Inadequate Bivariate Measures of Health Inequality: The Impact of Income Distribution*

Bivariate measures of health inequality are influenced by changes in two variables: health and a socioeconomic variable, such as income. For these measures, what is reported as an increase in health inequality might just as well be a reduction in income inequality. In particular, several papers have found that socioeconomic health inequalities in Nordic countries are no less than in other European countries. The correct interpretation could just be that income inequality is no higher in Nordic countries than in the rest of Europe. The problem is especially profound when the causality is running from health to income.     

Bread and Social Justice: Measurement of Social Welfare and Inequality Using Anthropometrics

We address the question of the measurement of health achievement and inequality in the context of variables exhibiting an inverted-U relation with health and well-being. The chosen approach is to measure separately achievement and inequality in the health increasing range of the variable, from a lower survival bound a to an optimum value m, and in the health decreasing range from m to an upper survival bound b. Because in the health decreasing range, the equally distributed equivalent value associated with a distribution is decreasing in progressive transfers, the paper introduces appropriate relative and absolute achievement and inequality indices to be used for variables exhibiting a negative association with well-being. We then discuss questions pertaining to consistent measurement across health attainments and shortfalls, as well as the ordering of distributions exhibiting an inverted-U relation with well-being. An illustration of the methodology is provided using a group of five Arab countries.     

Economic Development Indicators as Determinants of Medal Winning at the Sydney Olympics: An Extreme Bounds Analysis

This paper examines the variables that determine the performance of countries at the Olympic Games as measured by a weighted sum of the medals won at the Sydney 2000 Games. While previous studies have identified the importance of a country's economic size and the resources available to sport, this paper examines nine more variables including the number of athletes representing each nation and some development indicators. Based on 2310 regressions, both traditional and restricted extreme bounds analysis show that only two variables are robust: the number of athletes and national expenditure on health. Thus, the final model recognises four explanatory variables that include these two as well as GDP and population.     

Adaptation and Mitigation in Long-term Climate Policy

The paper analytically explores the optimal allocation of investments into mitigation and environmental adaptation against climate change damages at a macroeconomic level. The economic-environmental model is formulated as a social planner problem where adaptation and abatement investments are separate decision variables. The existence of a unique steady state is proven. A comparative static analysis of optimal investments leads to essential implications for associated long-term environmental policies. It is shown that the optimal policy mix between adaptation and mitigation is lower for countries with higher economic efficiency for all applicable parameter ranges. Data calibration and numerical simulations are provided to estimate practical validity of theoretical outcomes.     

On the determination of the US aggregate health care expenditure

Per capita real health care expenditure is examined against three major groups of explanatory variables: economic, demographic, and health stock, and it is found that the three groups of variables have an impact on real health care spending. Other subcategories, such as real private, and government health care, pharmaceutical, dental, home nursing, ambulatory, personal medical consumption, and in-patient expenditures have also been examined, and have been found to be affected by the explanatory variables. For several subcomponents there is evidence of supplier inducement. Of the demographic group of variables, the ageing population had an impact only on the per capita real overall, and private health care outlay, and pharmaceutical spending. Also, cointegrating relationships were found and consistent estimators of the elasticities found.     

The Impact of Power Equality,Income, and the Environment on Human Health: Some Inter‐Country Comparisons

Economic studies on environmental degradation generally have a narrow focus on per capita income as an explanatory variable, and often fail to distinguish among the various types of environmental quality or damage. This paper addresses both problems by examining the effect of relative equality in the distribution of power on environmental outcomes, and making a clear distinction between health‐related environmental outcomes and so‐called ‘environmental amenities,’ only the latter of which should correlate strongly with income. This paper introduces a national index of power equality that is derived from related socioeconomic variables, and studies its effects on individual country achievement in addressing environmental quality and population health. This model is applied to a data set of 180 countries, as well as to subgroups of the entire country set. Employing disability‐adjusted life expectancy and the population child mortality rate as two health proxies, this paper finds that power equality in most cases positively influences population health, and that power equality is in every case no worse and in some cases better than per capita income at explaining population health.     

