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Area Deprivation and its Impact on Population Health: Conceptual Aspects, Measurement and Evidence from Germany

Author

Listed:
  • Karmann Alexander

    (Faculty of Business and Economics, Technische Universität Dresden, Dresden, Sachsen, Germany)

  • Weinhold Ines
  • Wende Danny

    (Faculty of Business and Economics, Technische Universität Dresden, Dresden, Germany)

Abstract

Empirical evidence demonstrates associations between socioeconomic or environmental area deprivation and public health. To measure such structural effects, deprivation indices have been developed in the UK initially. Meanwhile their application is increasingly discussed in Germany, however with little attempts to adapt the concept to national conditions. In this paper, we develop a model of area deprivation differentiating between material, social and ecological deprivation effects. We apply structural equation modelling to endogenously estimate the latent deprivation dimensions as well as their relative impact on the health outcome, accounting for potential measurement errors and controlling for health care infrastructure. We use data at the level of German municipal associations (n=4,491) for the years 2013 and 2016, if available. We find that differences in material (βmaterial=−0.168, p

Suggested Citation

  • Karmann Alexander & Weinhold Ines & Wende Danny, 2019. "Area Deprivation and its Impact on Population Health: Conceptual Aspects, Measurement and Evidence from Germany," Review of Economics, De Gruyter, vol. 70(1), pages 69-98, April.
  • Handle: RePEc:lus:reveco:v:70:y:2019:i:1:p:69-98:n:4
    DOI: 10.1515/roe-2019-0001
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    1. Buchner, Florian & Goepffarth, Dirk & Wasem, Juergen, 2013. "The new risk adjustment formula in Germany: Implementation and first experiences," Health Policy, Elsevier, vol. 109(3), pages 253-262.
    2. Alex Fenton & Amanda Fitzgerald & Ruth Lupton, 2013. "The Distribution of Local Government Finance by Local Authority-Level Deprivation," CASE - Social Policy in a Cold Climate Research Note 005, Centre for Analysis of Social Exclusion, LSE.
    3. Eddy van Doorslaer & Xander Koolman, 2004. "Explaining the differences in income‐related health inequalities across European countries," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 609-628, July.
    4. Singh, G.K. & Kogan, M.D., 2007. "Widening socioeconomic disparities in US childhood mortality, 1969-2000," American Journal of Public Health, American Public Health Association, vol. 97(9), pages 1658-1665.
    5. Lawlor, D.A. & Smith, G.D. & Patel, R. & Ebrahim, S., 2005. "Life-course socioeconomic position, area deprivation, and coronary heart disease: Findings from the British women's heart and health study," American Journal of Public Health, American Public Health Association, vol. 95(1), pages 91-97.
    6. James P. Smith, 1999. "Healthy Bodies and Thick Wallets: The Dual Relation between Health and Economic Status," Journal of Economic Perspectives, American Economic Association, vol. 13(2), pages 145-166, Spring.
    7. Louise Sheiner, 2014. "Why the Geographic Variation in Health Care Spending Cannot Tell Us Much About the Efficiency or Quality of Our Health Care System," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 45(2 (Fall)), pages 1-72.
    8. Singh, G.K., 2003. "Area Deprivation and Widening Inequalities in US Mortality, 1969-1998," American Journal of Public Health, American Public Health Association, vol. 93(7), pages 1137-1143.
    9. Dirk Göpffarth & Thomas Kopetsch & Hendrik Schmitz, 2016. "Determinants of Regional Variation in Health Expenditures in Germany," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 801-815, July.
    10. repec:dau:papers:123456789/10510 is not listed on IDEAS
    11. Bauhoff, Sebastian, 2012. "Do health plans risk-select? An audit study on Germany's Social Health Insurance," Journal of Public Economics, Elsevier, vol. 96(9-10), pages 750-759.
    12. Siegel, Martin & Vogt, Verena & Sundmacher, Leonie, 2014. "From a conservative to a liberal welfare state: Decomposing changes in income-related health inequalities in Germany, 1994–2011," Social Science & Medicine, Elsevier, vol. 108(C), pages 10-19.
    13. Buehn, Andreas & Farzanegan, Mohammad Reza, 2013. "Hold your breath: A new index of air pollution," Energy Economics, Elsevier, vol. 37(C), pages 104-113.
    14. Wen, Ming & Browning, Christopher R. & Cagney, Kathleen A., 2003. "Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health," Social Science & Medicine, Elsevier, vol. 57(5), pages 843-860, September.
    15. Macintyre, Sally & Ellaway, Anne & Cummins, Steven, 2002. "Place effects on health: how can we conceptualise, operationalise and measure them?," Social Science & Medicine, Elsevier, vol. 55(1), pages 125-139, July.
    16. Louise Sheiner, 2014. "Why the Geographic Variation in Health Care Spending Cannot Tell Us Much About the Efficiency or Quality of Our Health Care System," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 49(2 (Fall)), pages 1-72.
    17. Andreas Buehn & Alexander Karmann & Friedrich Schneider, 2009. "Shadow Economy and Do-it-Yourself Activities: The German Case," Journal of Institutional and Theoretical Economics (JITE), Mohr Siebeck, Tübingen, vol. 165(4), pages 701-722, December.
    18. Krieger, N. & Chen, J.T. & Waterman, P.D. & Rehkopf, D.H. & Subramanian, S.V., 2003. "Race/Ethnicity, Gender, and Monitoring Socioeconomic Gradients in Health: Comparison of Area-Based Socioeconomic Measures - The Public Health Disparities Geocoding Project," American Journal of Public Health, American Public Health Association, vol. 93(10), pages 1655-1671.
    19. Oliver Reich & Cornelia Weins & Claudia Schusterschitz & Magdalena Thöni, 2012. "Exploring the disparities of regional health care expenditures in Switzerland: some empirical evidence," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(2), pages 193-202, April.
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    More about this item

    Keywords

    area deprivation; health inequality; structural equation modelling;
    All these keywords.

    JEL classification:

    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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