key challenges of global health policy are not limited to improving average health status, with a need for greater focus on reducing regional inequalities in health outcomes. This study aimed to assess health inequalities across the major Indian states used data from the Sample Registration System (SRS, 1981–2015), National Family Health Survey (NFHS, 1992–2015) and other Indian government official statistics. Catching-up plots, absolute and conditional β -convergence models, sigma ( σ ) plots and Kernel Density plots were used to test the Convergence Hypothesis, Dispersion Measure of Mortality (DMM) and the Gini index to measure progress in absolute and relative health inequalities across the major Indian states. The findings from the absolute β -convergence measure showed convergence in life expectancy at birth among the states. The results from the β - and σ -convergences showed convergence replacing divergence post-2000 for child and maternal mortality indicators. Furthermore, the estimates suggested a continued divergence for child underweight, but slow improvements in child full immunization. The trends in inter-state inequality suggest a decline in absolute inequality, but a significant increase or stationary trend in relative health inequality during 1981–2015. The application of different convergence metrics worked as robustness checks in the assessment of the convergence process in the selected health indicators for India over the study period.
... OPE for healthcare services generates utilisation inequalities and impoverishes women, and lower-income and socially marginalised groups (Taylor 2009). Further, the OPE effect is also associated with a poor health status (Eaddy et al. 2012;Tamblyn et al. 2001;Heisler et al. 2010;Soumerai et al. 1991). ...
This article examines the effects of socioeconomic position and urban–rural settlement on the distribution of out-of-pocket expenditure (OPE) for health in the Russian Federation. Data comes from 2005 to 2016 waves of the Russian Longitudinal Monitoring Survey. Concentration index reflects changes in the distribution of OPE between the worse-off and the better-off Russians over a 12-year period. Finally, unconditional quantile regression—a recentred influence function approach estimates differential impacts of covariates along the distribution of OPE. OPE is concentrated amongst the better-off Russians in 2016. Urban settlements contribute to top end OPE distribution for the richest and town settlements, at the median for the richest and the poorest. Our model for the analysis is unique in the context of study population, as it marginalises the effect over the distributions of other covariates used in the model.
... Given the importance of this question, recently few research studies have attempted to address the issue, but all of them focused typically on worldwide mortality (LEB and IMR) trends or in the developed world context (e.g. Bloom and Canning, 2007;Montero-Granados et al., 2007;Taylor, 2009;Dorius, 2010;Clark, 2011;Gächter and Theurl, 2011;Wilson, 2011). ...
This thesis comes out at a time when the debate on between-state and social group demographic and health inequalities continues to be largely debated based on most recent available information. However, analyses based on the recent demographic and health data have serious limitations in terms of understanding the true trajectories of between-state and social group inequalities. With the changing demographic scenario and most demographic indicators progressing towards the final stages of transition, the major concern in India has been heterogeneity across region and socioeconomic groups. While the demographic heterogeneity in India is well known, how far the differences are converging or diverging has been a matter of great interest. This study attempted to develop a comprehensive framework to study the demographic transition, convergence and its linkage with health inequalities in India. It innovate a mechanism of bridging the gap between demographic convergence and health inequalities by taking the theories and methods found in other social science disciplines. It revisits the old theories such as classic socioeconomic, demographic and health transition theories more clearly identifying the historical linkages between socioeconomic, demographic, health transition and health inequalities. It advances the empirical examination of demographic convergence assessment by assessing convergence not only in the averages, but also in the absolute and relative inequalities in population and health indicators. The core chapters of the thesis deal with the issue of convergence. Chapter 4, 5, 6 and 7 analyse the convergence using various indicators. While chapter four considers convergence in socioeconomic indicators, chapter 5 and 6 looks at the mortality and fertility convergence. Chapter 8 links fertility decline with child health inequalities and chapter 9 identifies the avoidable demographic difference. Chapter 10 presents summary and conclusion. The analyses foster that while economic variables are diverging, fertility variables are converging in recent years. Perhaps, it re-affirms the fact that fertility transition is not critically related to economic factors in India. The mortality convergence has some setbacks in recent years. The child health care utilization has shown converging although at a lesser magnitude. Moreover, fertility decline is associated with increasing in child health inequalities in a context where there are pre-existing socioeconomic inequalities. Inequality is often a consequence of progress. Not everyone gets rich at the same time, and not everyone gets immediate access to the latest life-saving measures. Further, growth, inequality, and catch up are the both sides of the same coin. The dark side is what happens when the process is hijacked, so that catch-up never comes. Powerful and wealthy elites have choked off demographic and health progress before, and they can do so again if they are allowed to undermine the institutions on which broad-based demographic and health progress depends. Now, it is confirmed from this study that a mere reduction in the number of children or fertility convergence in averages are not helping in distributing the fruits of demographic progress equally among the children of different states and socioeconomic groups. How far children and their development (particularly in terms of health) are faring during the progress of demographic transition is an important concern for population policy in India. In principle, inequalities are avoidable as disparities in health stem out from identifiable policy options exercised by governments. Thus, they are amenable to policy interventions. In general, this study promotes the importance of using effective health monitoring tools such as convergence models in countries such as India, which has huge socioeconomic and geographical disparities in the progress of demographic and health inequalities. The policy analyst can use convergence measures as tools for health policy evaluations in India and states. In an effort to continuously track regional progress in population and health indicators, it is important to test the convergence hypothesis for every five years.
... Rapid economic and social changes pose a significant challenge for adolescent health in a context of globalization [1][2][3]. An uneven economic growth and subsequent changes in social contexts and lifestyle may have negative impacts on adolescent health risk behaviors, such as alcohol consumption, tobacco use, unhealthy diet, and lack of physical activities [4]. ...
Purpose:
This study aimed at assessing the differences in prevalence rates of common health behavior among adolescents in the five Chinese cities and the influential factors at the contextual and individual levels.
