A PANEL DATA ANALYSIS ON SOCIAL DETERMINANTS OF HEALTH IN OECD COUNTRIES

Yıl 2024, Cilt: 27 Sayı: 1, 65 - 90, 27.03.2024

Elif Akdemirel

https://doi.org/10.61859/hacettepesid.1347335

Cited By: 1

Öz

Health is affected by biological and genetic factors as well as social, economic and environmental factors. For a country to improve and make better health outcomes, the socioeconomic structure that influences health should identify and develop the social determinants of health. The aim of this study is to examine the indicators of social determinants of health among OECD countries with the effects of countries on health outcomes over the years. In this study, the period between 2000 and 2020 data are available from health outcomes such as life expectancy at birth (LE) and infant mortality rate (IMR), socioeconomic environment, physical environment, health behavior and health care factors, gross domestic product (GDP), labor force participation rate. (LFP), Unemployment (Unemp), population with tertiary education (TE), nitrogen oxide (NOX), sulfur oxide (SOX), exposure to PM2.5 (PM25), alcohol consumption (Alcohol), daily cigarette consumption (Smoke), sugar intake (Sugar), fat intake (Fat), number of doctors (DOC), number of hospital beds (BED), total health expenditures (THE), total health and social employment (HSWorker) and child vaccination rate / measles (Vaccine) was investigated. In the study, panel regression analysis was applied as a method and the period between 2000 and 2020 of OECD member countries was included in the analysis as a data set. As a result of the analysis, it was determined that the effects of GDP, TE, Sugar and THE on LE were positive and significant, while the effects of Alcohol, Smoke and SOX were negative and significant. For IMR, it was determined that the effect of SOX was positive and significant, while the effect of THE was negative and significant. The measures to be taken by governments regarding alcohol and tobacco policies will contribute to the prolongation of the LE. Policies to reduce SOX need to be strengthened in reducing infant mortality and improving health outcomes.

Anahtar Kelimeler

Social determinants of health, panel data analysis, life expectancy at birth, infant motality rate

OECD ÜLKELERİNDE SAĞLIĞIN SOSYAL BELİRLEYİCİLERİ ÜZERİNE BİR PANEL VERİ ANALİZİ

Öz

Sağlık, biyolojik ve genetik faktörlerin yanı sıra sosyal, ekonomik ve çevresel faktörlerden de etkilenmektedir. Bir ülkenin, sağlık sonuçlarını iyileştirmesi ve geliştirmesi için sağlığı etkileyen sosyoekonomik yapının, sağlığın sosyal belirleyicilerini belirlemeli ve geliştirmelidir. Bu çalışmada amaç, OECD ülkeleri arasında sağlığın sosyal belirleyicilerini temsil eden göstergelerin ülkelerin sağlık sonuçlarına etkisini yıllar içinde incelemektir. Çalışmada, 2000-2020 yılları arası verisi mevcut olan sağlık sonuçlarından doğumda beklenen yaşam süresi (DBYS) ve bebek ölüm hızının (BÖH), sosyoekonomik çevre, fiziksel çevre, sağlık davranışı ve sağlık hizmetleri faktörlerinden, gayri safi yurtiçi hâsıla (GSYİH), işgücüne katılım oranı (İKO), işsizlik (İŞZ), yüksek-öğretimli nüfus (YÖN), nitrojen oksit (NOX), sülfür oksit (SOX), PM2.5’e maruz kalma (PM25), alkol tüketimi (Alkol), günlük sigara tüketimi (GünSig), şeker alımı (Şeker), yağ alımı (Yağ), doktor sayısı (DrSay), hastane yatak sayısı (HasYatSay), toplam sağlık harcamaları (TSH), toplam sağlık ve sosyal istihdam (TSveSI) ve çocuk aşılama oranı/kızamık (CocukAO) ile ilişkisi incelenmiştir. Çalışmada yöntem olarak panel regresyon analizi uygulanmış ve veri seti olarak OECD üyesi ülkelerinin 2000-2020 arası dönemi analize dâhil edilmiştir. Analiz sonucunda, GSYİH, YÖN, Şeker ve TSH’nin, DBYS’ne etkisinin pozitif yönlü ve anlamlı, Alkol, GünSig ve SOX’in ise etkisinin negatif yönlü ve anlamlı olduğu tespit edilmiştir. BÖH’ına ise, SOX’in etkisinin pozitif yönlü ve anlamlı, TSH’nin ise etkisinin negatif yönlü ve anlamlı olduğu tespit edilmiştir. Hükümetlerin, alkol ve tütün politikaları ile ilgili alacakları önlemler, DBYS’nin uzamasına katkı sağlayacaktır. Bebek ölüm hızının azaltılmasında ve sağlık sonuçlarının iyileştirilmesinde, SOX’nin azaltılmasına yönelik yapılacak politikaların güçlendirilmesi gerekmektedir.

