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The ‘Heart Kuznets Curve’? Understanding the relations between economic development and cardiac conditions
Abstract
As countries turn wealthier, some health indicators, such as child mortality, seem to have well-defined trends. However, others, including cardiovascular conditions, do not follow clear linear patterns of change with economic development. Abnormal blood pressure is a serious health risk factor with consequences for population growth and longevity as well as public and private expenditure in health care and labor productivity. This also increases the risk of the population in certain pandemics, such as COVID-19. To determine the correlation of income and blood pressure, we analyzed time-series for the mean systolic blood pressure (SBP) of men’s population (mmHg) and nominal Gross Domestic Product per capita (GDPPC) for 136 countries from 1980 to 2008 using regression and statistical analysis by Pearson’s correlation (r). Our study finds a trend similar to an inverted-U shaped curve, or a ‘Heart Kuznets Curve’. There is a positive correlation (increase GDPPC, increase SBP) in low-income countries, and a negative correlation in high-income countries (increase GDPPC, decrease SBP). As country income rises people tend to change their diets and habits and have better access to health services and education, which affects blood pressure. However, the latter two may not offset the rise in blood pressure until countries reach a certain income. Investing early in health education and preventive health care could avoid the sharp increase in blood pressure as countries develop, and therefore, avoiding the ‘Heart Kuznets Curve’ and its economic and human impacts.
... 13 Besides these public health interventions, another possible approach is to reduce socioeconomic disadvantage itself, through social protection (eg, income supplements for families and public investments in education). 14 Although there is a growing literature on the importance of social protection on adult obesity, [15][16][17] less attention has been paid to the roles of such social protection policies in childhood obesity prevention. This gap partly relates to the difficulty of estimating social spending at the individual level. ...
... Finally, we used the secondary exposure variables by replacing total social spending on children with five dimensions of social spending on children (family allowance, maternal and parental leave, ECEC, school education and other benefits), and repeated multivariable linear regressions. 16 In this analysis, we examined 29 OECD countries for which information on all the dimensions of social spending on children were available (Denmark, Mexico, Netherlands, New Zealand, Poland and the USA were excluded). All analyses were conducted using Stata V.15 (StataCorp LLC, College Station, Texas, USA). ...
... 44 There is also a growing literature on the effect of social programmes and education on adult obesity. [15][16][17] Our study extends these previous studies by further focusing on childhood obesity, one of the top public health issues in the modern context, and therefore reinforces the key roles of social protection policies and social spending as their indicator in population health. ...
Objectives
The burden of childhood obesity is clustered among children in low-socioeconomic groups. Social spending on children—public welfare expenditure on families and education—may curb childhood obesity by reducing socioeconomic disadvantages. The objective of this study was to examine the relationship between social spending on children and childhood obesity across the Organisation for Economic Cooperation and Development (OECD) countries.
Design
Ecological study.
Setting
Data on social spending on children were obtained from the OECD Social Expenditure Database and the OECD educational finance indicators dataset during 2000–2015. Data on childhood obesity were obtained from the NCD Risk Factor Collaboration database.
Participants
Aggregated statistics on obesity among children aged 5–19 years, estimated for OECD 35 countries based on the measured height and weight on 31.5 million children.
Outcome measures
Country-level prevalence of obesity among children aged 5–19 years.
Results
In cross-sectional analyses in 2015, social spending on children was inversely associated with the prevalence of childhood obesity after adjusting for potential confounders (the gross domestic product per capita, unemployment rate, poverty rate, percentage of children aged <20 years and prevalence of childhood obesity in 2000). In addition, when we focused on changes from 2000 to 2015, an average annual increase of US$100 in social spending per child was associated with a decrease in childhood obesity by 0.6 percentage points for girls (p=0.007) and 0.7 percentage points for boys (p=0.04) between 2000 and 2015, after adjusting for the potential confounders. The dimensions of social spending that contributed to these associations between the changes in social spending on children and childhood obesity were early childhood education and care (ECEC) and school education for girls and ECEC for boys.
Conclusion
Countries that increase social spending on children tend to experience smaller increases in childhood obesity.
... This finding is in line with the literature about expenditure on health care (e.g. Nagano et al., 2020). ...
The current Covid-19 pandemic has caused hundreds of thousands of deaths globally. As a consequence, a myriad of concomitant economic and social activities has been frozen. Many countries have had to enforce border blockages, travel restrictions and quarantine. The pandemic has changed consumers’ attitudes significantly and driven individuals and households to the state of panic buying. This paper examines the household stockpiling in Vietnam in response to the Covid-19 pandemic. Self-administered questionnaires were used to collect the data across the country. The empirical results show that householders’ education and household sizes are positively associated with the propensity that a household stocks up. However, the likelihood of a family stockpiling is lowered when members receive information about the pandemic from formal sources. There are also notable differences among the essential items being stockpiled by different households. Specifically, households living in urban areas or near (super)markets are more inclined to stock up food than other goods. By contrast, households with members working as doctors tend to spend a large portion of their stockpiling budget on medication.
... This performance often mirrors the country's ability to intervene in a case of a public health crisis [43][44][45][46][47][48]. Variables such as GDP per capita have been used in modeling health outcomes, mortality trends, cause-specific mortality estimation and health system performance and finances [49][50][51]. For poor countries, economic performance appears to improve health by providing the means to meet essential needs such as food, clean water and shelter, as well access to basic health care services. ...