Method:
We compared the standardized rates of three lifestyle behaviors (sedentary, dietary, and physical activity) and three addictive behaviors (cigarette smoking, alcohol consumption, and participation in gambling) among a sample of 13,950 adolescents. The sample was randomly selected from five cities, including Hong Kong, Macau, Taipei, Zhuhai, and Wuhan. Population size, GDP per capita, and literacy at the city level as well as parental monitoring and school performance at the student's level were assessed. Multi-level mixed effect models were used to examine the interaction of individual level factors with study sites.
Results:
The six health behaviors differed significantly across sites with the highest rates of alcohol consumption in Hong Kong (39.5 %), of cigarette smoking in Macau (9.8 %), and of gambling in Taipei (37.1 %) and Hong Kong (35.9 %). The city-level measures were associated with only a few behavioral measures. Relative to Hong Kong, parental monitoring had stronger association with the three addictive behaviors in the other sites.
Conclusion:
Findings suggest that although the study sites share similar Chinese culture, students in the five cities differed from each other with regard to levels of health behaviors. Relative to the broad socioeconomic development, differences in parental monitoring played a significant role in explaining the observed difference.
... A sizeable portion of this variability was attributable to aspects of national wealth. National wealth may reflect the following factors: economic resources available to individual households; public sector spending or investments in medical technology and health care; improved access to nutrition, goods, and transportation; and investments in education and social protection [36]. Future research is warranted to unravel the particular importance of these factors in explaining the differences found in the present study. ...
Sizeable variations in quality of life (QoL) and wellbeing according to socioeconomic status and national wealth have been observed. The assessment of children’s wellbeing may vary, depending on whether a parental or a child perspective is taken. Still, both perspectives provide important and valid information on children’s wellbeing. The Flash Eurobarometer no. 246 which was conducted for the European Commission assesses parents’ reports on their children’s health and wellbeing in 27 EU member states. Overall, 12,783 parents of 6–17-year-old children in the 27 EU states participated in telephone interviews. Parents reported children’s QoL and wellbeing using the KIDSCREEN-10 measure, as well as their occupational status and education level. Within a multilevel analysis, the KIDSCREEN-10 was regressed on parental occupation and education level. Random intercepts and slopes were regressed on gross domestic product per capita and income inequality. Low QoL was reported in 11.6% of cases, whereby cross-national variation accounted for 13% of the total variance in QoL. Children from countries with higher national wealth and lower income inequality were at lower risk for low QoL and wellbeing. Higher age of the child, a medium or low parental occupational status, and low parental educational status were associated with a higher risk for low QoL and wellbeing.
... Wealth and health disparities exist worldwide and the gap is widening even in the most developed countries. [1][2][3][4] These disparities are being addressed as a major public-health con-cern. [5,6] Policy makers are tackling the problem from an upstream reform perspective (e.g. ...
Growing social inequities have made it important for general practitioners to verify if patients can afford treatment and procedures. Incorporating social conditions into clinical decision-making allows general practitioners to address mismatches between patients' health-care needs and financial resources.
Identify a screening question to, indirectly, rule out patients' social risk of forgoing health care for economic reasons, and estimate prevalence of forgoing health care and the influence of physicians' attitudes toward deprivation.
Multicenter cross-sectional survey.
Forty-seven general practitioners working in the French-speaking part of Switzerland enrolled a random sample of patients attending their private practices.
Patients who had forgone health care were defined as those reporting a household member (including themselves) having forgone treatment for economic reasons during the previous 12 months, through a self-administered questionnaire. Patients were also asked about education and income levels, self-perceived social position, and deprivation levels.
Overall, 2,026 patients were included in the analysis; 10.7% (CI95% 9.4-12.1) reported a member of their household to have forgone health care during the 12 previous months. The question "Did you have difficulties paying your household bills during the last 12 months" performed better in identifying patients at risk of forgoing health care than a combination of four objective measures of socio-economic status (gender, age, education level, and income) (R2 = 0.184 vs. 0.083). This question effectively ruled out that patients had forgone health care, with a negative predictive value of 96%. Furthermore, for physicians who felt powerless in the face of deprivation, we observed an increase in the odds of patients forgoing health care of 1.5 times.
General practitioners should systematically evaluate the socio-economic status of their patients. Asking patients whether they experience any difficulties in paying their bills is an effective means of identifying patients who might forgo health care.
... However these reports also indicated that China's health outcome has exhibited several undesirable features: such as growing inequalities in access to health care and different health status across regions of different socioeconomic standings and between urban and rural areas. Hospital commercialization and deficiencies in the supply of medical care have driven up the cost of medical care delivery, thus further increased the barrier to access of medical care [6][7][8]. ...
We presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings.
A cohort of 6,592 adults, 15 years of age and older were sampled to estimate the number of urban-resident adults per 1,000 who visited a medical facility at least once in a month, by the method of three-stage stratified and cluster random sampling. Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics.
On average per 1,000 adults, 295 had at least one symptom, 217 considered seeking medical care, 173 consulted a physician, 129 visited western medical practitioners, 127 visited a hospital-based outpatient clinic, 78 visited traditional Chinese medical practitioners, 43 visited a primary care physician, 35 received care in an emergency department, 15 were hospitalized. Health care seeking behaviors varied with socio-demographic characteristics, such as gender, age, ethnicity, resident census register, marital status, education, income, and health insurance status. In term of primary care, the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing.
This study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China.
... However these reports also indicated that China's health outcome has exhibited several undesirable features: such as growing inequalities in access to health care and different health status across regions of different socioeconomic standings and between urban and rural areas. Hospital commercialization and deficiencies in the supply of medical care have driven up the cost of medical care delivery, thus further increased the barrier to access of medical care678. Facing a series of deeply rooted problems, Chinese government undertook phased measures in 2009 to achieve universal health care coverage by 2020 [9]. ...
Background: We presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings.
... Health disparities exist in all societies and recent data suggest that they might be widening [1][2][3][4]. Yet, many have argued that the existence of disparities in health status is unfair, should reasonable actions exist for their avoidance or mitigation [1,[4][5][6][7][8][9][10]. The concept of 'fairness' in health is related to (i) equality (the state of being equal) in health status; (ii) equality in health services; and (iii) equity (the quality of being fair and impartial) in health services [7]. Equality in health status may be impossible to achieve, given the vast array of behavioral, cultural, environmental, and genetic factors involved in generating each individuals' health outcome. ...
