1,721,159 research outputs found
The contribution of urbanization to non-communicable diseases: evidence from 173 countries from 1980 to 2008
Full text linkIt is widely believed that the expanding burden of non-communicable diseases (NCDs) is
in no small part the result of major macro-level determinants. We use a large amount of
new data, to explore in particular the role played by urbanization – the process of the
population shifting from rural to urban areas within countries – in affecting four important
drivers of NCDs world-wide: diabetes prevalence, as well as average body mass index
(BMI), total cholesterol level and systolic blood pressure. Urbanization is seen by many as a
double-edged sword: while its beneficial economic effects are widely acknowledged, it is
commonly alleged to produce adverse side effects for NCD-related health outcomes. In this
paper we submit this hypothesis to extensive empirical scrutiny, covering a global set of
countries from 1980–2008, and applying a range of estimation procedures. Our results
indicate that urbanization appears to have contributed to an increase in average BMI and
cholesterol levels: the implied difference in average total cholesterol between the most
and the least urbanized countries is 0.40 mmol/L, while people living in the least urbanized
countries are also expected to have an up to 2.3 kg/m2 lower BMI than in the most
urbanized ones. Moreover, the least urbanized countries are expected to have an up to
3.2 p.p. lower prevalence of diabetes among women. This association is also much stronger
in the low and middle-income countries, and is likely to be mediated by energy intake-
related variables, such as calorie and fat supply per capita
Attitudes to inequality ten years after transition
No full textThe purpose of this paper is to compare people’s attitudes to inequality at the end of the 1990s – the qualities they perceive are needed to get ahead, the role of government and rewards for employment – in Central and Eastern Europe (CEE) and Western countries. Our data (from the 1999 International Social Survey Programme) suggest that overall, people in CEE express substantially more ‘egalitarian’ attitudes than those in the West, even after 10 years of economic adjustment to the market economy: Eastern Europeans’ much stronger dislike of existing income differences and their corresponding preference for governmental redistribution at least partly reflected in the fact that they consider the factors that actually govern the income generation process (and therefore constitute the driving forces of income inequality) as not in line with meritocratic principles, such as effort, intelligence and skills. Surprisingly, however, they share basically the same values as the West when it comes to the factors that should in principle determine income. This evidence presents policymakers in the transition countries with a challenge. While people support the notion that incomes should be determined by factors relevant to the working of market forces – ability to perform on the job, responsibility and education – a lot of people in Central and Eastern Europe believe that, in reality, many differences in income do not reflect merit, and – as a result – they are very concerned about the extent of inequality in their societies
Does austerity really kill?
Full text linkA growing body of the literature has argued that austerity has been bad for health, though without directly measuring austerity. This paper explicitly distinguishes the association of mortality with macroeconomic fluctuations from that with fiscal policy measures, using data for 28 European Union (EU) countries covering the period 1991–2013. The main results present a nuanced, complex picture about the mortality impact of fiscal policies. We confirm the mortality decreasing (increasing) effect of recessions (booms), with the exception of suicide mortality, which shows the opposite effects. Austerity regimes are associated with an increase in all-cause mortality (0.7%). At the same time, fiscal stimuli tend to significantly increase death rates due to cirrhosis or chronic liver disease (3%) and those due to vehicle accidents (4.3%). Our results are sensitive to the set of countries included: when excluding the Baltics, Romania and Hungary, austerity policies turn out to significantly increase suicide-related mortality (2.8%), while the effect on all-cause mortality remains unaffected (0.7%). Overall, however it appears that the austerity-increasing effects are mostly compensated by the (mostly) mortality-decreasing effects of recessions. A notable exception appears to be suicides, which receive a ‘double-boost’ from both recessions and austerity
Psychological distress and problem drinking
Full text linkWe examine the influence of harmful alcohol use on mental health using a flexible two-step instrumental variables approach and household survey data from nine countries of the former Soviet Union. Using alcohol advertisements to instrument for alcohol, we show that problem drinking has a large detrimental effect on psychological distress, with problem drinkers exhibiting a 42% increase in the number of mental health problems reported and a 15% higher chance of reporting very poor mental health. Ignoring endogeneity leads to an underestimation of the damaging effect of excessive drinking. Findings suggest that more effective alcohol polices and treatment services in the former Soviet Union may have added benefits in terms of reducing poor mental health. Copyright © 2015 John Wiley & Sons, Ltd
Do political factors matter in explaining under- and overweight outcomes in developing countries?
No full textWe construct a rich dataset covering 47 developing countries over the years 1990–2007, combining several micro and macro level data sources to explore the link between political factors and body mass index (BMI). We implement a heteroskedastic generalized ordered logit model allowing for different covariate effects across the BMI distribution and accounting for the unequal BMI dispersion by geographical area. We find that systems with democratic qualities are more likely to reduce under-weight, but increase overweight/obesity, whereas effective political competition does entail double-benefits in the form of reducing both under-weight and obesity. Our results are robust to the introduction of country fixed effects
The influence of social capital on health in eight former Soviet countries: why does it differ?