The magnitude of the coronavirus disease (COVID-19) pandemic has an enormous impact on the social life and the economic activities in almost every country in the world. Besides the biological and epidemiological factors, a multitude of social and economic criteria also govern the extent of the coronavirus disease spread in the population. Consequently, there is an active debate regarding the critical socio-economic determinants that contribute to the resulting pandemic. In this paper, we contribute towards the resolution of the debate by leveraging Bayesian model averaging techniques and country level data to investigate the potential of 29 determinants, describing a diverse set of socio-economic characteristics, in explaining the coronavirus pandemic outcome. We show that the true empirical model behind the coronavirus outcome is constituted only of few determinants, but the extent to which each determinant is able to provide a credible explanation varies between countries due to their heterogeneous socio-economic characteristics. To understand the relationship between the potential determinants in the specification of the true model, we develop the coronavirus determinants Jointness space. In this space, two determinants are connected with each other if they are able to jointly explain the coronavirus outcome. As constructed, the obtained map acts as a bridge between theoretical investigations and empirical observations, and offers an alternate view for the joint importance of the socio-economic determinants when used for developing policies aimed at preventing future epidemic crises.
... This performance often mirrors the country's ability to intervene in a case of a public health crisis [43][44][45][46][47][48]. Variables such as GDP per capita have been used in modeling health outcomes, mortality trends, cause-specific mortality estimation and health system performance and finances [49][50][51]. For poor countries, economic performance appears to improve health by providing the means to meet essential needs such as food, clean water and shelter, as well access to basic health care services. ...
The magnitude of the coronavirus disease (COVID-19) pandemic has an enormous impact on the social life and the economic activities in almost every country in the world. Besides the biological and epidemiological factors, a multitude of social and economic criteria also govern the extent of the coronavirus disease spread in the population. Consequently, there is an active debate regarding the critical socio-economic determinants that contribute to the resulting pandemic. In this paper, we contribute towards the resolution of the debate by leveraging Bayesian model averaging techniques and country level data to investigate the potential of 29 determinants, describing a diverse set of socio-economic characteristics, in explaining the coronavirus pandemic outcome. We show that the true empirical model behind the coronavirus outcome is constituted only of few determinants, but the extent to which each determinant is able to provide a credible explanation varies between countries due to their heterogeneous socio-economic characteristics. To understand the relationship between the potential determinants in the specification of the true model, we develop the coronavirus determinants Jointness space. In this space, two determinants are connected with each other if they are able to jointly explain the coronavirus outcome. As constructed, the obtained map acts as a bridge between theoretical investigations and empirical observations, and offers an alternate view for the joint importance of the socio-economic determinants when used for developing policies aimed at preventing future epidemic crises.
This study analyses the agenda setting on social media in the COVID-19 pandemic by exploiting one of the disruptive technologies, big data analytics. Our purpose is to examine whether the agenda of news organisations matches the public agenda on social media in crisis situations, and to explore the feasibility and efficacy of applying big data analytics on social media data. To this end, we used an unsupervised machine learning approach, structural topic modelling and analysed 129,965 tweets posted by UK news media and citizens during April 2 and 8, 2020. Our study reveals a wide diversity of topics in the tweets generated by both groups and finds only a small number of topics are similar, indicating different agendas set in the pandemic. Moreover, we show that citizen tweets focused more on expressing feelings and sharing personal activities while news media tweets talked more about facts and analysis on COVID-19. In addition, our results find that citizens responded more significantly to breaking news. The findings of the study contribute to the agenda setting literature and offer valuable practical implications.
Corona pandemic has affected the whole world, and it is a highly researched area in biological sciences. As the current pandemic has affected countries socially and economically, the purpose of this bibliometric analysis is to provide a holistic review of the corona pandemic in the field of social sciences. This study aims to highlight significant, influential aspects, research streams, and themes. We have reviewed 395 journal articles related to coronavirus in the field of social sciences from 2003 to 2020. We have deployed ‘biblioshiny’ a web-interface of the ‘bibliometrix 3.0’ package of R-studio to conduct bibliometric analysis and visualization. In the field of social sciences, we have reported influential aspects of coronavirus literature. We have found that the ‘Morbidity and Mortality Weekly Report’ is the top journal. The core article of coronavirus literature is ‘Guidelines for preventing health-care-associated pneumonia’. The most commonly used word, in titles, abstracts, author’s keywords, and keywords plus, is ‘SARS’. Top affiliation is ‘The University of Hong Kong’. Hong Kong is a leading country based on citations, and the USA is on top based on total publications. We have used a conceptual framework to identify potential research streams and themes in coronavirus literature. Four research streams are found by deploying a co-occurrence network. These research streams are ‘Social and economic effects of epidemic disease’, ‘Infectious disease calamities and control’, ‘Outbreak of COVID 19,’ and ‘Infectious diseases and the role of international organizations’. Finally, a thematic map is used to provide a holistic understanding by dividing significant themes into basic or transversal, emerging or declining, motor, highly developed, but isolated themes. These themes and subthemes have proposed future directions and critical areas of research.
The World Health Organization (WHO) introduced the concept of stewardship to clarify the practical components of governance in the health sector. For the WHO, stewardship concentrated on how government actors take responsibility for the health system and the wellbeing of the population, fulfill health system functions, assure equity, and coordinate interaction with government and society. This article overviews the contents of this special issue, which offers examples of how health stewards in a variety of countries have addressed issues of health security, primary care expansion, family planning, and quality of care. The contributors' articles draw lessons for policy, programs, and management useful for practitioners and scholars. Our overview identifies several themes emerging from the articles: the foundational role of legal frameworks for effective stewardship, the importance of institutional arrangements as enablers, the influence of regional and global entities on national stewardship, the connection between credible decision‐making structures and stewardship, and pathways to sustainable financing and domestic resource mobilization. The discussion concludes with highlighting several gaps in knowledge and practice related to health stewardship.
National Ministries of Health in low‐ and middle‐income countries (LMICs) have a key role to play as stewards of the quality agenda in their health systems. This paper uses a previously developed six‐point framework for stewardship (strategy formulation, intersectoral collaboration, governance and accountability, health system design, policy and regulation, and intelligence generation) and identifies specific examples of activities in LMICs in each of these domains, pitfalls to avoid, and possible solutions to these pitfalls. Many LMICs now have quality strategies with clear vision statements. There are good examples of quality agencies and donor collaboration councils to coordinate activities across different sectors. There are multiple options for accountability, including public reporting, community accountability structures, results‐based payment, accreditation, and inspection. To improve health system design, available tools include decision support tools, task‐shifting models, supply chain management, and programs to train quality improvement staff. Policy options include legislation on disclosure of adverse events, and regulations to ensure skills of health care providers. Lastly, health information tools include patient registries, facility surveys, hospital discharge abstracts, standardized population and patient surveys, and dedicated agencies for reporting on quality. Policy‐makers can use this article to identify options for driving the quality agenda and address anticipated implementation barriers.