Access to health care is a major requirement in improving health and fostering socioeconomic development. In the People's Republic of China (P.R. China), considerable changes have occurred in the social, economic, and health systems with a shift from a centrally planned to a socialist market economy. This brought about great benefits and new challenges, particularly for vertical disease control programs, including schistosomiasis. We explored systemic barriers in access to equitable and effective control of schistosomiasis.
Between August 2002 and February 2003, 66 interviews with staff from anti-schistosomiasis control stations and six focus group discussions with health personnel were conducted in the Dongting Lake area, Hunan Province. Additionally, 79 patients with advanced schistosomiasis japonica were interviewed. The health access livelihood framework was utilized to examine availability, accessibility, affordability, adequacy, and acceptability of schistosomiasis-related health care.
We found sufficient availability of infrastructure and human resources at most control stations. Many patients with advanced schistosomiasis resided in non-endemic or moderately endemic areas, however, with poor accessibility to disease-specific knowledge and specialized health services. Moreover, none of the patients interviewed had any form of health insurance, resulting in high out-of-pocket expenditure or unaffordable care. Reports on the adequacy and acceptability of care were mixed.
There is a need to strengthen health awareness and schistosomiasis surveillance in post-transmission control settings, as well as to reduce diagnostic and treatment costs. Further studies are needed to gain a multi-layered, in-depth understanding of remaining barriers, so that the ultimate goal of schistosomiasis elimination in P.R. China can be reached.
... Population-based preventive strategies are remarkably costeffective because increasing population health is also a way to ensure continuing capacity to produce wealth. 113 This message should be highlighted in prevention advocacy at both a national and international level, particularly in emerging countries. Indeed, chronic conditions merit high priority in any sensible "Global New Public Health" agenda (defi ned as the collective action we take worldwide for improving health and health equity). 1 Numerous health organizations, universities, research groups, NGOs, donor groups, and development agencies, operating at national and international levels, play an important role in reducing chronic disease. ...
Chronic diseases are the major causes of morbidity and mortality across the globe in developed and developing countries, and in countries transitioning from former socialist status. Chronic diseases – including heart disease, cancer, stroke, diabetes, and respiratory diseases – share major risk factors beyond genetics and social inequalities including tobacco use, unhealthy diet, physical inactivity, and lack of access to preventive care. There are evidence-based interventions that are effective in modifying these risks and subsequently preventing disease. Evidence for prevention is strongest for measures aimed at reducing tobacco use and increasing physical activity, while large gaps remain in our knowledge about how to effectively change eating habits and achieve healthy weights in a population. The New Public Health addresses interventions delivered at three levels: 1) at the level of society, where public policy and governmental interventions can change the environment, as well as individual behavior (e.g., regulation of tobacco products and food composition, taxation, redesigning the built environment, banning advertising); 2) at the level of the community, through the activities of local institutions delivered at the population level (e.g., school-based and workplace health promotion, community education, training, and public awareness campaigns); and 3) at the level of the individual, through the provision of clinical preventive services including screening, counselling, chemoprophylaxis, and immunizations (in recognition of the growing evidence that infections cause important chronic diseases). We conclude with a discussion of comprehensive national and international efforts needed to stem the tide of the growing global burden of chronic disease.
This review of reviews examines the role of socioeconomic status (SES) indicators on health inequities among different racial and ethnic groups in the United States (US) between 2019 and 2023. Of the 419 articles, 27 reviews met the inclusion criteria and were aggregated into seven categories: COVID-19 and respiratory pandemic disparities; neighborhoods, gentrification, and food environment; surgical treatments; mental, psychological, and behavioral health; insurance, access to care, and policy impact; cancers; and other topics. The findings revealed a documented impact of SES indicators on racial/ethnic health inequities, with racial/ethnic minority communities, especially Black Americans, consistently showing poor health outcomes associated with lower SES, regardless of the outcome or indicator examined. These findings call attention to the importance of policies and practices that address socioeconomic factors and systemic racial/ethnic inequities affecting the social determinants of health affecting racial/ethnic inequities to improve health outcomes in the US population.
The paper examined convergence process and outcomes in gender indicators (gender inequality and development indexes) for two global panels of 106 and 75 economies over the 1990–2013 period. The five convergence dimensions were considered: beta, sigma, gamma, stochastic, and club convergence. The statistical methods included cross-sectional regression, kernel density plots, Markov transition probability matrices, panel unit root tests, the rank correlation, Phillips–Sul club convergence algorithm, as well as conditioning regression and panel quantile model. While there was reduction in gender inequality and improvement in gender development across the panel, the convergence in most dimensions was observed only for the gender development. Formation of the clubs and the absence of convergence to a single level were common for gender inequality. The change in the gender inequality and development ranks and mobility across classes of economies was small for both indicators, with the lowest upward (downward) change in gender development (inequality) observed in the least developed economies. The key role of economic variables (female labour force participation and labour productivity) in club formation and countries’ polarisation in gender development and inequality was indicated. Overall, the findings indicate that improvement in gender development indicators did not translate into higher gender equality, thereby suggesting corrective policy action at national and international levels.