Anahtar Kelimeler

Sağlığın sosyal belirleyicileri, panel veri analizi, doğumda beklenen yaşam süresi, bebek ölüm hızı

Kaynakça

• Abide, Ç.Y., Çoğendez, E., Kumru, P., Ergen, E.B. & Kılıççı, Ç. (2018). Gebelikte kullanılan sigara dozunun maternal ve fetal sonuçlar ile ilişkisi. Zeynep Kamil Tıp Bülteni, 49(1), 31-35.
• Ağazade, S. (2014). Türkiye’de işsizlik ve işgücüne katılım ilişkisinin doğrusal ve doğrusal olmayan koentegrasyon yöntemleri ile analizi. Eskişehir Osmangazi Üniversitesi İİBF Dergisi, 9(3), 145–161.
• Akcan, M.B. & Telli Üçler, Y. (2022). Türkiye’de 1991-2019 yılları arası bebek ölümlerinin sosyoekonomik belirleyicileri. Niğde Ömer Halisdemir Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 4(1), 58-66.
• Akın, C. S. (2007). Sağlık ve sağlık harcamalarının ekonomik büyüme üzerine etkisi: Türkiye’de sağlık sektörü harcamaları [Yuksek Lisans Tezi]. Çukurova Üniversitesi.
• Alkaya, A. & Gülbahar, H. O. (2022). Sağlık harcamaları üzerinde sağlık harcamaları belirleyicileri etkisi: OECD ülkeleri panel regresyon analizi. 3.Sektör Sosyal Ekonomi Dergisi, 57(1), 47-67.
• Anwar, A., Hyber, S., Nor, N.M. & Younis, M. (2023). Government health expenditures and health outcome nexus: A study on OECD countries. Frontiers in Public Health. 11, 1-7.
• Artiga, S. & Hinton. E. (2018). Beyond health care: The role of social determinants in promoting health and health equity. Henry J. Kaiser Family Foundation.
• Atılgan, D. & İspir, T. (2022). Yapısal kırılmalar altında bebek ölüm oranını etkileyen faktörler: Afrika ülkelerinden kanıtlar. Business, Economics and Management Research Journal, 5(3), 234-244.
• Aydan, S., Bayın Donar, G. & Arıkan, C. (2021). Kamu sağlık ve sosyal harcamalarının sağlık sonuçları üzerindeki etkisi: OECD ülkelerinde bir panel veri analizi. Hacettepe Sağlık İdaresi Dergisi, 24(3), 469-482.
• Ayoade, M.A. (2019). Regional and socioeconomic inequalities in infant mortality in Nigeria. GeoJournal, 85(2), 1-19.
• Bartley, M. & Plewis, I. (2002). Accumulated labour market disadvantage and limiting long-term illness: Data from the 1971-1991 office for national statistics’ longitudinal study. International Journal of Epidemiology, 31, 336–341.
• Bionity, (2023, August 18). Sugar leads to early death, but not due to obesity. Bionity. https://www.bionity.com/en/news/1165521/sugar-leads-to-early-death-but-not-due-to-obesity.html.
• Braveman, P., Egerter, S. & Barclay, C. (2011). What shapes health-related behaviors? The role of social factors. Exploring the social determinant of health. Robert Wood Johnson Foundation: Issue Brief Series.
• Braveman, P. & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Rep, 129, 19–31.
• Bunyaminu A., Mohammed, I., Yakubu, I.N. vd., (2022). The effect of health expenditure on average life expectancy: Does government effectiveness play a moderating role?. International Journal of Health Governance, 27(4), 365-377.
• Butler, S. M., Matthew, D. B. & Cabello, M. (2017). Re-balancing medical and social spending to promote health: Increasing state flexibility to improve health through housing. Brookings.
• Chelak, K. & Chakole, S. (2023). The role of social determinants of health in promoting health equality: A narrative review. Cureus, 15(1).
• Couso-Viana, S., Bentué-Martínez, C., Delgado-Martín, M. V. vd., (2022). Analysis of the impact of social determinants and primary care morbidity on population health outcomes by combining big data: A research protocol. Frontiers in Medicine, 9, 1-9.