BACKGROUND: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. METHODS: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. RESULTS: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. CONCLUSIONS: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.
Background:
Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure.
Methods:
We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure.
Results:
In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association.
Conclusions:
Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.
Research on economic status and adult mortality is often stymied by the reciprocity of this relationship and lack of clarity on which aspect of economic status matters. While financial resources increase access to healthcare and nutrition and reduce mortality, sickness also reduces labor force participation, thereby reducing income. Without longitudinal data, it is difficult to study the linkage between economic status and mortality. Using data from a national sample of 132,116 Indian adults aged 15 years and above, this paper examines their likelihood of death between wave 1 of the India Human Development Survey (IHDS), conducted in 2004–05 and wave 2, conducted in 2011–12. The results show that mortality between the two waves is strongly linked to the economic status of the household at wave 1 regardless of the choice of indicator for economic status. However, negative relationship between economic status and mortality for individuals already suffering from cardiovascular and metabolic conditions varies between three markers of economic status—income, consumption, and ownership of consumer durables—reflecting two-way relationship between short- and long-term markers of economic status and morbidity.
Background Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings We pooled 1479 studies that had measured the blood pressures of 19.1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127.0 mm Hg (95% credible interval 125.7-128.3) in men and 122.3 mm Hg (121.0-123.6) in women; age-standardised mean diastolic blood pressure was 78.7 mm Hg (77.9-79.5) for men and 76.7 mm Hg (75.9-77.6) for women. Global age-standardised prevalence of raised blood pressure was 24.1% (21.4-27.1) in men and 20.1% (17.8-22.5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1.13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe. Funding Wellcome Trust. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.
Zambia removed user fees in publicly supported–government and faith-based–health facilities in 54 out of 72 districts in 2006. This was extended to rural areas of previously unaffected districts in 2007. The natural experiment provided by the step-wise implementation of the removal policy and five waves of nationally representative household survey data enables us to study the impact of the removal policy on utilization and household health expenditure. We find that the policy increased overall use of health services in the short term and the effects were sustained in the long term. The increases were higher for individuals whose household heads were unemployed or had no or less education. The policy also led to a small shift in care seeking from private to publicly supported facilities, an effect driven primarily by individuals whose household heads were either formally employed or engaged in farming. The likelihood of incurring any spending reduced, although this weakened slightly in the long term. At the same time, there was an upward pressure on conditional health expenditure, i.e., expenditure was higher after removal of fees for those who incurred any spending. Hence, total (unconditional) household health expenditure was not significantly affected.
Background:
Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher.
Methods:
For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure.
Findings:
We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7-128·3) in men and 122·3 mm Hg (121·0-123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9-79·5) for men and 76·7 mm Hg (75·9-77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4-27·1) in men and 20·1% (17·8-22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence.
Interpretation:
During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.
Funding:
Wellcome Trust.
The distribution of income related health inequalities appears to exhibit changing patterns when both developing countries and developed countries are examined. This paper tests for the existence of a health Kuznets’ curve; that is, an inverse U-shape pattern between economic developments (as measured by GDP per capita) and income-related health inequalities (as measured by concentration indices). We draw upon both cross sectional (the World Health Survey) and a long longitudinal (the European Community Household Panel survey) dataset. Our results suggest evidence of a health Kuznets’ curve on per capita income. We find a polynomial association where inequalities decline when GDP per capita reaches a magnitude ranging between $26,000 and $38,700. That is, income-related health inequalities rise with GDP per capita, but tail off once a threshold level of economic development has been attained.
This paper develops a dynamic model to illustrate how diet and body weight change when novel food products become available to consumers. We propose a microfounded test to empirically discriminate between habit and taste formation in intertemporal preferences. Moreover, we show that 'novelty consumption' and endogenous preferences can explain the persistent correlation between economic development and obesity. Empirically studying the German reunification, we find that East Germans consumed more novel western food and gained more weight than West Germans when they got access to a larger variety of food products after the fall of the Wall. The observed consumption patterns suggest that food consumption features habit formation.
Health and education are known to be highly correlated, but the mechanisms behind the relationship are not well understood. In particular, there is sparse evidence on whether adolescent health may influence educational attainment. Using a large registry dataset of twins, including comprehensive information on health status at the age of 18 and later educational attainment, we investigate whether health predicts final education within monozygotic (identical) twin pairs. We find no evidence of this and conclude that health in adolescence may not have an influence on the level of schooling. Instead, raw correlations between adolescent health and schooling appear to be driven by genes and twin-pair-specific environmental factors.
La defensa gadameriana del caracter extra-metodico de la verdad de las ciencias humanas, teorizada en Verdad y metodo, no es el simple rechazo del metodo; ella nace de la conciencia de que hay verdades que no pueden ser reducibles a las condiciones del metodo, porque se refieren a una dimension ontologica que no se refiere a la repetitividad y a la conmensurabilidad. Tales aspectos de lo real son los acontecimientos contingentes, accidentales, aquellos que definimos como propiamente historicos. En este texto me propongo poner a la luz esta dimension ontologica, que en Aristoteles esta en particular en aquella de la praxis, de la accion humana, buscando mostrar que la necesidad de su tematizacion esta estrechamente ligada a las discusiones logicas y ontologicas que atravesaron el pensamiento griego despues del descubrimiento de las grandezas inconmensurables. La ontologia de la praxis es una ontologia que toma en consideracion aquella “irracionalidad” constituida a partir de lo contingente y lo accidental, a la que corresponde una forma de racionalidad que no es mas conmensuradora sino mediadora, representada por la phronesis
BACKGROUND:
High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010.