This chapter examined the long-term trajectories across the states and tested the convergence hypothesis of whether the inequality in adult mortality (45q15 and e15) is declining (convergence) or increasing (divergence) using the various convergence matrix between 1981–85 and 2011–15 in India. The results of σ-convergence and β-convergence showed an overall converging pattern in adult mortality for Indian states during 1981–85 to 2011–15. The rapid convergence speed was observed for females in both indicators. Interestingly, the convergence speed increased after considering the existing regional inequality in socioeconomic healthcare characteristics. However, convergence’s overall speed is slower to achieve the SDGs and grand convergence in adult health across India. For laggard states to catch up with advanced states in terms of adult mortality, public health investments in health care and the adoption and innovation of new health technologies are needed.KeywordsAdult mortalityAdult health inequalityConvergenceDivergenceRegional health inequalityIndia
Introducción Lucro es un concepto controvertido. La definición dada por la Real Academia de la Lengua Española señala que lucro es la "Ganancia o provecho que se saca de algo"(1); sin embargo, erróneamente o no, es habitual que el término lucro sea entendido como un sinónimo de usura, es decir una ganancia "excesiva" que se saca de algo. La distinción entre una acepción y la otra estaría dada por la idea de que una ganancia excesiva tiene una connotación negativa desde un punto de vista moral-sería excesiva aquella ganancia que está por sobre lo que sería justo recibir. Desde este punto de vista, la discusión ética se reduciría a definir cuándo una ganancia es excesiva, de modo tal de establecer un punto de corte que separe aquella ganancia moralmente legítima de aquella que no lo es. Sin embargo, establecer un punto de corte que separe lo que es excesivo de lo que no lo es, no es una tarea fácil, y habitualmente se plantean criterios que en sí mismos son
An important approach for global health and epidemiology research is to collect and use data from multiple study-sites within one or between various cultures to address high impact medical and health issues. When multisite data are used, it is challenge to deal with data heterogeneity, since such heterogeneity cannot be efficiently addressed using conventional multivariate regression methods. In this chapter, we describe application of mixed effects modeling, a statistical method designated for analyzing longitudinal trials, in analyzing cross-sectional multisite data. We demonstrate the application using data collected among middle and high school students in five Chinese cities (n = 13,950), including Hong Kong, Macau, Taipei, Wuhan, and Zhuhai. Data for lifestyle (sedentary, dietary, physical activity) and addictive behaviors (cigarette smoking, alcohol consumption and participation in gamble) were analyzed as outcomes. Factors at the individual and contextual level, as well as interventions between the two were associated with the outcome variables. Findings of this study indicate that although sharing a similar mainstream Chinese culture, these adolescent participants were significantly different from each other with regard to engagement in health-related behavior and the differences were associated with both individual- and contextual-level factors.
With overall global improvements in life expectancy, one important concern is whether there is cross-country convergence in life expectancy at various ages. Insights in convergence patterns can help realign research priorities help governments better structure health investments across various age groups. In the case of life expectancy at younger ages, most countries are moving in the same direction, but we observe significant cross-country variation for older adults and the elderly. Further, we observe increasing variance in life expectancy for older adults and elderly across countries. Increasing global heterogeneity in survival experience of older adults and the elderly population has remained a neglected aspect in the discussions on global life expectancy improvements. Data, research and policy focus beyond life-expectancy at birth is therefore critical to accelerate survival gains among older adults and elderly, particularly from the developing world.
Background & Objectives:: To assess inequity of childhood health care package provision according to the distance of health houses from the town and the provincial capital in Markazi province (Iran). Methods: We used 4 measures of childhood health care provision by family medicine program in randomly selected health houses in Markazi province. The measures included were monitoring of the childhood health by the GP (General Practitioner), childhood disease management according to the Iranian MOHME guidelines, good knowledge of the GP about the content of the guidelines and good knowledge of the GP about the 1-59 month death registration system. These measures were estimated by a predefined, interviewer administered questionnaire. The distance of each selected health house was determined in each district health center. To assess the inequity of the measures we estimated concentration index and its 95% confidence interval using covariance method. P Values of greater than 0.05 were considered as statistically insignificant. Results: About 46 health house were randomly selected. All of the estimated concentration indices about the childhood care measures were less than 0.1 and their differences with zero score were insignificant
( p value> 0.05 ).
Conclusion: according to the data of our study it seems there is no inequity between different health houses in accordance of their distance from district center and provincial capital. It seems necessary to measure other health indices to assess the inequity of the whole of the health care providing system.
China's expenditure on healthcare has increased dramatically over the last 20 years, and three broad trends are seen in the associated health outcomes. First, limited improvements have been achieved to aggregate high-level health outcomes, e.g. infant mortality. Second, development of large and widening health inequalities associated with disparate wealth between provinces and a rural-urban divide. Finally, the burden of disease is shifting from predominantly communicable diseases to chronic diseases. Reasons for the limited gains from investment in healthcare are identified as: (1) increased out-of-pocket expenditure including a high proportion of catastrophic expenditure; (2) a geographical imbalance in healthcare spending, focusing on secondary and tertiary hospital care and greater expenditure on urban centres compared with rural centres; and (3) the commercialization of healthcare without adequate attention to cost control, which has led to escalation of prices and decreased efficiency. Recently, the Chinese Government has initiated widespread reform. Three key policy responses are to establish rural health insurance, partly funded by the Government (the New Rural Co-operative Medical Care System); to develop community health centres; and to aspire to universal basic healthcare coverage by 2020 (Healthy China 2020).
OBJECTIVE: To assess the impact of structural adjustment on health indicators in Latin America and the Caribbean during 1980-2000. METHODS: This was an ecological study. Public spending and per capita gross domestic product (pcGDP) figures were obtained from the World Bank, and life expectancy (LE) and infant mortality (IM) figures were obtained from the World Health Organization. Structural adjustment (government downsizing) was assessed by looking at the change in the amount of spending taken up by the government (or the reduction in public spending) in Latin American and Caribbean countries during 1980-1990. Changes in health indicators were measured in terms of the percentage variation in LE and IM. The variations found in Latin America and the Caribbean were compared to those seen in different groups of countries in other parts of the world during 1980-2000. Pearsons chi squared test was used to explore the associations between the decrease in public spending and health indicators. In order to estimate the health effects of such changes, a multivariate linear regression model was created, with adjustments for pcGDP. RESULTS: A deceleration in the rise of LE and in the decline of IM in Latin America and the Caribbean was noted, especially over the period from 1980 through 1990. Significant associations were observed between health indicators and the change in public spending in all groups of countries included in the study. When adjustments were introduced into the multiple regression model, the only associations that remained were seen in Latin America and the Caribbean. CONCLUSIONS: In the decade of 1980, adjustments in macroeconomic policies had a negative effect on social indicators, specifically those that had to do with health conditions in Latin America and the Caribbean. Such an effect lasted throughout the following decade.