• Dahlgren G, Whitehead M. (1991). Policies and strategies to promote social equity in health background document to Who – strategy paper for europe. Stockholm, Sweden: Institute for FuturesStudies.
• Dales, R., Burnett, R.T., S-Dorion, M. vd., (2004). Air pollution and sudden infant death syndrome. Pediatrics, 113(6), 628-31.
• Darama, A. (2023, Ağustos 18). Gebelikte şeker hastalığı. Opr.Dr.Ayşe Darama. https://www.aysedarama.com/gebelikte-seker-hastaligi.
• DeSouza, P.N., Dey, S., Mwenda, K.M. vd., (2022). Robust relationship between ambient air pollution and infant mortality in India. Science of The Total Environment, (815), 152755.
• Dooley, D., Fielding, J. & Levi, L. (1996). Health and unemployment. Annual Review of Public Health, 17, 449–465. Duyar, I. (2013). Çalış(tırıl)an çocuklarda bedensel yıpranmalar. İnsanBilim Dergisi, 2(1), 1-14.
• Elliott, A.J., Kinney, H.C., Haynes, R.L. vd., (2020). Concurrent prenatal drinking and smoking increases risk for SIDS: Safe passage study report. EClinicalMedicine Part of The Lancet Discovery Science, 19, 1-10.
• Eştürk, Ö. (2018). Türkiye’de şeker sektörünün önemi ve geleceği üzerine bir değerlendirme. In Anatolian Journal of Economics and Business, 2(1), 67-81.
• Fuchs, V. R. (2004). Reflections on the socio-economic correlates of health. Journal of Health Economics, 23(4), 653–661.
• Gillespie, K.M, Kemps, E., White, M.J. & Bartlett, S.E. (2023). The impact of free sugar on human health-a narrative review. Nutrients, 15(4), 889.
• Gisselmann, M. D. (2005). Education, infant mortality, and low birth weight in Sweden 1973-1990: Emergence of the low birth weight paradox. Scandinavian Journal of Social Medicine, 33, 65–71.
• Greene, W. H. (2008). The econometric approach to efficiency analysis William H. Greene. In The Measurement of Productive Efficiency and Productivity Change (pp. 92–250). Oxford University Press.
• Grossman, M. (2006). Education and nonmarket outcomes. In Handbook of the Economics of Education (Vol. 1, pp. 577–633).
• Gumà, J., Solé-Auró, A. & Arpino, B. (2019). Examining social determinants of health: The role of education, household arrangements and country groups by gender. BMC Public Health, 19(1), 1-9.
• Güleryüz, E.H. & Köse, T. (2017). İşsizlik ve sağlık göstergeleri: Türkiye örneği. Finans Politik & Ekonomik Yorumlar, 54, 633.
• Hao, L., Xu, X., Dupre, M.E. vd., (2020). Adequate access to healthcare and added life expectancy among older adults in China. BMC Geriatrics, 20(129), 1-15.
• Hergenrather, K. C., Zeglin, R. J., McGuire-Kuletz, M. vd., (2015). Employment as a social determinant of health: A systematic review of longitudinal studies exploring the relationship between employment status and physical health. Rehabilitation Research Policy and Education, 29(1), 2–26.
• Islam, M. M. (2019). Social determinants of health and related inequalities: Confusion and implications. In Frontiers in Public Health (Vol. 7, Issue FEB). Frontiers Media S.A.
• Jaba, E., Balan C.B. & Robu, I.B. (2014). The relationship between life expectancy at birth and health expenditures estimated by a cross-country and time-series analysis. Procedia Economics and Finance, 15, 108-114.
• Jeong, A.-S., Lee, K.-S. & Shin, H.-S. (2007). The determinants of health outcome between two health care financing systems. Health Policy and Management, 17, 31-53.