METHODS:
We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates.
FINDINGS:
In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain.
INTERPRETATION:
The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases.
Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods.
To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study.
A cross-sectional study of 153,996 adults (complete data for this analysis on 142,042) aged 35 to 70 years, recruited between January 2003 and December 2009. Participants were from 628 communities in 3 high-income countries (HIC), 10 upper-middle-income and low-middle-income countries (UMIC and LMIC), and 4 low-income countries (LIC).
Hypertension was defined as individuals with self-reported treated hypertension or with an average of 2 blood pressure measurements of at least 140/90 mm Hg using an automated digital device. Awareness was based on self-reports, treatment was based on the regular use of blood pressure-lowering medications, and control was defined as individuals with blood pressure lower than 140/90 mm Hg.
Among the 142,042 participants, 57,840 (40.8%; 95% CI, 40.5%-41.0%) had hypertension and 26,877 (46.5%; 95% CI, 46.1%-46.9%) were aware of the diagnosis. Of those who were aware of the diagnosis, the majority (23,510 [87.5%; 95% CI, 87.1%-87.9%] of those who were aware) were receiving pharmacological treatments, but only a minority of those receiving treatment were controlled (7634 [32.5%; 95% CI, 31.9%-33.1%]). Overall, 30.8%, 95% CI, 30.2%-31.4% of treated patients were taking 2 or more types of blood pressure-lowering medications. The percentages aware (49.0% [95% CI, 47.8%-50.3%] in HICs, 52.5% [95% CI, 51.8%-53.2%] in UMICs, 43.6% [95% CI, 42.9%-44.2%] in LMICs, and 40.8% [95% CI, 39.9%-41.8%] in LICs) and treated (46.7% [95% CI, 45.5%-47.9%] in HICs, 48.3%, [95% CI, 47.6%-49.1%] in UMICs, 36.9%, [95% CI, 36.3%-37.6%] in LMICs, and 31.7% [95% CI, 30.8%-32.6%] in LICs) were lower in LICs compared with all other countries for awareness (P <.001) and treatment (P <.001). Awareness, treatment, and control of hypertension were higher in urban communities compared with rural ones in LICs (urban vs rural, P <.001) and LMICs (urban vs rural, P <.001), but similar for other countries. Low education was associated with lower rates of awareness, treatment, and control in LICs, but not in other countries.
Among a multinational study population, 46.5% of participants with hypertension were aware of the diagnosis, with blood pressure control among 32.5% of those being treated. These findings suggest substantial room for improvement in hypertension diagnosis and treatment.
Background—It is commonly assumed that cardiovascular disease risk factors are associated with affluence and Westernization. We investigated the associations of body mass index (BMI), fasting plasma glucose, systolic blood pressure, and serum total cholesterol with national income, Western diet, and, for BMI, urbanization in 1980 and 2008. Methods and Results—Country-level risk factor estimates for 199 countries between 1980 and 2008 were from a previous systematic analysis of population-based data. We analyzed the associations between risk factors and per capita national income, a measure of Western diet, and, for BMI, the percentage of the population living in urban areas. In 1980, there was a positive association between national income and population mean BMI, systolic blood pressure, and total cholesterol. By 2008, the slope of the association between national income and systolic blood pressure became negative for women and zero for men. Total cholesterol was associated with national income and Western diet in both 1980 and 2008. In 1980, BMI rose with national income and then flattened at ?Int$7000; by 2008, the relationship resembled an inverted U for women, peaking at middle-income levels. BMI had a positive relationship with the percentage of urban population in both 1980 and 2008. Fasting plasma glucose had weaker associations with these country macro characteristics, but it was positively associated with BMI. Conclusions—The changing associations of metabolic risk factors with macroeconomic variables indicate that there will be a global pandemic of hyperglycemia and diabetes mellitus, together with high blood pressure in low-income countries, unless effective lifestyle and pharmacological interventions are implemented.
Aims:
Current knowledge on the prognosis of metabolically healthy but obese phenotype is limited due to the exclusive use of the body mass index to define obesity and the lack of information on cardiorespiratory fitness. We aimed to test the following hypotheses: (i) metabolically healthy but obese individuals have a higher fitness level than their metabolically abnormal and obese peers; (ii) after accounting for fitness, metabolically healthy but obese phenotype is a benign condition, in terms of cardiovascular disease and mortality.
Methods and results:
Fitness was assessed by a maximal exercise test on a treadmill and body fat per cent (BF%) by hydrostatic weighing or skinfolds (obesity = BF% ≥ 25 or ≥ 30%, men or women, respectively) in 43 265 adults (24.3% women). Metabolically healthy was considered if meeting 0 or 1 of the criteria for metabolic syndrome. Metabolically healthy but obese participants (46% of the obese subsample) had a better fitness than metabolically abnormal obese participants (P < 0.001). When adjusting for fitness and other confounders, metabolically healthy but obese individuals had lower risk (30-50%, estimated by hazard ratios) of all-cause mortality, non-fatal and fatal cardiovascular disease, and cancer mortality than their metabolically unhealthy obese peers; while no significant differences were observed between metabolically healthy but obese and metabolically healthy normal-fat participants.
Conclusions:
(i) Higher fitness should be considered a characteristic of metabolically healthy but obese phenotype. (ii) Once fitness is accounted for, the metabolically healthy but obese phenotype is a benign condition, with a better prognosis for mortality and morbidity than metabolically abnormal obese individuals.