It might be assumed that welfare states that have done so much to reduce inequality of opportunity have also reduced inequality of health outcomes. While great advances have been seen in reducing the rates of many diseases in welfare states, disparities in health have not been eliminated. Is it the case that lowering risks overall will leave disparities that cannot be remediated, and that such efforts are at the point of diminishing returns? The evidence suggests that this is not true. Instead the lens of social epidemiology can be used to identify groups that are at unequal risk and to suggest strategies for reducing health inequalities through upstream, midstream, and downstream interventions. The evidence suggests that these interventions be targeted at low socioeconomic position, place-based limitations in opportunities and resources, stages of the life course and the accumulation of disadvantage across the life course, and the underlying health-related factors that are associated with the marginalization and exclusion of certain groups. In their commitment to the values of equity and social justice, welfare states have unique opportunities to demonstrate the extent to which health inequalities can be eliminated.
This paper assesses the impacts of globalisation on the cross-country comparative patterns of growth and development. In the theoretical section, some of the key linkages between growth, development and globalisation are explored including the positive and negative impacts of globalisation and the constraints on effective development in a globalised world. Some of the key factors emphasised include trade and capital flows as well as computerisation. These issues are then analysed empirically using σ and club convergence models, estimated using panel techniques. The empirical evidence presented indicates that globalisation has been associated with increasing trade and financial flows to less developed countries. It has also coincided with increasing penetration of the Internet suggesting that increases in informational flows have complemented economic and financial linkages, but the empirical evidence also shows that the current era of globalisation has not been associated with convergence in economic outcomes; instead less-developed countries have suffered from increases in international income inequality. In the final section, conclusions and policy implications are presented including a discussion of how international and national development policies could be designed properly to ameliorate tendencies towards growing international disparities in economic growth.
It has been argued by several commentators (e.g. Wilkinson, Evans) that psycho-social stress associated with an individual’s relative position in the social and economic hierarchy is a predominant determinant of their health status, with an individual’s absolute level of income of lesser importance. In this paper, we argue that the concentration on psycho-social stress as the primary pathway for health determination neglects a number of important economic pathways for the impact of relative income on health. These economic pathways include firstly the impact on health of positional goods, whose absolute level of consumption is a function of the relative position of an individual in the distribution of income and wealth. One key positional good is that of land, whose consumption level has important health-determining correlates, such as overcrowding, sanitation needs, commuting stress, pollution levels, and mortgage pressures. The second economic pathway involves changes in relative prices associated with rising absolute incomes, which interact with different price and income elasticities for different commodities that possess different health-inducing characteristics, to produce a pattern of health inequalities within and across countries, as a function of relative and absolute income levels, that is similar to that observed. The third economic pathway examined is that of the hysteresis effect of past economic stresses on the current state of individual human capital and relative competitiveness and their associated health levels. Each of these economic pathways is examined, and their importance analysed, in the context of both the Aboriginal population of Australia and inner city areas in the UK, and their associated major health inequalities.
We evaluated the effects of the Family Health Program (FHP), a strategy for reorganization of primary health care at a nationwide level in Brazil, on infant mortality at a municipality level.
We collected data on FHP coverage and infant mortality rates for 771 of 5561 Brazilian municipalities from 1996 to 2004. We performed a multivariable regression analysis for panel data with a negative binomial response by using fixed-effects models that controlled for demographic, social, and economic variables.
We observed a statistically significant negative association between FHP coverage and infant mortality rate. After we controlled for potential confounders, the reduction in the infant mortality rate was 13.0%, 16.0%, and 22.0%, respectively for the 3 levels of FHP coverage. The effect of the FHP was greater in municipalities with a higher infant mortality rate and lower human development index at the beginning of the study period.
The FHP had an important effect on reducing the infant mortality rate in Brazilian municipalities from 1996 to 2004. The FHP may also contribute toward reducing health inequalities.
The availability of good medical care tends to vary inversely with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced. The market distribution of medical care is a primitive and historically outdated social form, and any return to it would further exaggerate the maldistribution of medical resources.
To determine whether employment status after job loss due to privatisation influences health and use of health services and whether financial strain, psychosocial measures, or health related behaviours can explain any findings.
Data collected before and 18 months after privatisation.
One department of the civil service that was sold to the private sector.
666 employees during baseline screening in the department to be privatised.
Health and health service outcomes associated with insecure re-employment, permanent exit from paid employment, and unemployment after privatisation compared with outcomes associated with secure re-employment.
Insecure re-employment and unemployment were associated with relative increases in minor psychiatric morbidity (mean difference 1.56 (95% confidence intervals interval 1.0 to 2.2) and 1.25 (0.6 to 2.0) respectively) and having four or more consultations with a general practitioner in the past year (odds ratio 2.04 (1.1 to 3.8) and 2.39 (1.2 to 4.7) respectively). Health outcomes for respondents permanently out of paid employment closely resembled those in secure re-employment, except for a substantial relative increase in longstanding illness (2.25; 1.1 to 4.4). Financial strain and change in psychosocial measures and health related behaviours accounted for little of the observed associations. Adjustment for change in minor psychiatric morbidity attenuated the association between insecure re-employment or unemployment and general practitioner consultations by 26% and 27%, respectively.
Insecure re-employment and unemployment after privatisation result in increases in minor psychiatric morbidity and consultations with a general practitioner, which are possibly due to the increased minor psychiatric morbidity.
In this glossary, the authors address eight key questions pertinent to health inequalities: (1) What is the distinction between health inequality and health inequity?; (2) Should we assess health inequalities themselves, or social group inequalities in health?; (3) Do health inequalities mainly reflect the effects of poverty, or are they generated by the socioeconomic gradient?; (4) Are health inequalities mediated by material deprivation or by psychosocial mechanisms?; (5) Is there an effect of relative income on health, separate from the effects of absolute income?; (6) Do health inequalities between places simply reflect health inequalities between social groups or, more significantly, do they suggest a contextual effect of place?; (7) What is the contribution of the lifecourse to health inequalities?; (8) What kinds of inequality should we study?