• Joumard, I., André, C., Nicq, C. ve Chatal, O. (2008). Health status determinants: lifestyle, environment, health care resources and efficiency, OECD Economics Department. Working Papers, No. 627, OECD Publishing, Paris.
• Kasım H. , Bekar T., Bulut Y. E. & Piyal B. (2023). The effect of particulate air pollution on infant mortality in the short term: The case of Ankara province in 2018-2020. Turkish Journal of Family Medicine and Primary Care, 1-10, 351-359.
• Kennedy, P. (2006). Ekonometri Klavuzu (5.Baskı). Gazi Kitabevi.
• Kim, S.-H., Kwon, I.-W. G. & Martin, D. (2017). Statistical analysis of social determinants of health: An exploratory study for global comparison. Management Review: An International Journal, 12(2), 1-29.
• Kiross, G.T., Chojenta, C., Barker, D. vd., (2020). The effects of health expenditure on infant mortality in Sub-Saharan Africa: Evidence from panel data analysis. Health Economics Review, 10(5), 1-9.
• Kumar, P., Patel, R., Chanhan S. vd., (2021). Does socio-economic inequality in infant mortality still exists in India? An analysis based on national family health survey 2005–06 and 2015–16. Clinical Epidemiology and Global Health, 9, 116-122.
• Küçükkaya, H., Özçağ, M. & Bozdağlıoğlu, Y. (2019). Geçiş ekonomilerinde işgücüne katılım oranı ile işsizlik oranı ilişkisinin dinamik panel veri analizi, dynamic panel data analysis of relationship between labor force participation rate and unemployment rate in transition economies. Journal of Yaşar University, 14, 62-68.
• Laaksonen, M., Rahkonen, O., Martikainen, P. vd., (2005). Socioeconomic position and self-rated health: The contribution of childhood socioeconomic circumstances, adult socioeconomic status, and material resources. American Journal of Public Health, 95(8), 1403–1409.
• Marmot, M. (2005). Social determinants of health inequalities. Lancet, 365(9464), 1099–1104.
• Marmot, M. (2011). Global action on social determinants of health. In Bulletin of the World Health Organization, 89(10), 702.
• Montgomery, D. C., Peck, E. A. & Vining, G. G. (2012). Introduction to linear regression analysis (6th ed.). John Wiley & Sons Inc.
• Nygren-Krug, H. (2002). 25 questions & answers on health & human rights. World Health Organization.
• OECD. (2023a, July 22). Air and Ghg Emissions. https://data.oecd.org/Air/Air-and-Ghg-Emissions.Htm
• OECD. (2023b, July 22). https://data.oecd.org/Eduatt/Population-with-Tertiary-Education.Htm
• OECD. (2023c, July 22). PM2.5. https://stats.oecd.org/Index.Aspx?DataSetCode=EXP_PM2_5
• Oh, C., Han, S. & Jeong, J. (2020). Time-series data augmentation based on interpolation. Procedia Computer Science, 175, 64–71.
• Ortigoza, A., Gouveia, N., Kephart, J. vd., (2021). Association between ambient PM2·5 and under-5, infant, and child mortality in Latin America, 2010–15: A longitudinal analysis. The Lancet, (5), 16.
• Öngören, B. (2020). Sağlığın sosyal belirleyicileri açısından Türkiye, Ege Bölgesi ve Muğla üzerine bir değerlendirme. Güncel Sosyoloji ve Felsefe Araştırmaları, Akademisyen Kitabevi A.Ş.
• Östergren, O., Martkainen, P. & Lundberg, O. (2017). The contribution of alcohol consumption and smoking to educational inequalities in life expectancy among Swedish men and women during 1991–2008. International Journal of Public Health, 63, 41-48.
• Or, Z. (2000). Determinants of health outcomes in industrialised countries: A pooled, cross-country, time-series analysis. OECD Economic Studies, 30, 53–78.