In this paper we investigate the contribution of health related behaviors to the education gradient, using an empirical approach that addresses the endogeneity of both education and behaviors in the health production function. We apply this approach to a multi-country data set, which includes 12 European countries and has information on education, health and health behaviors for a sample of individuals aged 50+. Focusing on self reported poor health as our health outcome, we find that education has a protective role both for males and females. When evaluated at the sample mean of the dependent variable, one additional year of education reduces self-reported poor health by 7.1% for females and by 3.1% for males. Health behaviors – measured by smoking, drinking, exercising and the body mass index – contribute to explaining the gradient. We find that the effects of education on smoking, drinking, exercising and eating a proper diet account for at most 23% to 45% of the entire effect of education on health, depending on gender.
The relationship between national carbon dioxide emissions intensity (CO2 emitted per unit of Gross Domestic Product) and level of economic development has changed from essentially linear in 1962 to strongly curvilinear in 1991. The inverted-U curve reached statistical significance briefly in the early 1970s and increasingly since 1982. This is the result not of groups of countries passing through stages of development, but of efficiency improvements in a small number of wealthy countries combined with worse performance in poor and middle-income countries. The curvilinear relation is deepening and is likely to persist due to constraints on poorer countries in the world economy.
Mortality rates from hypertension related diseases such as coronary heart disease, hypertensive heart disease, stroke and end stage renal disease show an inverse association with socio-economic status (SES).
To review the published literature in order to assess whether (i) there is an association between SES and blood pressure (BP), and if so whether this is explained by (ii) SES differences in treatment rates, or (iii) SES differences in established risk factors for hypertension, or (iv) psycho-social factors associated with SES.
A narrative systematic review of published articles identified from a MEDLINE search from 1966-1996 and manual searching of the retrieved articles' bibliographies.
Lower SES was associated with higher mean BPs in almost all studies in developed countries. This inverse gradient was both stronger and more consistently found in women than in men. The magnitude of the association varied but generally was quite small, with age adjusted mean systolic BP differences of about 2-3 mm Hg between the highest and lowest SES groups. The finding of an SES gradient in BP, despite adjusting for treatment in some studies and the lack of consistent SES differences in hypertension treatment rates, makes differential treatment an unlikely explanation for the SES gradient in BP. A substantial part of the SES gradient was accounted for by the SES gradient in body mass index. Alcohol consumption across SES groups accounted for part of the association in men though few studies examined this issue specifically. In contrast, in undeveloped or developing countries a direct association between SES and BP has often been found which may reflect a higher prevalence of obesity, and higher salt and alcohol intakes among those of higher SES. The SES differences in BP were not detectable in most studies in children. There is little evidence that adverse psycho-social factors associated with low SES cause chronic elevations in BP.
A major challenge in reducing the SES gradient in BP is to understand and prevent the SES differences in obesity, which are particularly large in women. Future research should be directed to this question.
We investigate determinants of household firewood collection in rural Nepal, using 1995-96 and 2002-3 World Bank Living Standards Measurement Survey (LSMS) data. We incorporate village fixed effects, endogenous censoring, measurement error in living standards and heterogeneous effects of different household assets. We find no evidence in favor of the poverty-environment hypothesis. The evidence for the environmental Kuznets curve depends on the precise measure of living standards and time period studied. Firewood collections fall with a transition to modern occupations and rise with increasing population and household division. The local interhousehold collection externality is negligible, indicating that policy interventions are justified only by ecological considerations or nonlocal spillovers.
This paper analyzes the causal impact of retirement in China on Body Mass Index (BMI) and weight, which are a good gauge of the risk for some diseases. Many middle income developing countries are aging very rapidly and may have to adjust the retirement age to have financially feasible government budgets. It is important to know and understand any plausible health consequences of raising the retirement age in developing countries, and which sub-populations within these countries may be most affected. By using 2011, 2013 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS), our identification strategy uses variation in China’s mandatory retirement age with a fuzzy discontinuity design to examine an exogenous shock to retirement behavior. Our study finds that retirement will increase weight and BMI among men. This effect is much larger for men with low education. The channel may be that men with low education drink more and take less vigorous exercises after they get retired. Retirement does not affect weight and BMI for women. These effects are robust with different definitions of retirement, narrow retirement bandwidth for samples as well as dropping samples with rural Hukou.
This paper assesses whether health insurance is successful in improving health. More specifically, it investigates whether a same health insurance scheme has differentiated impacts on children depending on the way it is implemented and on the characteristics of the beneficiaries. To do so, I analyze the case of Ghana’s National Health Insurance Scheme that provides free coverage for children and has decentralized operations. I exploit the Multiple Indicator Cluster Survey of 2011 and I use propensity score matching to account for selection in the scheme. The study finds that, even though the NHIS is successful in improving health outcomes among insured children in Ghana, gains are not shared equally across regions. To understand this regional heterogeneity, mechanisms are investigated. The positive impact of health insurance is concentrated among the lower-income households in regions with a high quality of public health care. Further evidence points to the importance of health care utilization to explain these results. This paper sheds a new light on the mixed results of the literature on the impact of health insurance on health outcomes. It provides an understanding of the sources of the heterogeneous impact of a National Health Insurance Scheme and highlights the importance of context and implementation as drivers of its effectiveness. Such evidence is relevant for both the evaluation and monitoring of existing health care schemes and for the implementation of new large-scale public policies.
Between 1990 and 2008, many industrializing countries have experienced tremendous economic growth, which coincided with a substantial increase in the use of materials. That poses the question how a continued economic convergence of developing nations will affect the use of biomass, fossil fuels, and minerals. Building on the Environmental Kuznets Curve hypothesis, this study investigates whether material use reaches a maximum at a certain level of economic development and declines in income thereafter. Two indicators operationalize material use. Domestic Material Consumption (DMC) measures the apparent use of materials in a country. The Material Footprint (MF) quantifies all materials extracted to produce a country's final demand, including materials embodied in imports. Employing a panel consisting of 144 countries, initial estimations results suggest an S-shaped (cubic) relationship between GDP per capita and material use, but the relationship is monotonically positive over most of the income range. The coefficients of the cubic model tend to become nonsignificant once endogeneity and non-stationarity are accounted for. A linear specification yields a significant (positive) coefficient irrespective of the estimation method and can thus be considered a satisfactory approximation to the income-material use relationship. The linear models that account for endogeneity and non-stationarity suggest a greater income-materials elasticity for MF than for DMC. The long-run income elasticity is estimated to be 0.562 for DMC and 0.752 for MF. The income elasticity of MF is rather uniform across country groups. While being below average for biomass, it is greater than unity for fossil fuels.