We sought to investigate to what extent worldwide improvements in mortality over the past 50 years have been accompanied by convergence in the mortality experience of the world's population.
We have adopted a novel approach to the objective measurement of global mortality convergence. The global mortality distribution at a point in time is quantified using a dispersion measure of mortality (DMM). Trends in the DMM indicate global mortality convergence and divergence. The analysis uses United Nations data for 1950-2000 for all 152 countries with populations of at least 1 million in 2000 (99.7% of the world's population in 2000).
The DMM for life expectancy at birth declined until the late 1980s but has since increased, signalling a shift from global convergence to divergence in life expectancy at birth. In contrast, the DMM for infant mortality indicates continued convergence since 1950.
The switch in the late 1980s from the global convergence of life expectancy at birth to divergence indicates that progress in reducing mortality differences between many populations is now more than offset by the scale of reversals in adult mortality in others. Global progress needs to be judged on whether mortality convergence can be re-established and indeed accelerated.
Globalization is a key context for the study of social determinants of health (SDH). Broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives.In this first article of a three-part series, we describe the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. We explain our rationale for defining globalization with reference to the emergence of a global marketplace, and the economic and political choices that have facilitated that emergence. We identify a number of conceptual milestones in studying the relation between globalization and SDH over the period 1987-2005, and then show that because globalization comprises multiple, interacting policy dynamics, reliance on evidence from multiple disciplines (transdisciplinarity) and research methodologies is required. So, too, is explicit recognition of the uncertainties associated with linking globalization - the quintessential "upstream" variable - with changes in SDH and in health outcomes.
The article compares the incidence of public healthcare across 11 Asian countries and provinces, testing the dominance of
healthcare concentration curves against an equal distribution and Lorenz curves and across countries. The analysis reveals
that the distribution of public healthcare is prorich in most developing countries. That distribution is avoidable, but a
propoor incidence is easier to realize at higher national incomes. The experiences of Malaysia, Sri Lanka, and Thailand suggest
that increasing the incidence of propoor healthcare requires limiting the use of user fees, or protecting the poor effectively
from them, and building a wide network of health facilities. Economic growth may not only relax the government budget constraint
on propoor policies but also increase propoor incidence indirectly by raising richer individuals' demand for private sector
alternatives.
Provides an overview of the changes in income distribution in developing and transition countries in recent decades, and assesses the incidence of taxes and government expenditure in these countries. For the overview of income distribution, the chapter relies largely on a set of newly available 'highquality' income-distribution data. For the assessment of tax and government expenditure incidence, it relies on existing incidence studies on individual countries. The chapter has five sections: Introduction; The Role of Taxes and Social Spending; Selective Literature Survey-a survey of the studies on the incidence of taxes and expenditure, paying particular attention to the incidence of government spending on education and health, and reviewing the available evidence for a large number of developing countries; Role of Taxes and Government Social Spending Policy-this section offers an overview of the changes in income distribution in developing countries from the 1970s to the 1990s, with separate discussion of the nature of tax reforms and social expenditure policy and their distributional implications in selected countries (Hungary, Indonesia, and Thailand); and Summary and Conclusions. © United Nations University/World Institute for Development Economics Research (UNU/WIDER) 2004. All rights reserved.
Reasons of high inequality in the modern world are considered in the article. In developing countries it interacts with underdeveloped markets and inefficient government programs to slow growth, which in turn slows progress in reducing poverty. Increasing reach of global markets makes rising inequality more likely and deepens the gap between rich and poor countries. Because global markets work better for the already rich, we should increase the representation of poor countries in global fora.
OBJECTIVE: We sought to investigate to what extent worldwide improvements in mortality over the past 50 years have been accompanied by convergence in the mortality experience of the world's population. METHODS: We have adopted a novel approach to the objective measurement of global mortality convergence. The global mortality distribution at a point in time is quantified using a dispersion measure of mortality (DMM). Trends in the DMM indicate global mortality convergence and divergence. The analysis uses United Nations data for 1950-2000 for all 152 countries with populations of at least 1 million in 2000 (99.7% of the world's population in 2000). FINDINGS: The DMM for life expectancy at birth declined until the late 1980s but has since increased, signalling a shift from global convergence to divergence in life expectancy at birth. In contrast, the DMM for infant mortality indicates continued convergence since 1950. CONCLUSION: The switch in the late 1980s from the global convergence of life expectancy at birth to divergence indicates that progress in reducing mortality differences between many populations is now more than offset by the scale of reversals in adult mortality in others. Global progress needs to be judged on whether mortality convergence can be re-established and indeed accelerated.
The 1980s began with many developing countries facing severe debt problems. Stabilization and structural adjustment policies were introduced by the IMF and the World Bank, as the conditions for obtaining loans. By 1985 some parts of the United Nations — notably the Economic Commission for Africa, the ILO and UNICEF — were drawing attention to the severe human costs which these policies involved, in terms of unemployment, child malnutrition and setbacks in education and health. The following piece was presented by Richard Jolly, then Deputy Executive Director of UNICEF on leave of absence from IDS, as the Barbara Ward memorial lecture at the 18th World Conference of the Society for International Development in Rome. It was an early presentation of the need for an alternative approach. Two years later, Giovanni Andrea Cornia, Frances Stewart and Richard Jolly, all at the time working for UNICEF, published their detailed analysis and country data in two volumes, also entitled Adjustment with A Human Face. Partly in response, the Bretton Woods Institutions made some changes to their policies, though far less than were necessary.