• Park, M. B. & Nam, E. W. (2019). National level social determinants of health and outcomes: Longitudinal analysis of 27 industrialized countries. SAGE Open, 9(2), 1-8.
• Park, Y., Mulligan, N., Gleize, M. vd., (2021). Discovering associations between social determinants and health outcomes: Merging knowledge graphs from literature and electronic health data. AMIA Annual Symp Proc, 940-949.
• Poerwanto, S., M. Stevenson & De Klerk, N. (2003). Infant mortality and family welfare: Policy implications for Indonesia, Journal of Epidemiology & Community Health, 57(7), 493- 498.
• Sey, N. & Aydın, B. (2019). Beklenen yaşam süresinin belirleyicileri: Japonya örneği üzerine ekonometrik bir inceleme. Uluslararası Ekonomi, İşletme ve Politika Dergisi, 3(2), 151-170.
• Shobiye, D.M., Omotola, A., Zhao, Y., Zhang, J., Ekawati, F.M. & Shobiye, H.O. (2022). Infant mortality and risk factors in Nigeria in 2013−2017: A population-level study. The Lancet, 51(101622), 1-12.
• Şahin, G. (2022). Yüksek hava kirliliği yaşanan ülkelerde doğumda yaşam beklentisi ve çevresel bozulma bağlantısı. Ekonomi, Politika & Finans Araştırmaları Dergisi, 7(3), 758-783.
• Şahin, M. (2018). Sağlığın sosyal belirleyicileri ve sosyal politikalar. In Türkiye’de Sağlık Harcamaları ve Özel Kesim Uygulamaları, Ekin Basım Yayın.
• Townsend, P., Whitehead, M. & Davidson, N. (1992). Inequalities in health: The black report, the health divide. In Inequalities in Health: The Black Report & the Health Divide. Penguin Books Ltd. University of Wisconsin Population Health Institute. (2023, July 22). County Health Rankings & Roadmaps/CHR&R. https://www.countyhealthrankings.org/about-us
• WHO. (1978). Declaration of Alma-Ata, International Conference on Primary Health Care, Alma-Ata.
• WHO. (2023a, July 22). Air Quailty and health. https://www.who.int/News-Room/Fact-Sheets/Detail/Ambient-(Outdoor)-Air-Quality-and-Health
• WHO. (2023b, July 22). Commission on Social Determinants of Health. https://www.who.int/initiatives/action-on-the-social-determinants-of-health-for-advancing-equity/world-report-on-social-determinants-of-health-equity/commission-on-social-determinants-of-health
• WHO. (2023c, July 22). Measles. https://www.who.int/News-Room/Fact-Sheets/Detail/Measles?Gclid=CjwKCAjw5MOlBhBTEiwAAJ8e1oK2xIgZ-_cNq0HuUGUyv7G3UWxAt0DvWC4lT-Toi-GB9Jt20Evq4hoCpCMQAvD_BwE
• WHO. (2023d, July 22). Social Determinants of Health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
• WHO. (2023e, July 22). Social Determinants of Health 2. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_2
• WHO. (2023f, July 22). Social determinants of health 3. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_3
• WHO. (2023g, July 22). Tobacco. https://www.who.int/Health-Topics/Tobacco#tab=tab_1
• WHO. (2023h, July 22). Alcohol. https://www.who.int/health-topics/alcohol#tab=tab_1
• WHO. (2008). Closing the Gap in a Generation: Health Equity Th rough Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health.
• WHO. (2010). A Conceptual Framework for Action on the Social Determinants of Health.
• WHO. (‎2010a)‎. Action on the social determinants of health: learning from previous experiences. World Health Organization. https://apps.who.int/iris/handle/10665/44488
• Yetim, B., Demirci, Ş., Konca, M., İlgün, G. & Çilhoroz, Y. (2021). Türkiye’de bebek ölüm hızının sosyoekonomik belirleyicileri. Sosyoekonomi, 29(47), 367-381.