OBJECTIVES This study examined the relationship between income inequality and heart failure outcomes.
BACKGROUND The income inequality hypothesis postulates that population health is influenced by income distribution within a society, with greater inequality associated with worse outcomes.
METHODS This study analyzed heart failure outcomes in 2 large trials conducted in 54 countries. Countries were divided by tertiles of Gini coefficients (where 0% represented absolute income equality and 100% represented absolute income inequality), and heart failure outcomes were adjusted for standard prognostic variables, country per capita income, education index, and hospital bed, and health worker density.
RESULTS Of the 15,126 patients studied, 5,320 patients lived in Gini coefficient tertile 1 countries (coefficient: <33%), 6,124 patients lived in tertile 2 countries (33% to 41%), and 3,772 patients lived in tertile 3 countries (>41%). Patients in tertile 3 were younger than tertile 1 patients, were more often women, and had less comorbidity and several indicators of less severe heart failure, yet the tertile 3-to-1 hazard ratios (HR) for the primary composite outcome of cardiovascular death or heart failure hospitalization were 1.57 (95% confidence interval [CI]: 1.38 to 1.79) and 1.48 for all-cause death
(95% CI: 1.29 to 1.71) after adjustment for recognized prognostic variables. After additional adjustments were made for per capita income, education index, hospital bed density, and health worker density, these HRs were 1.46 (95% CI: 1.25 to 1.70) and 1.30 (95% CI: 1.10 to 1.53), respectively.
CONCLUSIONS Greater income inequality was associated with worse heart failure outcomes, with an impact similar to those of major comorbidities. Better understanding of the societal and personal bases of these findings may suggest approaches to improve heart failure outcomes.
OBJECTIVE: To assess the relationships between the observed drop in mean systolic blood pressure (SBP) in Japan in 1986-2002 and the use of antihypertensive treatment and lifestyle factors. METHODS: A nationally representative sample of 90 554 men and 101 903 women aged 20 years and over was obtained from pooled data of annual cross-sectional surveys in Japan during 1986-2002. Using two-stage least squares with an instrumental variable, we examined the association between SBP and antihypertensive medication and lifestyle factors, including body mass index (BMI), physical activity, alcohol consumption, cigarette smoking and dietary salt intake. In the surveys, regular exercise was defined as exercise for more than 30 minutes at a time more than twice a week for over 1 year. Current smoking was defined as either daily or occasional cigarette use. Current drinking was defined as an intake of more than one standard cup of Japanese sake, one large bottle of regular beer, or one double measure of whisky at a time more than three times a week. Changes in mean predicted SBP in each sex and age group between 1986 and 2002 were decomposed into the respective contributions of these explanatory variables. FINDINGS: Age-specific means of predicted SBP declined during this period by 1.8 (95% confidence interval, CI: 1.2-2.5) to 3.0 (95% CI: 2.4-3.6) mmHg in men and 3.7 (95% CI: 3.4-4.1) to 5.1 (95% CI: 4.5-5.7) mmHg in women. These reductions were partly explained by the increased use of medications across all sex and age groups and decreased mean BMI in women in their 30s and 40s. The contributions of treatment effects increased with age. Elevated mean BMI in men and elderly women offset part of the decline of their mean SBP. CONCLUSION: Declining mean SBP in Japan between 1986 and 2002 was partly attributable to the increased use of antihypertensive medications, especially in the older population, and lowered mean BMI in young women. However, a substantial part of the decline was left unexplained and needs to be investigated further. A still greater decline in SBP would be expected through improvements in body weight management, salt and alcohol intake, and treatment and control of hypertension.
Few studies have attempted to identify a causal link between family income and child health, especially in developing countries. This article takes advantage of an exogenous income shock created by China’s rural tax reform between 2000 and 2003 to study the causal impact of household income on child health. The analysis finds that an increase in family income significantly raises children’s height-for-age z-scores. These effects are robust to alternative specifications and a comprehensive set of controls. The article also investigates possible mechanisms generating this result. We find that with a higher income level, better nutritional intake partially accounts for the improvement in child health.
Elevated blood pressure is the strongest modifiable risk factor for cardiovascular disease worldwide. Despite extensive knowledge about ways to prevent as well as to treat hypertension, the global incidence and prevalence of hypertension and, more importantly, its cardiovascular complications are not reduced—partly because of inadequacies in prevention, diagnosis, and control of the disorder in an ageing world. The aim of the Lancet Commission on hypertension is to identify key actions to improve the management of blood pressure both at the population and the individual level, and to generate a campaign to adopt the suggested actions at national levels to reduce the impact of elevated blood pressure globally. The first task of the Commission is this report, which briefly reviews the available evidence for prevention, identification, and treatment of elevated blood pressure, hypertension, and its cardiovascular complications. The report focuses on how as-yet unsolved issues might be tackled using approaches with population-wide impact and new methods for patient evaluation and education in the broadest sense (some of which are not always strictly evidence based) to manage blood pressure worldwide. The report is built around the concept of lifetime risk applicable to the entire population from conception. Development of subclinical and sometimes clinical cardiovascular disease results from lifetime exposure to cardiovascular risk factors combined with the susceptibility of individuals to the harmful consequences of these risk factors. The Commission recognises the importance of other cardiovascular risk factors—eg, smoking, obesity, dyslipidaemia, and diabetes mellitus—on antihypertensive treatment. However, as a Commission on hypertension, this report focuses mainly on issues and actions related to elevated blood pressure. Previous action plans for improving management of elevated blood pressure and hypertension have not yet provided adequate results. Therefore, the Commission has identified ten essential and achievable goals and ten accompanying, mutually additive, and synergistic key actions that—if implemented effectively and broadly—will make substantial contributions to the management of blood pressure globally. The Commission deliberately has not listed these complementary key actions by priority because the balance between strength of evidence, feasibility, and potential benefit could differ by country.