Interrelationships between income,health and the environment: extending the Environmental Kuznets Curve hypothesis

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.     

PUBLIC PROGRAMS PARE POVERTY: EVIDENCE FROM CHILE

This study examines the effect of government health care and education programs on the poor in Chile from 2000 to 2006. Results are obtained from a country-wide provincial-level panel data set with information on poverty and indigence head-count ratios, measures on the severity of poverty as captured by the Foster–Greer–Thorbecke P ₂ statistic, per capita public expenditures on health and education, as well as other variables that are thought to influence well-being. We use fixed-effects techniques to correct for time-invariant province-specific characteristics that may affect program placement. Our analysis demonstrates that per capita public health and education expenditures significantly reduce the incidence of poverty and indigence in Chile. In particular, for a 10,000 pesos (about $23) increase in provincial per capita health spending, the poverty head-count ratio decreases by 0.48 percent. Per capita education expenditures are particularly important to reducing the severity of poverty. Our results indicate that for a 10,000 pesos increase in education spending, the severity of poverty declines by as much as 1.53 percent. Furthermore, we provide evidence that public spending in Chile is non-random. In particular, government education expenditures may be allocated in keeping with compensatory motives.     

Effects of a short-term linguistic class on communication competence of international nurses: implications for practice, policy, and research

International nurses face a host of challenges in their transition and adaptation to the U.S. health care environment. Language and communication barriers have been ranked consistently as a top concern by employers, regulatory agencies, and international nurses themselves. Researchers in this study examined the effects of a 10-week linguistic class on the reduction of phonologic errors affecting foreign accent in a sample of international nurses. The linguistic course appeared to be effective in improving the international nurses' linguistic competence by reducing their phonologic errors significantly. Moreover, the intervention narrowed the linguistic gap between international nurses from non-English and English-speaking countries. Findings from this study have important implications for practice, policy, and research regarding quality of care, as well as for the transition, job satisfaction, and retention of international nurses.     

Is Post-Communist Health Spending Unusual?

What factors determine a country's spending on health? And what factors determine the share of spending financed by the public sector? Taking these factors into account, is post-communist health spending unusual? For the OECD economies, we find that per capita health spending is strongly related to per capita income, with an elasticity of about 1.5. The elasticity for developing economies is close to one. Spending is also positively related to the elderly dependency rate, but the relationship is weaker than a static comparison of spending by the elderly and non-elderly would suggest. Even though health spending as a share of GDP in the post-communist countries of eastern and central Europe is below the OECD average, there is evidence of above normal health spending in most countries when we control for income and demographics. For Hungary, the ‘excess’ spending reached over three percentage points of GDP in 1994. For the OECD sample, four development indicators account for half the variation in the public sector share of total health spending. Political variables help explain the remainder. If the post-communist countries converge to the market economy pattern, the share of public financing will fall, yet still remain well above half.     

MENTAL HEALTH AND LIFE SATISFACTION OF YOUNG AUSTRALIANS: THE ROLE OF FAMILY BACKGROUND*

This paper uses the Household, Income and Labour Dynamics in Australia Survey to investigate the factors that influence young Australians’ mental health and life satisfaction, with an emphasis upon the role of family background. It also explores male and female differences concerning those background effects. The results indicate a particularly significant negative association between parental divorce and well‐being, and suggest that the timing of divorce matters. Distinguishing the samples by gender shows that this relationship remains significant only for females. Past living arrangements consistently turn out to be statistically insignificant whether the sample used is the total, males or females. The current living arrangements, however, appear to be significantly associated with both mental health and life satisfaction of males. Adding potentially confounding characteristics to our basic regression, which includes only the family background variables, suggests that some of the ‘aggregate’ effects of family background might work indirectly through the mediating variables such as education or lifestyles, though most of them remain direct. Among those, marital status, education, labour market experience and lifestyles seem to be the major factors explaining the dispersion in well‐being of young Australians. Income and wealth, on the other hand, have only a minor impact.     

