Capitalism, socialism, and the physical quality of life

This study compared capitalist and socialist countries in measures of the physical quality of life (PQL), taking into account the level of economic development. The World Bank was the principal source of statistical data, which pertained to 123 countries and approximately 97 percent of the world's population. PQL variables included indicators of health, health services, demographic conditions, and nutrition (infant mortality rate, child death rate, life expectancy, crude death rate, crude birth rate, population per physician, population per nursing person, and daily per capita calorie supply); measures of education (adult literacy rate, enrollment in secondary education, and enrollment in higher education); and a composite PQL index. All PQL measures improved as economic development increased. In 30 of 36 comparisons between countries at similar levels of economic development, socialist countries showed more favorable PQL outcomes (p less than .05 by two-tailed t-test). This work with the World Bank's raw data included cross-tabulations, analysis of variance, and regression techniques, which all confirmed the same conclusions. The data indicated that the socialist countries generally have achieved better PQL outcomes than the capitalist countries at equivalent levels of economic development.     

Correlation between national income, HIV/AIDS and political status and mortalities in African countries

OBJECTIVES: To investigate associations between mortalities in African countries and problems that emerged in Africa in the 1990s (reduction of national income, HIV/AIDS and political instability) by adjusting for the influences of development, sanitation and education. METHODS: We compiled country-level indicators of mortalities, national net income (the reduction of national income by the debt), infection rate of HIV/AIDS, political instability, demography, education, sanitation and infrastructure, from 1990 to 2000 of all African countries (n=53). To extract major factors from indicators of the latter four categories, we carried out principal component analysis. We used multiple regression analysis to examine the associations between mortality indicators and national net income per capita, infection rate of HIV/AIDS, and political instability by adjusting the influence of other possible mortality determinants. RESULTS: Mean of infant mortality per 1000 live births (IMR); maternal mortality per 100,000 live birth (MMR); adult female mortality per 1000 population (AMRF); adult male mortality per 1000 population (AMRM); and life expectancy at birth (LE) in 2000 were 83, 733, 381, 435, and 51, respectively. Three factors were identified as major influences on development: education, sanitation and infrastructure. National net income per capita showed independent negative associations with MMR and AMRF, and a positive association with LE. Infection rate of HIV/AIDS was independently positively associated with AMRM and AMRF, and negatively associated with LE in 2000. Political instability score was independently positively associated with MMR. CONCLUSIONS: National net income per capita, HIV/AIDS and political status were predictors of mortality indicators in African countries. This study provided evidence for supporting health policies that take economic and political stability into account.     

The evaluation of educational and economic effects on life expectation by linear regression analysis

Socioeconomic effects are supposed to have a fairly long time delay in regard to health development. Taking into consideration time lags, correlation and regression analysis are executed to explain the difference in health levels which exist among countries. The infant mortality rate, life expectation at birth, adult literacy rate, proportions of school enrollment and GNP per capita are taken as variables and their characteristics are discussed. In addition, countries are divided into three groups, i.e. low income, middle income, and industrialized countries, to show that the educational and economic effects on health development vary according to the economic level of the countries.     

Socioeconomic determinants of infant mortality: a worldwide study of 152 low-, middle-, and high-income countries

BACKGROUND: To reach the Millennium Development Goals for health, influential international bodies advocate for more resources to be directed to the health sector, in particular medical treatment. Yet, health has many determinants beyond the health sector that are less evident than proximate predictors. AIM: To assess the relative importance of major socioeconomic determinants of population health, measured as infant mortality rate (IMR), at country level. METHODS: National-level data from 152 countries based on World Development Indicators 2003 were used for multivariate linear regression analyses of five socioeconomic predictors of IMR: public spending on health, GNI/capita, poverty rate, income equality (Gini index), and young female illiteracy rate. Analyses were performed on a global level and stratified for low-, middle-, and high-income countries. RESULTS: In order of importance, GNI/capita, young female illiteracy, and income equality predicted 92% of the variation in national IMR whereas public spending on health and poverty rate were non-significant determinants when adjusted for confounding. In low-income countries, female illiteracy was more important than GNI/capita. Income equality (Gini index) was an independent predictor of IMR in middle-income countries only. In high-income countries none of these predictors was significant. CONCLUSIONS: The relative importance of major health determinants varies between income levels, thus extrapolating health policies from high- to low-income countries is problematic. Since the size, per se, of public health spending does not independently predict health outcomes, functioning health systems are necessary to make health investments efficient. Potential health gains from improved female education and economic growth should be considered in low- and middle-income countries.     

