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Priorities for action on the social determinants of health: Empirical evidence on the strongest associations with life expectancy in 54 low-income countries, 1990–2012

Author

Listed:
  • Hauck, K.
  • Martin, S.
  • Smith, P.C.

Abstract

The WHO Commission on the Social Determinants of Health set out an impressive collection of policy proposals on the social determinants of health. However, a serious weakness for securing implementation is the difficulty for policymakers in identifying priorities for action. The objective of this study is to determine a small set of the most influential determinants using existing data and an empirical approach. 45 Indicators from the World Bank's World Development Indicators are selected to measure attainment for the determinants proposed by the Commission. Panel data models of life expectancy at birth for 54 low-income countries over the years 1990–2012 (1188 country-years) are estimated. Each determinant is subjected to a robustness test using Extreme Bound Analysis, to determine the stability of its estimated impact on life expectancy. For 20 robust and significant determinants the magnitude of association with life expectancy is determined. The largest average increases in life expectancy at 14.5 months per capita is associated with a one standard deviation reduction in HIV prevalence among children, followed by advances in gender equality at 9.4 months. Improvements in life expectancy between 6 and 9 months are associated with agricultural production, political stability, access to clean water and sanitation, good governance, and primary school enrolment. Improvements below 6 months are associated with increases in private health expenditure and overseas development assistance, and control of armed conflict and HIV prevalence among men. There is no evidence that national income, public spending on healthcare and education, secondary schooling, terms of international trade, employment, debt service and relief, out-of-pocket expenditures, agricultural ex- or imports, lifestock production, foreign investment, urbanization or environmental degradation are robustly associated with population health. Results provide support for the relevance of some proposed policies. The findings can inform priorities for future research and policy action on the social determinants of health.

Suggested Citation

  • Hauck, K. & Martin, S. & Smith, P.C., 2016. "Priorities for action on the social determinants of health: Empirical evidence on the strongest associations with life expectancy in 54 low-income countries, 1990–2012," Social Science & Medicine, Elsevier, vol. 167(C), pages 88-98.
  • Handle: RePEc:eee:socmed:v:167:y:2016:i:c:p:88-98
    DOI: 10.1016/j.socscimed.2016.08.035
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    References listed on IDEAS