This paper reviews the economic research on obesity, covering topics such as the measurement of, and trends in, obesity, the economic causes of obesity (e.g. the monetary price and time cost of food, food assistance programs, income, education, macroeconomic conditions, and peer effects), and the economic consequences of obesity (e.g. lower wages, a lower probability of employment, and higher medical care costs). It also examines the extent to which obesity imposes negative externalities, and economic interventions that could potentially internalize such externalities, such as food taxes, subsidies for school-based physical activity programs, and financial rewards for weight loss. It discusses other economic rationales for government intervention with respect to obesity, such as imperfect information, time inconsistent preferences, and irrational behavior. It concludes by proposing a research agenda for the field. Overall, the evidence suggests that there is no single dominant economic cause of obesity; a wide variety of factors may contribute a modest amount to the risk. There is consistent evidence regarding the economic consequences of obesity, which are lower wages and higher medical care costs that impose negative externalities through health insurance. Studies of economic approaches to preventing obesity, such as menu labeling, taxes on energy-dense foods, and financial rewards for weight loss find only modest effects on weight and thus a range of policies may be necessary to have a substantial effect on the prevalence of obesity.
Copyright © 2015. Published by Elsevier B.V.
We examine the reduced-form relationship between per capita income and various environmental indicators. Our study covers
four types of indicators: urban air pollution, the state of the oxygen regime in river basins, fecal contamination of river
basins, and contamination of river basins by heavy metals. We find no evidence that environmental quality deteriorates steadily
with economic growth. Rather, for most indicators, economic growth brings an initial phase of deterioration followed by a
subsequent phase of improvement. The turning points for the different pollutants vary, but in most cases they come before
a country reaches a per capita income of $8000.
Simon Kuznets’ (1955) hypothesis that as a country develops, a natural cycle develops where inequality first increases, then decreases, has become known as the Kuznets curve. This pattern has also been applied to the environment, an ‘Environmental Kuznets curve’, showing that as development occurs, pollution first increases; then decreases because people value clean air. We expand the Kuznets curve to an ‘Obesity Kuznets curve’; as incomes rise, resources become available to buy more food. As such, people consume more calories and obesity rates increase. However, as incomes continue to rise, personal health becomes a more valued asset and people decrease their obesity levels (increasing their health levels). We find evidence of an Obesity Kuznets curve for white females. In addition, we find that as income inequality increases, obesity rates fall.
Hypertension rates in low- and middle-income countries are “broadly comparable” to those of high-income countries, and levels of treatment and control are inadequate, an international team of researchers has found (Lloyd-Sherlock P et al. Int J Epidemiol. doi:10.1093/ije/dyt215 [published online February 6, 2014]). The researchers determined patterns of hypertension prevalence, awareness, treatment, and control based on survey data from 35 125 people 50 years and older in South Africa, China, Ghana, India, Mexico, and Russia, collected for the World Health Organization’s Study on Global Aging and Adult Health (SAGE).
Background—It is commonly assumed that cardiovascular disease risk factors are associated with affluence and Westernization. We investigated the associations of body mass index (BMI), fasting plasma glucose, systolic blood pressure, and serum total cholesterol with national income, Western diet, and, for BMI, urbanization in 1980 and 2008.
Methods and Results—Country-level risk factor estimates for 199 countries between 1980 and 2008 were from a previous systematic analysis of population-based data. We analyzed the associations between risk factors and per capita national income, a measure of Western diet, and, for BMI, the percentage of the population living in urban areas. In 1980, there was a positive association between national income and population mean BMI, systolic blood pressure, and total cholesterol. By 2008, the slope of the association between national income and systolic blood pressure became negative for women and zero for men. Total cholesterol was associated with national income and Western diet in both 1980 and 2008. In 1980, BMI rose with national income and then flattened at ≈Int$7000; by 2008, the relationship resembled an inverted U for women, peaking at middle-income levels. BMI had a positive relationship with the percentage of urban population in both 1980 and 2008. Fasting plasma glucose had weaker associations with these country macro characteristics, but it was positively associated with BMI.
Conclusions—The changing associations of metabolic risk factors with macroeconomic variables indicate that there will be a global pandemic of hyperglycemia and diabetes mellitus, together with high blood pressure in low-income countries, unless effective lifestyle and pharmacological interventions are implemented.
We propose a methodology to evaluate social projects from an (equality of) opportunity perspective by looking at their effect on (parts of) the distribution of outcomes conditional on morally irrelevant characteristics, taken here to be parental education level and indigenous background. The methodology is applied to evaluate the effects on children’s health outcomes of Mexico’s Oportunidades program, one of the world’s largest conditional cash transfer programs for poor households. The evidence shows that the gains in health opportunities for children from indigenous background are substantial and situated in crucial parts of the distribution, while the gains for children from nonindigenous backgrounds are more limited.
Based on the recent World Bank urban transport strategy review "Cities on the move", the paper examines the critical differences between the urban transport problems facing cities in the developing and industrialized worlds. Premature congestion and deteriorating environmental safety and security conditions are seen as endemic in the developing country cities. Although the proportion of urban space devoted to movement is often relatively low in the developing world, rates of motorization are seen to be not untypical of those experienced in industrialized countries at similar average income levels. Hence rather than explaining the differences primarily in terms of natural endowments, the paper emphasizes the different and weaker policy and institutional contexts in which urban transport is typically performed in developing countries. It argues that the industrialized world, and particularly the multilateral banks and aid agencies, can make their most effective contribution to development by concentrating on assisting developing countries to overcome these institutional impediments to successful urban development.