"Social capital," GNP per capita, relative income, and health: an ecological study of 23 countries.

The effects of social capital, income inequality, and absolute per capita income were investigated in an ecological analysis of 23 rich and poor countries. Trust was chosen as an indicator of social capital, and GNP (gross national product) per capita and Gini index measured absolute and relative income, respectively. These independent variables were analyzed in a linear regression model with the dependent variables adult mortality rate (25-64 years), life expectancy, and infant mortality rate (IMR). Separate analyses were performed for poor and rich countries as well as all countries combined. Social capital (trust) showed no significant association with the three health outcomes. A particularly strong relationship was found between Gini index and IMR for rich countries, and GNP per capita and life expectancy for all countries. In the group of poor countries, GNP per capita and Gini index in the same model were associated with IMR. The results contradict the suggested impact of social capital on health, and instead support the notion that economic factors such as absolute income and relative income distribution are of importance.     

Societal characteristics and health in the former communist countries of Central and Eastern Europe and the former Soviet Union: a multilevel analysis

OBJECTIVES: To examine whether, in former communist countries that have undergone profound social and economic transformation, health status is associated with income inequality and other societal characteristics, and whether this represents something more than the association of health status with individual socioeconomic circumstances. DESIGN: Multilevel analysis of cross-sectional data. SETTING: 13 Countries from Central and Eastern Europe and the former Soviet Union. PARTICIPANTS: Population samples aged 18+ years (a total of 15 331 respondents). MEAN OUTCOME MEASURES: Poor self-rated health. RESULTS: There were marked differences among participating countries in rates of poor health (a greater than twofold difference between the countries with the highest and lowest rates of poor health), gross domestic product per capita adjusted for purchasing power parity (a greater than threefold difference), the Gini coefficient of income inequality (twofold difference), corruption index (twofold difference) and homicide rates (20-fold difference). Ecologically, the age- and sex-standardised prevalence of poor self-rated health correlated strongly with life expectancy at age 15 (r = -0.73). In multilevel analyses, societal (country-level) measures of income inequality were not associated with poor health. Corruption and gross domestic product per capita were associated with poor health after controlling for individuals' socioeconomic circumstances (education, household income, marital status and ownership of household items); the odds ratios were 1.15 (95% confidence interval 1.03 to 1.29) per 1 unit (on a 10-point scale) increase in the corruption index and 0.79 (95% confidence interval 0.68 to 0.93) per $5000 increase in gross domestic product per capita. The effects of gross domestic product and corruption were virtually identical in people whose household income was below and above the median. CONCLUSION: Societal measures of prosperity and corruption, but not income inequalities, were associated with health independently of individual-level socioeconomic characteristics. The finding that these effects were similar in persons with lower and higher income suggests that these factors do not operate exclusively through poverty.     

Has the relation between income inequality and life expectancy disappeared? Evidence from Italy and top industrialised countries

OBJECTIVE: To investigate the relation between income inequality and life expectancy in Italy and across wealthy nations. DESIGN AND SETTING: Measure correlation between income inequality and life expectancy at birth within Italy and across the top 21 wealthy countries. Pearson correlation coefficients were calculated to study these relations. Multivariate linear regression was used to measure the association between income inequality and life expectancy at birth adjusting for per capita income, education, and/or per capita gross domestic product. DATA SOURCES: Data on the Gini coefficient (income inequality), life expectancy at birth, per capita income, and educational attainment for Italy came from the surveys on Italian household on income and wealth 1995-2000 and the National Institute of Statistics information system. Data for industrialised nations were taken from the United Nations Development Program's human development indicators database 2003. RESULTS: In Italy, income inequality (beta = -0.433; p<0.001) and educational attainment (beta = 0.306; p<0.001) were independently associated with life expectancy, but per capita income was not (beta = 0.121; p>0.05). In cross national analyses, income inequality had a strong negative correlation with life expectancy at birth (r = -0.864; p<0.001). CONCLUSIONS: In Italy, a country where health care and education are universally available, and with a strong social safety net, income inequality had an independent and more powerful effect on life expectancy at birth than did per capita income and educational attainment. Italy had a moderately high degree of income inequality and an average life expectancy compared with other wealthy countries. The cross national analyses showed that the relation between income inequality and population health has not disappeared.     

Health status during the transition in Central and Eastern Europe: development in reverse?