Using the stochastic health state function to forecast healthcare demand and healthcare financing: Evidence from Singapore

Typically, healthcare financing for an ageing population requires projections on healthcare demand and cost. However, projecting healthcare demand based on projected elderly does not consider changes in population health state over time. This paper proposes a new approach to forecast health variables using a stochastic health state function and the well‐established Lee–Carter stochastic mortality model. With the estimated health state at each age over time, we project the hospitalization rate, healthcare demand, and financing cost for Singapore using historical life tables and hospital admission data. Our findings show that while hospital insurance claims increase owing to an aging population, improving health state could save costs from hospital insurance claims. This has policy implications: more attention should be given to preventive healthcare such as health screening to improve the overall health state of the population.     

Spatial and economic patterns in life expectancy among US States

This study investigates the determinants of gender-specific life expectancy across US states over the period 1995–2007. We employ a production function specification where life expectancy depends on health expenditure, income, education and lifestyle variables, allowing for spatial effects. Empirical results suggest that education attainment and health expenditure are the main factors behind improving longevity, whereas smoking bears a strong negative influence. For robustness purposes, we also use health spending as well as education criteria, apart from geographical ones to model interstate spillovers. In the former case, states with similar health expenditure are ‘neighbors’ and affect positively the life expectancy process. If education is applied instead of health spending together with geographic proximity, the spatial correlation is insignificant, i.e. education ‘neighbors’ do not affect life expectancy. Our findings do not imply significant gender differences regarding health production. The results suggest that health care policy will have to focus on wider economic and social considerations, like education and lifestyle changes, except medical care provision in order to exploit the full potential for life expectancy improvements of the US population.     

New panel results on cointegration of international health expenditure and GDP

This article tests for existence of cointegration between health expenditure and GDP using data from 25 OECD countries for the period 19607ndash;1997. The empirical modelling is based on a heterogeneous bivariate vector error correction panel model that allows for trending data as well as intercepts and trends in the cointegrating relations. Univariate country-by-country and panel unit root tests generally fail to reject the null of a unit root in the health expenditure and GDP variables. Country-by-country results based on the Johansen multivariate likelihood-based inference indicate somewhat mixed results on country-specific cointegration with a rank of one found for 12 countries and a rank of zero for the remaining 13 countries. Application of a new panel test for cointegration rank with higher power than the individual tests indicates that health expenditure and GDP are cointegrated around linear trends.     

Economic and other determinants of infant and child mortality in small developing countries: the case of Central America and the Caribbean

Inter-country differences in infant and child mortality are explained by looking at demographic, economic, health and educational factors. A model is presented in which the infant mortality rate, the child mortality rate, and the birth rate are endogenous. The model is tested using cross-national multiple regression analysis and simulations. The presence of simultaneity is confirmed. Introducing non-economic factors transforms the character of the relationship between exogenous and endogenous variables, from a 'diminishing returns' to an 'increasing returns' one. The role played by public expenditure in education, vaccination coverage, low birth weight, female schooling, number of nurses, access to safe water, or malnutrition can be assessed, as well as that played by 'structural adjustment' variables such as the inflation rate or the external debt to GNP ratio. Infant and child mortality can be diminished everywhere in the region with relatively small amounts of expenditure. Disappointing outcomes in some countries obey political rather than economic problems. It would be a mistake to blame the debt crisis.     