East Asian economies have experienced rapid growth over three decades, with relatively low levels of income inequality, and
appear to have also achieved reductions in income inequality. We argue that policies that reduced poverty and income inequality,
such as emphasizing high-quality basic education and augmenting labor demand, also stimulated growth. Closing two virtuous
circles, rapid growth and reduced inequality led to higher demand for, and supply of, education, Moreover, low levels of income
inequality may have directly stimulated growth. We present cross-economy regression results that are consistent with a positive
causal effect of low inequality on economic growth and with low inequality of income as an independent contributing factor
to Fast Asia's rapid growth. We conclude that policies for sharing growth can also stimulate growth. In particular, investment
in education is a key to sustained growth, both because it contributes directly through productivity effects and because it
reduces income inequality.
Based on original research and analysis by a group of health policy experts and economists from across the world, this book analyzes the causes and consequences of the expanding global and local commercialization of health care. It argues for the necessity and possibility of effective policy responses to develop good quality, universally inclusive health systems worldwide. The book aims to contribute to a shift in the international 'common sense' in health policy towards a more humane, inclusive, egalitarian, and ethical framework for policy formulation.
This book covers the lifelong importance to health of determinants such as poverty, drugs, working conditions, unemployment, social support, good food and transport policy. It provides a discussion of the social gradient in health, and an explanation of how psychological and social influences affect physical health and longevity. The focus is on the role that public policy can play in shaping the social environment and on structural issues such as unemployment, poverty and the experience of work. Each of the chapters contains a brief summary of what has been established by research, followed by some implications for public policy. [Country: Europe]
http://deepblue.lib.umich.edu/bitstream/2027.42/62466/1/health inequalities and the welfare state perspectives from social epidemiology_2007.pdf
Background:
During the early-1990s, adult mortality rates rose in most post-communist European countries. Substantial differences across countries and over time remain unexplained. Although previous studies have suggested that the pace of economic transition was a key driver of increased mortality rates, to our knowledge no study has empirically assessed the role of specific components of transition policies. We investigated whether mass privatisation can account for differences in adult mortality rates in such countries.
Methods:
We used multivariate longitudinal regression to analyse age-standardised mortality rates in working-age men (15-59 years) in post-communist countries of eastern Europe and the former Soviet Union from 1989 to 2002. We defined mass privatisation programmes as transferring at least 25% of large state-owned enterprises to the private sector within 2 years with the use of vouchers and give-aways to firm insiders. To isolate the effect of mass privatisation, we used models to control for price and trade liberalisation, income change, initial country conditions, structural predispositions to higher mortality, and other potential confounders.
Findings:
Mass privatisation programmes were associated with an increase in short-term adult male mortality rates of 12.8% (95% CI 7.9-17.7; p<0.0001), with similar results for the alternative privatisation indices from the European Bank for Reconstruction and Development (7.8% [95% CI 2.8-13.0]). One mediating factor could be male unemployment rates, which were increased substantially by mass privatisation (56.3% [28.3-84.3]; p<0.0001). Each 1% increase in the percentage of population who were members of at least one social organisation decreased the association of privatisation with mortality by 0.27%; when more than 45% of a population was a member of at least one social organisation, privatisation was no longer significantly associated with increased mortality rates (3.4% [95% CI -5.4 to 12.3]; p=0.44).
Interpretation:
Rapid mass privatisation as an economic transition strategy was a crucial determinant of differences in adult mortality trends in post-communist countries; the effect of privatisation was reduced if social capital was high. These findings might be relevant to other countries in which similar policies are being considered.
Many important social determinants of health are also the focus for social policies. Welfare states contribute to the resources available for their citizens through cash transfer programmes and subsidised services. Although all rich nations have welfare programmes, there are clear cross-national differences with respect to their design and generosity. These differences are evident in national variations in poverty rates, especially among children and elderly people. We investigated to what extent variations in family and pension policies are linked to infant mortality and old-age excess mortality.
Infant mortality rates and old-age excess mortality rates were analysed in relation to social policy characteristics and generosity. We did pooled cross-sectional time-series analyses of 18 OECD (Organisation for Economic Co-operation and Development) countries during the period 1970-2000 for family policies and 1950-2000 for pension policies.
Increased generosity in family policies that support dual-earner families is linked with lower infant mortality rates, whereas the generosity in family policies that support more traditional families with gainfully employed men and homemaking women is not. An increase by one percentage point in dual-earner support lowers infant mortality by 0.04 deaths per 1000 births. Generosity in basic security type of pensions is linked to lower old-age excess mortality, whereas the generosity of earnings-related income security pensions is not. An increase by one percentage point in basic security pensions is associated with a decrease in the old age excess mortality by 0.02 for men as well as for women.
The ways in which social policies are designed, as well as their generosity, are important for health because of the increase in resources that social policies entail. Hence, social policies are of major importance for how we can tackle the social determinants of health.
In terms of economic development, China is widely acclaimed as a miracle economy. Over a period of rapid economic growth, however, China's reputation for health has been slipping. In the 1970s China was a shining example of health development, but no longer. Government and public concerns about health equity have grown. China's health-equity challenges are truly daunting because of a vicious cycle of three synergistic factors: the social determinants of health have become more inequitable; imbalances in the roles of the market and government have developed; and concerns among the public have grown about fairness in health. With economic boom and growing government revenues, China is unlike other countries challenged by health inequities and can afford the necessary reforms so that economic development goes hand-in-hand with improved health equity. Reforms to improve health equity will receive immense popular support, governmental commitment, and interest from the public-health community worldwide.
This analysis reflects on the importance of political parties, and the policies they implement when in government, in determining the level of equalities/inequalities in a society, the extent of the welfare state (including the level of health care coverage by the state), the employment/unemployment rate, and the level of population health. The study looks at the impact of the major political traditions in the advanced OECD countries during the golden years of capitalism (1945-1980) -- social democratic, Christian democratic, liberal, and ex-fascist -- in four areas: (1) the main determinants of income inequalities, such as the overall distribution of income derived from capital versus labor, wage dispersion in the labor force, the redistributive effect of the welfare state, and the levels and types of employment/ unemployment; (2) levels of public expenditures and health care benefits coverage; (3) public support of services to families, such as child care and domiciliary care; and (4) the level of population health as measured by infant mortality rates. The results indicate that political traditions more committed to redistributive policies (both economic and social) and full-employment policies, such as the social democratic parties, were generally more successful in improving the health of populations, such as reducing infant mortality. The erroneous assumption of a conflict between social equity and economic efficiency, as in the liberal tradition, is also discussed. The study aims at filling a void in the growing health and social inequalities literature, which rarely touches on the importance of political forces in influencing inequalities. The data used in the study are largely from OECD health data for 1997 and 1998; the OECD statistical services; the comparative welfare state data set assembled by Huber, Ragin and Stephens; and the US Bureau of Labor Statistics.