This paper reports on a study of the cross-national trends in health status during the economic transition and associated health sector reforms in Central and Eastern Europe (CEE). The central premise is that before long-run gains in health status are realized, the transition towards a market economy and adoption of democratic forms of government should lead to short-run deterioration as a result of: (i) reduction in real income and widening income disparities; (ii) stress and stress-related behaviour; (iii) lax regulation of environmental and occupational risks; and (iv) breakdown in basic health services. Analysis focused on three broad indicators of health status: life expectancy at birth, infant mortality rate and the probability of dying between the ages of 15 and 65 years, shown by the notation '50q15'. The study revealed significant new information about health status and the health sector which could not have been obtained without a proper cross-national study. Infant mortality rates in former socialist economies (FSE) follow the global trend, declining as per capita income rises. However, rates are lower than would be predicted given their income levels. Despite declining infant mortality, life expectancy at birth in the former socialist economies decreases as per capita income rises, in marked contrast to global trends. This is because rising income level is associated with greater probability of death between the ages of 15 and 65: the wealthier the society, the less healthy is its population, particularly for its males. Causes of death in the FSE follow global trends: higher death rates due to infectious and parasitic diseases in poorer countries, and higher death rates due to chronic diseases in wealthier countries. However, age-standardized death rates for chronic diseases generally associated with unhealthy lifestyles and environmental risk factors are very high when compared with wealthier established market economies (EME). Policies and procedures which alter the effectiveness of health services have had a demonstrable but mixed impact on health status during the early phase of transition. Effective preventive health strategies must be formulated and implemented to reverse the adverse trends observed in Central and Eastern Europe.     

A crossectional country group study of three health level outcomes and four potential causes.

A crossectional study of four country groups segmented by per capita income of the majority of the world's countries was made to evaluate the relationship between health level outcomes and potential causes which may impact on the health level outcomes. The health level outcomes consist of life expectancy at birth, infant mortality rate and child mortality rate. The potential causes consist of secondary school children per 100 in school age group, daily calory supply per capita, population per physician and population per nurse. For the two lower income country groups the two important determinants of life expectancy were daily calory supply per capita and secondary school children per 100 in school age group. For the upper middle income the country group the important positive determinant of life expectancy was population per nurse and for the upper income country group the important negative determinant of life expectancy was daily calory supply per capita. Infant and child mortality rates were associated with secondary school children per 100 in school age group and population per physician or population per nurse for the two lower income country groups. For the upper middle income country group population per nurse or population per physician was supplemented by daily calory supply per capita for both infant and child mortality. For the upper income country group only infant mortality had statistically significant determinants. They were daily calory supply per capita and secondary school children per 100 in school age groups.     

马鞍山市公民健康素养现况研究

目的了解马鞍山市公民健康素养现状。方法在马鞍山市辖区内分层整群随机抽取603人进行问卷调查。结果健康素养总体正确认知率为71.25%;健康知识的正确认知率为71.71%,健康知识正确认知率与文化程度和家庭经济状况有关;健康信念正确率为72.82%,健康信念与年龄、文化程度、职业、婚姻状况和家庭经济状况有关;健康行为正确率为67.63%,健康行为与文化程度和家庭规模有关;健康技能认知的正确率为71.96%,健康技能认知水平与年龄、文化程度、职业、婚姻状况和家庭经济状况有关。结论健康知识正确认知率受文化程度和家庭经济状况影响;健康信念正确率受年龄、文化程度、职业、婚姻状况和家庭经济状况的影响;健康技能正确率受年龄、文化程度、职业、婚姻状况和经济状况的影响;健康行为正确率受文化程度和家庭规模的影响。针对居民在健康素养方面存在的误区应加强宣传。     

The scorecard on development: 25 years of diminished progress.

This article looks at the available data on economic growth and various social indicators-including health outcomes and education-and compares the past 25 years (1980-2005 or latest available year) with the prior two decades (1960-1980). The past 25 years have seen a sharp slowdown in the rate of economic growth for the vast majority of low- and middle-income countries. For the health indicators, there is a marked decrease in progress for life expectancy and for infant, child, and adult mortalities. For education, there is a reduction in progress in secondary school enrollment and in public spending on education, and reduced progress in primary school enrollment for the bottom two quintiles of countries. The results are discussed in the context of a number of economic reforms implemented over the past 25 years, with the intention of promoting growth and development. The authors conclude that economists and policymakers should devote more effort to determining the causes of the economic and development failure of the last quarter-century.     