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    1. Matteo Cervellati & Uwe Sunde, 2011. "Life expectancy and economic growth: the role of the demographic transition," Journal of Economic Growth, Springer, vol. 16(2), pages 99-133, June.
    2. Sudhir Anand and Amartya Sen, 1995. "Gender Inequality in Human Development: Theories and Measurement," Human Development Occasional Papers (1992-2007) HDOCPA-1995-01, Human Development Report Office (HDRO), United Nations Development Programme (UNDP).
    3. Jochen Hartwig & Jan-Egbert Sturm, 2012. "An outlier-robust extreme bounds analysis of the determinants of health-care expenditure growth," KOF Working papers 12-307, KOF Swiss Economic Institute, ETH Zurich.
    4. Angus Deaton, 2006. "Global Patterns of Income and Health: Facts, Interpretations, and Policies," NBER Working Papers 12735, National Bureau of Economic Research, Inc.
    5. Nicolas Depetris Chauvin & Aart Kraay, 2005. "What Has 100 Billion Dollars Worth of Debt Relief Done for Low- Income Countries?," International Finance 0510001, EconWPA.
    6. Joshua D. Angrist & Jörn-Steffen Pischke, 2010. "The Credibility Revolution in Empirical Economics: How Better Research Design Is Taking the Con out of Econometrics," Journal of Economic Perspectives, American Economic Association, vol. 24(2), pages 3-30, Spring.
    7. Esther Duflo, 2003. "Grandmothers and Granddaughters: Old-Age Pensions and Intrahousehold Allocation in South Africa," World Bank Economic Review, World Bank Group, vol. 17(1), pages 1-25, June.
    8. World Bank, 2015. "World Development Indicators 2015," World Bank Publications, The World Bank, number 21634, August.
    9. Levine, Ross & Renelt, David, 1992. "A Sensitivity Analysis of Cross-Country Growth Regressions," American Economic Review, American Economic Association, vol. 82(4), pages 942-963, September.
    10. David M. Cutler & Adriana Lleras-Muney, 2006. "Education and Health: Evaluating Theories and Evidence," NBER Working Papers 12352, National Bureau of Economic Research, Inc.
    11. Farasat A. S. Bokhari & Yunwei Gai & Pablo Gottret, 2007. "Government health expenditures and health outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 257-273.
    12. Céline Azémar & Rodolphe Desbordes, 2009. "Public Governance, Health and Foreign Direct Investment in Sub-Saharan Africa," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 18(4), pages 667-709, August.
    13. Michael Kremer, 2007. "What Works in Fighting Diarrheal Diseases in Developing Countries? A Critical Review," NBER Working Papers 12987, National Bureau of Economic Research, Inc.
    14. W. Robert Reed, 2009. "The Determinants Of U.S. State Economic Growth: A Less Extreme Bounds Analysis," Economic Inquiry, Western Economic Association International, vol. 47(4), pages 685-700, October.
    15. Emily Oster, 2012. "Routes Of Infection: Exports And Hiv Incidence In Sub-Saharan Africa," Journal of the European Economic Association, European Economic Association, vol. 10(5), pages 1025-1058, October.
    16. Martin Gassebner & Michael J. Lamla & James Raymond Vreeland, 2013. "Extreme Bounds of Democracy," Journal of Conflict Resolution, Peace Science Society (International), vol. 57(2), pages 171-197, April.
    17. Moral-Benito, Enrique, 2010. "Model averaging in economics," MPRA Paper 26047, University Library of Munich, Germany.
    18. World Bank, 2014. "World Development Indicators 2014," World Bank Publications, The World Bank, number 18237, August.
    19. Rodrigo Moreno-Serra & Peter C. Smith, 2015. "Broader health coverage is good for the nation's health: evidence from country level panel data," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 178(1), pages 101-124, January.
    20. David Bishai & Asma Quresh & Prashant James & Abdul Ghaffar, 2006. "National road casualties and economic development," Health Economics, John Wiley & Sons, Ltd., vol. 15(1), pages 65-81.
    21. Bussmann, Margit, 2009. "The Effect of Trade Openness on Women's Welfare and Work Life," World Development, Elsevier, vol. 37(6), pages 1027-1038, June.
    22. Andreas Bergh & Irina Mirkina & Therese Nilsson, 2014. "Globalization and Institutional Quality-A Panel Data Analysis," Oxford Development Studies, Taylor & Francis Journals, vol. 42(3), pages 365-394, September.
    23. Bartley, William Alan & Cohen, Mark A, 1998. "The Effect of Concealed Weapons Laws: An Extreme Bound Analysis," Economic Inquiry, Western Economic Association International, vol. 36(2), pages 258-265, April.
    24. Jan- Sturm & Jakob de Haan, 2005. "Determinants of long-term growth: New results applying robust estimation and extreme bounds analysis," Empirical Economics, Springer, vol. 30(3), pages 597-617, October.
    25. McIntyre, Diane & Thiede, Michael & Dahlgren, Göran & Whitehead, Margaret, 2006. "What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?," Social Science & Medicine, Elsevier, vol. 62(4), pages 858-865, February.
    26. Grant Miller, 2008. "Women's Suffrage, Political Responsiveness, and Child Survival in American History," The Quarterly Journal of Economics, Oxford University Press, vol. 123(3), pages 1287-1327.
    27. Dreher, Axel & Sturm, Jan-Egbert & Vreeland, James Raymond, 2009. "Development aid and international politics: Does membership on the UN Security Council influence World Bank decisions?," Journal of Development Economics, Elsevier, vol. 88(1), pages 1-18, January.
    28. repec:pri:cheawb:deaton_wider_final_annual_lecture_all.pdf is not listed on IDEAS
    29. Ming-Chang Tsai, 2007. "Does globali zation affect human well-being?," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 81(1), pages 103-126, March.
    30. T. Paul Schultz, 1999. "Health and Schooling Investments in Africa," Journal of Economic Perspectives, American Economic Association, vol. 13(3), pages 67-88, Summer.
    31. Sala-i-Martin, Xavier, 1997. "I Just Ran Two Million Regressions," American Economic Review, American Economic Association, vol. 87(2), pages 178-183, May.
    32. Jakob de Haan & Jan-Egbert Sturm, 2005. "Determinants of Long-term Growth: New Results Applying Roboust Estimation and Extreme Bounds," TWI Research Paper Series 12, Thurgauer Wirtschaftsinstitut, Universität Konstanz.
    33. Lucia Hanmer & Robert Lensink & Howard White, 2003. "Infant and child mortality in developing countries: Analysing the data for Robust determinants," Journal of Development Studies, Taylor & Francis Journals, vol. 40(1), pages 101-118.
    34. Alsan, Marcella & Bloom, David E. & Canning, David, 2006. "The effect of population health on foreign direct investment inflows to low- and middle-income countries," World Development, Elsevier, vol. 34(4), pages 613-630, April.
    35. Leamer, Edward E & Leonard, Herman B, 1983. "Reporting the Fragility of Regression Estimates," The Review of Economics and Statistics, MIT Press, vol. 65(2), pages 306-317, May.
    36. Leamer, Edward E, 1985. "Sensitivity Analyses Would Help," American Economic Review, American Economic Association, vol. 75(3), pages 308-313, June.
    37. repec:pri:cheawb:deaton_wider_final_annual_lecture_all is not listed on IDEAS
    38. repec:eme:ijsepp:v:39:y:2012:i:11:p:51-67 is not listed on IDEAS
    39. Tsuchiya, Aki & Williams, Alan, 2005. "A "fair innings" between the sexes: are men being treated inequitably?," Social Science & Medicine, Elsevier, vol. 60(2), pages 277-286, January.
    40. Fabrizio Carmignani & Sriram Shankar & Eng Tan & Kam Tang, 2014. "Identifying covariates of population health using extreme bound analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(5), pages 515-531, June.
    41. Mumtaz Hussain & Oscar Brookins, 2001. "On the determinants of national saving: An extreme-bounds analysis," Review of World Economics (Weltwirtschaftliches Archiv), Springer;Institut für Weltwirtschaft (Kiel Institute for the World Economy), vol. 137(1), pages 150-174, March.
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