Economic growth, income equality, and population health among the Asian Tigers

Is Economic Growth Good for Population Health? A Critical Review

A large multidisciplinary literature discusses the relationship between economic growth and population health. The idea that economic growth is good for societies has inspired extensive academic debate, but conclusions have been mixed. To help shed light on the subject, this paper focuses on opportunities for consensus in this large literature. Much scholarship finds that the health-growth relationship varies according to (1) which aspect of "health" is under consideration, (2) shape (e.g., positive linear or logarithmic), (3) issues of timing (e.g., growth over the short or long term), (4) a focus on health inequalities as opposed to population averages, and (5) multivariable relationships with additional factors. After reflecting upon these findings, I propose that economic growth promotes health in some respects, for some countries, and in conjunction with other life-supporting priorities, but does not by itself improve population health generally speaking. I then argue there is already wide, interdisciplinary consensus to support this stance. Moreover, policies focusing exclusively on economic growth threaten harm to both population health and growth, which is to say that political dynamics are also implicated. Yet multivariable approaches can help clarify the bigger picture of how growth relates to health. For moving this literature forward, the best opportunities may involve the simultaneous analysis of multiple factors. The recognition of consensus around these issues would be welcome, and timely.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42650-023-00072-y.

Predictors of (in)efficiencies of Healthcare Expenditure Among the Leading Asian Economies - Comparison of OECD and Non-OECD Nations

Purpose

The goal of this study was to assess the effectiveness of healthcare spending among the leading Asian economies.

Methods

We have selected a total of nine Asian nations, based on the strength of their economic output and long-term real GDP growth rates. The OECD members included Japan and the Republic of Korea, while the seven non-OECD nations were China, India, Indonesia, Malaysia, Pakistan, the Philippines, and Thailand. Healthcare systems efficiency was analyzed over the period 1996–2017. To assess the effectiveness of healthcare expenditure of each group of countries, the two-way fixed effects model (country- and year effects) was used.

Results

Quality of governance and current health expenditure determine healthcare system performance. Population density and urbanization are positively associated with a healthy life expectancy in the non-OECD Asian countries. In this group, unsafe water drinking has a statistically negative effect on healthy life expectancy. Interestingly, only per capita consumption of carbohydrates is significantly linked with healthy life expectancy. In these non-OECD Asian countries, unsafe water drinking and per capita carbon dioxide emissions increase infant mortality. There is a strong negative association between GDP per capita and infant mortality in both sub-samples, although its impact is far larger in the OECD group. In Japan and South Korea, unemployment is negatively associated with infant mortality.

Conclusion

Japan outperforms other countries from the sample in major healthcare performance indicators, while South Korea is ranked second. The only exception is per capita carbon dioxide emissions, which have maximal values in the Republic of Korea and Japan. Non-OECD nations’ outcomes were led by China, as the largest economy. This group was characterized with substantial improvement in efficiency of health spending since the middle of the 1990s. Yet, progress was noted with remarkable heterogeneity within the group.

Equally inequitable? A cross-national comparative study of racial health inequalities in the United States and Canada

Prior research suggests that racial inequalities in health vary in magnitude across societies. This paper uses the largest nationally representative samples available to compare racial inequalities in health in the United States and Canada. Data were obtained from ten waves of the National Health Interview Survey (n = 162,271,885) and the Canadian Community Health Survey (n = 19,906,131) from 2000 to 2010. We estimated crude and adjusted odds ratios, and risk differences across racial groups for a range of health outcomes in each country. Patterns of racial health inequalities differed across the United States and Canada. After adjusting for covariates, black-white and Hispanic-white inequalities were relatively larger in the United States, while aboriginal-white inequalities were larger in Canada. In both countries, socioeconomic factors did not explain inequalities across racial groups to the same extent. In conclusion, while racial inequalities in health exist in both the United States and Canada, the magnitudes of these inequalities as well as the racial groups affected by them, differ considerably across the two countries. This suggests that the relationship between race and health varies as a function of the societal context in which it operates.

Interplay of politics and law to promote health: improving economic equality and health: the case of postwar Japan

The health situation in Japan after World War II was extremely poor. However, in less than 35 years the country's life expectancy was the highest in the world. Japan's continuing health gains are linked to policies established at the end of World War II by the Allied occupation force that established a democratic government. The Confucian principles that existed in Japan long before the occupation but were preempted during the war years were reestablished after the war, facilitating subsequent health improvements. Japan's good health status today is not primarily the result of individual health behaviors or the country's health care system; rather, it is the result of the continuing economic equality that is the legacy of dismantling the prewar hierarchy.

Can social factors explain sex differences in insomnia? Findings from a national survey in Taiwan

STUDY OBJECTIVE

To examine sociological explanations for the higher level of insomnia in women, including social roles and socioeconomic status (SES).

DESIGN

Cross sectional survey research

SETTING

Taiwanese 2001 "social trend survey"

PARTICIPANTS

A nationally representative sample of 39,588 citizens aged 15 years or older living in Taiwan.

MAIN RESULTS

On average, women scored 1.25 points higher than men on the insomnia inventory (p<0.001) but after controlling for social roles, the sex discrepancy in insomnia decreased slightly. SES did not, however, explain women's higher levels of insomnia. Subscale analysis showed an association between the role of homemaker and increased night time sleep disturbance and decreased daytime sequelae of poor sleep while higher educational attainment was related only to more severe daytime sequelae.

CONCLUSION

The sex discrepancy in insomnia narrowed slightly after taking social role factors into consideration but was not explained by SES. The persistent sex gap in insomnia warrants further investigation.

State size as measured in terms of public spending and world health, 1990-2000

OBJECTIVE

To determine the relationship between state size (measured in terms of public spending) and public health indicators in a sample of countries representing all regions of the world and from 1990-2000.

METHODS

An ecological study was performed using data on Central Government Spending (CGS) and per capita Gross National Product (GNP) obtained from the International Monetary Fund, and on life expectancy, maternal, and infant mortality, provided by the World Health Organization. A multiple linear regression model was fitted to estimate the effect of CGS on health, which also took into consideration per capita GNP and geographical region.

RESULTS

CGS varied little over the study period, with convergence around an average of 28%, but within a relatively wide range (7.80-53.0%); the countries with the strongest economies (according to per capita GNP) had the highest levels of CGS. The influence of this factor was particularly relevant for the infant mortality rate (r = 0.40; beta = -1.327; EE = 0.237; t = -5.590; p < 0.001). Per capita GNP and geographic location were also associated with variations in health; health indicators tended to be worse for poorer countries in Africa and Asia. In the adjusted model, CGS was statistically significant with regard to infant and maternal mortality rates.

CONCLUSION

The study suggests that state size (in terms of public spending) has an important influence upon health and particularly upon mortality. Although it is important to bear in mind the limitations of this study and the reduced time window used, these results should be taken into consideration in the current political and epidemiological debate.