The impact of health worker migration on development dynamics: evidence of wealth effects from Africa

This article examines three relevant hypotheses on the effect of health worker migration on human development and economic prosperity (at the macro- and micro-levels) in Africa. Owing to the lack of relevant data on health human resource (HHR) migration for the continent, the subject matter has remained empirically void over the last decades despite the acute concern about health professional emigration. Using quantile regression, the following findings have been established. (1) The effect of HHR emigration is positive (negative) at low (high) levels of economic growth. (2) HHR emigration improves (mitigates) human development (GDP per capita growth) in low (high) quantiles of the distribution. (3) Specific differences in effects are found in top quantiles of human development and low quantiles of GDP per capita growth where the physician (nurse) emigration elasticities of development are positive (negative) and negative (positive), respectively. As a policy implication, blanket health-worker emigration control policies are unlikely to succeed across countries with different levels of human development and economic prosperity. Hence, the policies should be contingent on the prevailing levels of development and tailored differently across the most and least developed African countries.     

Determinants of health status and the influence of primary health care services in Latin America, 1990-98

Primary health care (PHC) services have been advocated as a means by which less developed countries may improve the health of their populations even in the face of poverty, low levels of literacy, poor nutrition and other factors that negatively influence health status. Using aggregated data from the World Bank and UNICEF this study examined which factors, both within the health care system and outside of it, are associated with under-5 mortality rates in 22 countries of Latin America and the Caribbean during the 1990s. In a multivariate analysis using generalized estimating equations for repeated measures, five factors were found to be independent predictors of lower under-5 mortality rates (U5MRs). These were vaccination levels, female literacy, the use of oral rehydration therapy, access to safe water and GNP per capita. When the magnitude of these associations were assessed, higher levels of GNP per capita was found to be very weakly associated with lower U5MRs, compared with female literacy and vaccination rates. These findings suggest that government policies which focus only on promoting economic growth, while not making important investments in PHC services, female education and access to safe water are unlikely to see large improvements in health status.     

Health spending, access, and outcomes: trends in industrialized countries.

In 1997 the United States spent $3,925 per capita on health or 13.5 percent of gross domestic product (GDP), while the median Organization for Economic Cooperation and Development (OECD) country spent $1,728 or 7.5 percent. From 1990 to 1997 U.S. health spending per capita increased 4.3 percent per year, compared with the OECD median of 3.8 percent. The United States has the lowest percentage of the population with government-assured health insurance. It also has the fewest hospital days per capita, the highest hospital expenditures per day, and substantially higher physician incomes than the other OECD countries. On the available outcome measures, the United States is generally in the bottom half, and its relative ranking has been declining since 1960.     

Demographic transition and economic growth: Evidence from China and United States

In the context of todays ageing population, this paper uses the connectedness network model proposed by Diebold and Yilmaz in 2014 to analyse the directionality and degree of interaction between the population ageing index, life expectancy, per capita gross domestic product, and per capita health expenditure from a systematic perspective for China; then, these results from China are compared with the United States. A number of new findings can be identified, as follows: (1) for China and the United States, economic growth may promote the growth of health expenditure and increased life expectancy may cause an increase in the ageing population; (2) China's population age structure has already led to some constraints on economic growth, whereas the United StatesUS's population age structure has had a weak impact on its economic growth; and (3) the ageing population structure for China has a net impact on per capita health expenditure, whereas no such net directional impact was found in the United States. These findings support the idea that policy synergies should be strengthened in the economic, social, and health fields in order to promote both the quality of life of the ageing population and the sustainable development of the economy.     

Availability, safety, and quality of blood for transfusion in the Americas.

OBJECTIVES: This article has two objectives: (1) to present for countries and territories of the Region of the Americas data on the number of blood donations, proportion of voluntary blood donors versus remunerated blood donors, coverage of screening for infectious agents, and separation of donated blood into its components and (2) to explore the relationships of those characteristics with economic and organizational factors in the countries and territories. METHODS: We carried out comparative analyses using population and health information gathered annually by the Pan American Health Organization (PAHO) from national health officials from the countries in the Americas, as well as economic information (gross national product (GNP) per capita) obtained from publications of the World Bank. RESULTS: There is a direct correlation between the availability of blood for transfusion and GNP per capita. Seven countries with a GNP per capita above US$ 10 000 per year account for 38% of the Regional population but 68% of the Regional blood donations. Voluntary blood donation is more common in the countries with better blood availability. There is no association between GNP per capita and coverage of screening for infectious agents. Nevertheless, of the six countries with a GNP per capita below US$ 1 000, only one of the six screens all units for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B surface antigen (HBsAg). Countries with a higher proportion of voluntary blood donors tend to have lower prevalence rates of infectious markers. Separation of blood into its components is also more common in countries with higher blood donation rates. CONCLUSIONS: The availability, safety, and quality of blood for transfusion in the Americas needs to be improved. As part of that effort, national policies and strategies must be put into place so that the resources already allocated for blood services are better utilized.     