Full text linkBACKGROUND: Previous research has identified the role of social capital in explaining variations in health in the countries of the former Soviet Union. This study explores whether the benefits of social capital vary among these countries and why. METHODS: The impact of micro social capital (trust, membership and social isolation) on individual health was estimated in each of eight former Soviet republics using instrumental variables to overcome methodological hazards such as endogeneity and reverse causality. Interactions with institutional variables (voice and accountability, effectiveness of the legal system, informal economy) and social protection variables (employment protection, old age and disability benefits, sickness and health benefits) were examined. RESULTS: Most social capital indicators, in most countries, are associated with better health but the magnitude and significance of the impact differ between countries. Some of this variation can be explained by interacting social capital indicators with measures of institutional quality, with membership of organisations bringing greater benefit for health in countries where civil liberties are stronger, whereas social isolation has more adverse consequences where there is a large informal economy. A lesser amount is explained by the interaction of social capital indicators with selected measures of social protection. CONCLUSION: When considering interventions to improve social capital as a means of improving population health, it seems advisable to take into account the influence of macrocontextual variables, in order not to overstate or understate the likely impact of the intervention
How to measure premature mortality?:A proposal combining "relative" and "absolute" approaches
Full text linkBACKGROUND: The concept of "premature mortality" is at the heart of many national and global health measurement and benchmarking efforts. However, despite the intuitive appeal of its underlying concept, it is far from obvious how to best operationalise it. The previous work offers at least two basic approaches: an absolute and a relative one. The former-and far more widely used- approach sets a unique age threshold (e.g. 65 years), below which deaths are defined as premature. The relative approach derives the share of premature deaths from the country-specific age distribution of deaths in the country of interest. The biggest disadvantage of the absolute approach is that of using a unique, arbitrary threshold for different mortality patterns, while the main disadvantage of the relative approach is that its estimate of premature mortality strongly depends on how the senescent deaths distribution is defined in each country. METHOD: We propose to overcome some of the downsides of the existing approaches, by combining features of both, using a hierarchical model, in which senescent deaths distribution is held constant for each country as a pivotal quantity and the premature mortality distribution is allowed to vary across countries. In this way, premature mortality estimates become more comparable across countries with similar characteristics. RESULTS: The proposed hierarchical models provide results, which appear to align with related evidence from specific countries. In particular, we find a relatively high premature mortality for the United States and Denmark. CONCLUSIONS: While our hybrid approach overcomes some of the problems of previous measures, some issues require further research, in particular the choice of the group of countries that a given country is assigned to and the choice of the benchmarks within the groups. Hence, our proposed method, combined with further study addressing these issues, could provide a valid alternative way to measure and compare premature mortality across countries
Public acceptability of population-level interventions to reduce alcohol consumption: a discrete choice experiment
Full text linkPublic acceptability influences policy action, but the most acceptable policies are not always the most effective. This discrete choice experiment provides a novel investigation of the acceptability of different interventions to reduce alcohol consumption and the effect of information on expected effectiveness, using a UK general population sample of 1202 adults. Policy options included high, medium and low intensity versions of: Minimum Unit Pricing (MUP) for alcohol; reducing numbers of alcohol retail outlets; and regulating alcohol advertising. Outcomes of interventions were predicted for: alcohol-related crimes; alcohol-related hospital admissions; and heavy drinkers. First, the models obtained were used to predict preferences if expected outcomes of interventions were not taken into account. In such models around half of participants or more were predicted to prefer the status quo over implementing outlet reductions or higher intensity MUP. Second, preferences were predicted when information on expected outcomes was considered, with most participants now choosing any given intervention over the status quo. Acceptability of MUP interventions increased by the greatest extent: from 43% to 63% preferring MUP of £1 to the status quo. Respondents' own drinking behaviour also influenced preferences, with around 90% of non-drinkers being predicted to choose all interventions over the status quo, and with more moderate than heavy drinkers favouring a given policy over the status quo. Importantly, the study findings suggest public acceptability of alcohol interventions is dependent on both the nature of the policy and its expected effectiveness. Policy-makers struggling to mobilise support for hitherto unpopular but promising policies should consider giving greater prominence to their expected outcomes.<br/
Public financial management and health service delivery:a literature review
Full text linkThis chapter provides a summary review of the existing academic literature, both theoretical and empirical, on the contributions of public financial management (PFM) systems and reforms to improving the effectiveness of health service delivery based on a literature review conducted by Goryakin et al. (2017). We consider both population health indicators as well as more proximate process indicators related to health system performance. The existing literature is limited and only 53 articles are reviewed, divided across three subthemes: first, "system quality" studies, on the impact of PFM quality and good governance generally; second, "health system strengthening" studies, including articles on medium-term expenditure frameworks (MTEFs), reforms related to budget transparency and participatory budgeting and decentralization; third, studies on the impact of donor-related reforms such as the introduction of sector-wide approaches (SWAps). The theoretical literature predicts that high-quality PFM systems will have a positive impact on various dimensions of performance; whereas evidence from empirical studies is more limited, though generally positive. Overall, evidence shows good governance has an important role in health service delivery. Increased public funding of health programmes is likely to be more effective in countries with better governance, but what this means in practice is highly context-specific.</p
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