Generalized cointegration: a new concept with an application to health expenditure and health outcomes

We propose a new generalization of the concept of cointegration that allows for the possibility that a set of variables are involved in an unknown nonlinear relationship. Although these variables may be unit-root non-stationary, there exists a nonlinear combination of them that takes account of such non-stationarity. We then introduce an estimation technique that allows us to test for the presence of this generalized cointegration in the absence of knowledge as to the true nonlinear functional form and the full set of regressors. We outline the basic stages of the technique and discuss how the issue of unit-root non-stationarity and cointegration affects each stage of the estimation procedure. We then apply this technique to the relationship between health expenditure and health outcomes, which is an important but controversial issue. A number of studies have found very little or no relationship between the level of health expenditure and outcomes. In econometric terms, if there is such a relationship, then there should exist a cointegrating relationship between these two variables and possibly many others. The problem that arises is that we may be either unable to measure these other variables or that we do not know about them, in which case we may incorrectly find no relationship between health expenditures and outcomes. We then apply the concept of generalized cointegration; we obtain a highly significant relationship between health expenditure and health outcomes.     

Is soccer good for you? The motivational impact of big sporting events on the unemployed

We examine the effect of salient international soccer tournaments on the motivation of unemployed individuals to search for employment using the German Socio Economic Panel 1984–2010. Exploiting the random scheduling of survey interviews, we find significant effects on motivational variables such as the intention to work or the reservation wage. Furthermore, the sporting events increase perceived health as well as worries about the general economic situation.     

Income–happiness paradox in Australia: Testing the theories of adaptation and social comparison

This paper investigates whether the theories of adaptation and social comparison can explain the income–happiness puzzle (Easterlin Paradox) in Australia. Alternative specifications of happiness model that incorporate adaption, comparison incomes and other relevant variables are estimated using the panel data from the five waves (2001–2005) of the Household Income and Labour Dynamics in Australia (HILDA) surveys. The statistical tests provide no support for the adaptation effect on happiness. However, we find strong support for the theory of social comparison as an explanation for the happiness paradox. An increase in peer group income hurts the poor more than the rich, suggesting that a redistribution of income is likely to enhance the overall wellbeing of society. A sensitivity analysis is conducted to check the robustness of results.     

Climate and happiness

Climate is an important input to many human activities. Climate affects heating and cooling requirements, health, clothing and nutritional needs as well as recreational activities. As such, it is to be expected that individuals will have a preference for particular types of climate. This paper analyses a panel of 67 countries attempting to explain differences in self-reported levels of happiness by reference to, amongst other things, temperature and precipitation. Various indices are used for each of these variables, including means, extremes and the number of hot, cold, wet and dry months. Using a panel-corrected least squares approach, the paper demonstrates that, even when controlling for a range of other factors, climate variables have a highly significant effect on country-wide self-reported levels of happiness. On the basis of these results, it is determined that differential patterns of anthropogenically induced climate change might alter dramatically the distribution of happiness between nations, with some countries moving towards a preferred climate and others moving further away. We find that high-latitude countries included in our dataset might benefit from temperature changes. Countries already characterized by very high summer temperatures would most likely suffer losses from climate change.     

Impact of Human Capital Endowments on Inequality of Outcomes in Cameroon

This paper evaluates the impact of human capital endowments on measured inequality in Cameroon. We first estimate determinants of household economic well‐being (HEW) in which human capital endowments are considered as endogenous effort‐related regressors, while controlling for exogenous circumstance‐related variables. Second, we simulate alternative counterfactual distributions of HEW: one in which human capital endowments are equalized; and the other in which variations are entirely attributable to the unobservable terms. Finally we compare inequality in the factual distribution of household well‐being with inequality in each of the simulated distributions. Direct and indirect exogenous opportunity‐inducing circumstances are inequality‐augmenting, whereas human capital endowments are inequality‐reducing in the actual distribution. Education and health interventions will ameliorate well‐being and mitigate inequality. Thus, leveling the playing ground for individuals to have equitable exposure to education, health and labor market participation is required for a low‐income country like Cameroon to enhance equity and sustainable household economic growth.