The major risk factors for cardiovascular diseases (CVDs) have been known for at least half a century from both observational and clinical trial study designs1-6. Despite advances in many countries, progress in prevention has been slow from a global perspective. The INTERHEART study and many epidemiologic studies have shown that the vast majority of CVD can be explained by common risk factors, including hypercholesterolaemia, hypertension, diabetes and smoking7. The Global Burden of Disease (GBD) Study has led to a seismic shift in conceptualising the burden of diseases and risk factors across countries and regions, and showed that the "Western affluence" model may be flawed when considering CVDs in low-income settings, where a "dual burden" of communicable and non-communicable diseases exists8-9. Data exists at many levels in many forms and the message of growing burden of risk factors and resultant disease is undeniable. Researchers and clinicians alike strive for better data, better study designs and better analytic methods in order to improve our knowledge of causation and prevention of CVD, which will in turn, allow us to plan the most effective strategies. However, readers are forgiven for concluding that sufficient data already exists, and that it is time for action.
Health production models include participation in physical activity as an input. We investigate the relationship between participation in physical activity and health using a bivariate probit model. Participation is identified with an exclusion restriction on a variable reflecting sense of belonging to the community. Estimates based on data from Cycle 3.1 of the Canadian Community Health Survey indicate that participation in physical activity reduces the reported incidence of diabetes, high blood pressure, heart disease, asthma, and arthritis as well as being in fair or poor health. Increasing the intensity above the moderate level and frequency of participation in physical activity appears to have a diminishing marginal impact on adverse health outcomes. Our results provide support for guidelines about engaging in exercise regularly to achieve health benefits. Copyright © 2013 John Wiley & Sons, Ltd.
We examine the role of information in understanding the differential effects of income on the demand for health. In the health capital framework of Grossman (JPE, 1972), we derive the testable hypotheses that individuals adjust their diet in a healthier direction upon receiving negative health information, and that the effect is greater for richer individuals. Based on unique Chinese longitudinal data and a regression discontinuity design that exploits the exogenous cutoff of systolic blood pressure in the diagnosis of hypertension, we find that, upon receiving hypertension diagnosis, individuals reduce fat intake significantly, and richer individuals reduce more. Our results also indicate that among the rich, hypertension diagnosis is more effective for individuals with lower education.
Economic analyses of equity which focus solely on horizontal inequity offer a partial assessment of socioeconomic inequity in healthcare use. We analyse income-related inequity in cardiovascular disease-related healthcare utilisation by individuals reporting cardiovascular disease in England, including both horizontal and vertical aspects. For the analysis of vertical inequity, we use target groups to estimate the appropriate relationship between healthcare needs and use. We find that including vertical inequity considerations may lead us to draw different conclusions about the nature and extent of income-related inequity. After accounting for vertical inequity in addition to horizontal inequity, there is no longer evidence of inequity favouring the poor for nurse visits, whereas there is some evidence that doctor visits and inpatient stays are concentrated among richer individuals. The estimates of income-related inequity for outpatient visits, electrocardiography tests and heart surgery become even more pro-rich when accounting for vertical inequity. Copyright © 2012 John Wiley & Sons, Ltd.
The relationship between deforestation and income across 66 countries of Latin America, Africa and Asia is examined. Institutional characteristics as well as macroeconomic policies of each country are hypothesized to impact deforestation. Results show strong evidence of an environmental Kuznets Curve (EKC) relationship between income and deforestation for all three continents. Institutional structure and macroeconomic policy significantly affect the tropical deforestation process. Improvements in political institutions and governance significantly reduce deforestation. The factors leading to deforestation differ across regions, however, and there is no one-size-fits-all global policy recommendation for restraining the tropical deforestation process.
This paper provides a cross-country comparison of how income inequality has evolved within countries at different levels of development. It uses overlapping nonparametric regression, which allows visual comparisons of inequality both within and across countries. As a result, the methodology allows more specific conclusions than cross-country regressions, and yet is more general than within-country case studies. The approach highlights the problematic conclusions that can arise with parametric regressions, in particular with tests of the Kuznets curve. While some previous results are confirmed, some new results on inequality across countries are also discovered.
This paper examines the link between the health indicators and the environmental variables for a cross-section of countries widely dispersed on the economic development spectrum. While environment and income are seen to have an inverted-U shaped relationship (Environmental Kuznets Curve (EKC) hypothesis), it is also well established that environment and health are positively related. Our study focuses on the implications of this for the relationship between health and income. In the early phases of income growth, the gains in health and the losses in environmental quality could cancel each other out and this challenges the idea that as incomes increase health would always improve. To empirically analyse these issues, we estimate a two-stage least squares model that focuses on the impact of income and the environment on health status, with environment being an endogenous variable. Our results show that the environmental stress variable has a significant negative effect on health status. At the same time, gross national product (GNP) levels are shown to vary positively with health status variables. We find that the health gains obtained through improved incomes can be negated to a significant extent if the indirect effect of income acting via the environment is ignored. Research findings in this regard would be a useful policy instrument towards maximising both the environmental and health gains that come with economic growth and development.
Recent studies characterize the last half of the twentieth century as an era of cross-national health convergence, with some attributing welfare gains in the developing world to economic growth. In this study, I examine the extent to which welfare outcomes have actually converged and the extent to which economic development is responsible for the observed trends. Drawing from estimates covering 195 nations during the 1955-2005 period, I find that life expectancy averages converged during this time, but that infant mortality rates continuously diverged. I develop a narrative that implicates economic development in these contrasting trends, suggesting that health outcomes follow a "welfare Kuznets curve." Among poor countries, economic development improves life expectancy more than it reduces infant mortality, whereas the situation is reversed among wealthier nations. In this way, development has contributed to both convergence in life expectancy and divergence in infant mortality. Drawing from 674 observations across 163 countries during the 1980-2005 period, I find that the positive effect of GDP PC on life expectancy attenuates at higher levels of development, while the negative effect of GDP PC on infant mortality grows stronger.