Thomas McKeown was a rhetorically powerful critic, from the inside, of the medical profession's mid-20th-century love affair with curative and scientific medicine. He emphasized instead the importance of economic growth, rising living standards, and improved nutrition as the primary sources of most historical improvements in the health of developed nations.
This interpretation failed to emphasize the simultaneous historical importance of an accompanying redistributive social philosophy and practical politics, which has characterized the public health movement from its 19th-century origins. Consequently, the current generation of public health practitioners are having to reconstruct such a politics and practice following its virtual dismantlement during the last 2 decades of the 20th century.
This is the third paper in the series on child survival. The second paper in the series, published last week, concluded that in the 42 countries with 90% of child deaths worldwide in 2000, 63% of these deaths could have been prevented through full implementation of a few known and effective interventions. Levels of coverage with these interventions are still unacceptably low in most low-income and middle-income countries. Worse still, coverage for some interventions, such as immunisations and attended delivery, are stagnant or even falling in several of the poorest countries. This paper highlights the importance of separating biological or behavioural interventions from the delivery systems required to put them in place, and the need to tailor delivery strategies to the stage of health-system development. We review recent initiatives in child health and discuss essential aspects of delivery systems, including: need for data at the subnational level to support health planning; regular monitoring of provision and use of health services, and of intervention coverage; and the need to achieve high and equitable coverage with selected interventions. Community-based initiatives can extend the delivery of interventions in areas where health services are hard to access, but strengthening national health systems should be the long-term aim. The millennium development goal for child survival can be achieved, but only if strategies for delivery interventions are greatly improved and scaled-up.
Health trends over much of the past century have been generally, and notably, positive throughout the world. In several regions, however, life expectancy has declined over the past 1-2 decades. This trend suggests that the expectation that emerged in the 1960s and 1970s of worldwide gains and convergence in population health status is not guaranteed by a general deterministic process. National populations can now be clearly grouped into those that have achieved rapid gains in life expectancy; those whose gains are slower or are perhaps plateauing; and those in which the trends have reversed. Over the past two centuries, outside times of war and famine, such reversals have been rare. Exploration of these varied population health trends elucidates better the close relation between population health and the processes of economic, social, and technological change. Such analysis has shown that the health status of human populations should be a guiding criterion in the debate on sustainable development.
Samuel H Prestons classic paper The Changing Relation between Mortality and Level of Economic Development published in 1975 remains a cornerstone of both global public health policy and academic discussion of public health. Prestons paper illuminates two central stylized facts. The first is a strong positive relationship between national income levels and life expectancy in poorer countries though the relationship is non-linear as life expectancy levels in richer countries are less sensitive to variations in average income. The second is that the relationship is changing with life expectancy increasing over time at all income levels. Preston examined the relationship between life expectancy and income in three different decades: the 1900s 1930s and 1960s. In each decade the association between the two measures held true; more recent research shows that the income-life expectancy relationship still applies and continues to move upwards (although the AIDS epidemic in Sub-Saharan Africa has reduced life expectancy at the low end of the income scale in recent years). Although the basic facts set out by Preston are generally accepted there is still a great deal of dispute about the mechanisms that lie behind the relationships and the policy implications we can draw from them. (excerpt)
Many countries rely heavily on patients' out-of-pocket payments to providers to finance their health care systems. This prevents some people from seeking care and results in financial catastrophe and impoverishment for others who do obtain care. Surveys in eighty-nine countries covering 89 percent of the world's population suggest that 150 million people globally suffer financial catastrophe annually because they pay for health services. Prepayment mechanisms protect people from financial catastrophe, but there is no strong evidence that social health insurance systems offer better or worse protection than tax-based systems do.
This paper studies the theoretical and empirical implications of monetary policy making by committee under four different voting protocols. The protocols are a consensus model, where a supermajority is required for a policy change; an agenda-setting model, where the chairman controls the agenda; a dictator model, where the chairman has absolute power over the committee; and a simple majority model, where policy is determined by the median member. These protocols give preeminence to different aspects of the actual decision-making process and capture the observed heterogeneity in formal procedures across central banks. The models are estimated by maximum likelihood using interest rate decisions by the committees of five central banks, namely the Bank of Canada, the Bank of England, the European Central Bank, the Swedish Riksbank, and the U.S. Federal Reserve. For all central banks, results indicate that the consensus model fits actual policy decisions better than the alternative models. This suggests that despite institutional differences, committees share unwritten rules and informal procedures that deliver observationally equivalent policy decisions. (c) 2010 by the President and Fellows of Harvard College and the Massachusetts Institute of Technology..
The Socioeconomic Gradient in Health: A Never-Ending Story? Department of General Practice and Primary Health Care
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Willems S (2005) The Socioeconomic Gradient in Health: A Never-Ending Story?
Department of General Practice and Primary Health Care, University of Ghent.
Medicine on a Grand Scale. Rudolf Virchow, Liberalism, and the Public Health, Occasional Publication, No. 1
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McNeely I (2002) Medicine on a Grand Scale. Rudolf Virchow, Liberalism, and the Public
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Aid and Health. Background Paper for the Globalisation Knowledge Network of the Commission on Social Determinants of Health
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Taylor S (2008) Aid and Health. Background Paper for the Globalisation Knowledge
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Globalisation and Health: Impact Pathways and Recent Evidence. Globalisation Knowledge Network Background Paper
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How successful are pro-poor health programmes at reaching the poor
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Health for All? A Critical Analysis of Public Health Policies in Eight European Countries
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