International variations in trust in health care systems

Public trust in health care systems has been measured in many countries, but there have been few studies of the intercountry variability in trust, or the degree to which such variability is because of population or structural characteristics. We used data from the health care survey conducted by the International Social Survey Program from 2011 to 2013 in 31 countries to assess whether intercountry variability was significantly greater than intracountry variability using general linear models in which country was treated as a fixed factor. We also assessed the extent to which intercountry variability was because of respondent and economic circumstances (gross national income per capita). Public trust in the health care system varied significantly across countries (P < .001), even after adjustment for 8 within‐country predictors and gross national income per capita. One of the strongest predictors of trust was the respondents' most recent health care experience. Higher respondent education, urban residence, and a lower country's gross national income predicted less trust in the health care system. After countries with the 10% highest health expenditures per capita (United States) and the 10% lowest health care expenditures per capita (China and the Philippines) were removed, public trust in the health care system was positively associated with the remaining countries' health care expenditures per capita (Pearson correlation coefficient, 0.490; P = .008) and gross national income per capita (Pearson correlation coefficient, 0.495; P = .007). There is significant variation in public trust in health care across the countries studied. The intercountry differences are due, in part to economic circumstances.     

Income inequality,illiteracy rate,and life expectancy in Brazil

OBJECTIVES: The link between income disparities and health has been studied mostly in developed nations. This study assesses the relationship between income disparities and life expectancy in Brazil and measures the impact of illiteracy rates on the association. METHODS: The units of analysis (n = 27) are all the Brazilian states and the federal capital. Simple and multiple linear regressions were performed to measure the association between income disparity, measured by the Gini coefficient, gross domestic product (GDP) per capita, and illiteracy rate. Data came from publicly available sources at the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics. RESULTS: Income disparities and illiteracy rates were negatively associated with life expectancy in Brazil. GDP per capita was positively associated with life expectancy. The inclusion of illiteracy rates in the regression model removed the effect of income disparities. CONCLUSIONS: Illiteracy rate is strongly associated with life expectancy in Brazil. This finding is in accord with reports from the United States and has implications for health policy and planning for both developed and developing countries.     

International health care spending

Trends in health are reviewed for the member countries of the Organization for Economic Cooperation and Development (OECD) covering the following: the basic difficulties inherent in international comparative studies; the absolute levels of health expenditures in 1984; the levels and rates of growth of the health share in the gross domestic product (GDP) and the public share of total health expenditures; the elasticities of real health expenditures to real GDP for the 1960-75, 1975-84, and 1960-84 time periods; growth in health expenditures for the largest 7 OECD countries in terms of growth in population, health prices, health care prices in excess of overall prices, and utilization/intensity of services per person. International comparisons are a problem due to differences in defining the boundaries of the health sector, the heterogeneity of data, and methodological problems arising from comparing different economic, demographic, cultural, and institutional structures. The most difficult problem in international comparisons of health expenditures is lack of appropriate measures of health outcome. Exhibit 1 contains per capita health expenditures denominated in US dollars based on GDP purchasing power parities for 21 OECD countries for 1984. Per capita health expenditures ranged from less than $500 in Greece, Portugal, and Spain to over $1400 in Sweden and the US, with an OECD average of $871. After adjusting for price level differences, there still appears to be a greater than 3-fold difference in the "volume" of services consumed across the OECD countries. To determine if per capita health expenditures are related to a country's wealth as measured by its per capita GDP, the relationship between per capita health expenditures and per capita GDP for the 21 countries were examined for 1984. The data points and the "best fitting" trend line indicate a statistically significant relationship in which each $100 difference in per capita GDP is associated with a $10.50 difference in per capita health expenditures. The calculated elasticity is 1.4 indicating that each 10% difference in per capita GDP is associated with a 14% difference in per capita health expenditures. The analysis indicates that variations in per capita GDP, alone, are associated with 7 of the variation in per capita health spending. In 1984, health spending in the 18 OECD countries (for which data were consistently available for all 6 different years) was on average 7.5% of GDP. The US had the highest GDP share (10.7%) and Greece had the lowest (4.6%). The average elasticity of 16 of the 18 countries as a group substantially exceeded 1.0 for the 1960-84 period, as well as the 1960-75 (1.6) and 1975-84 (1.3) subperiods. Thus, real health spending increased 60% faster than the real GDP between 1960-84 and between 1960-75 and 30% faster between 1975-84.