Türkiye’de Genel Sağlık Durumunun Belirleyicileri: Sosyo Ekonomik Faktörler ve Kapalı Ortam Hava Kirliliği

Abstract

Bireylerin sağlık düzeylerinin iyi olmaması yaşam şekilleri, içinde bulundukları sosyal sınıflar nedeniyle adil bir durum değildir. Bu çalışmanın amacı Türkiye’deki bireylerin genel sağlık durumlarını belirleyen temel faktörleri incelemektir. Analizde mikro veri seti olarak Türkiye İstatistik Kurumu (TÜİK) Gelir ve Yaşam Koşulları (GYK) 2015-2018 yıllarına ait yatay kesit verileri kullanılmıştır. Bireylerin genel sağlıklı durumunu etkileyebilecek sosyo ekonomik faktörlerin yanı sıra kapalı ortam hava kirliliği faktörleri genelleştirilmiş sıralı logit (gologit) yöntemi uygulanarak Türkiye için araştırılması amaçlanmıştır. Genelleştirilmiş sıralı logit model sonuçları, eğitimin ve gelirin yanı sıra yaşın, medeni durumun ve cinsiyetin genel sağlık durumunu etkileyen önemli faktörler olduğu yönündedir. Gelir ve eğitim düzeylerinde artış bireylerin genel sağlık durumunun iyi olma olasılığını artırmaktadır. Ayrıca kapalı ortam hava kirliliğine ilişkin olarak hanelerin yakıt olarak kullandığı doğalgaz sağlığı pozitif etkilerken kömür negatif yönde etkilemektedir. Çalışma bulgularının, eğitimde yapılanma politikalarının, gelir eşitliğini sağlayıcı politikaların ve temiz hava koşullarını sağlamaya yönelik politikaların sağlıklı bireylerin gelişmesinde ve toplumda sağlık düzeyi eşitsizliklerini aza indirgenmesinde önemli katkı sağlayacağı yönündedir.    

Keywords

• Sağlık Durumu
• Sosyo Ekonomik Statü
• Kapalı Ortam Hava Kirliliği

Determinants of General Health Status in Turkey: Socio-Economic Factors and Indoor Air Pollution

Abstract

The fact that individuals’ poor health is not a fair situation due to their lifestyle and social class. This study’s aim is to examine the main factors that determine the general health status of individuals in Turkey. The analysis is used micro-level data from the Turkish Statistical Institute (TURKSTAT) Cross-Sectional Income and Living Conditions Survey over the years 2015-2018. This study is to investigate the socio-economic factors which may effect on the general health status of individuals besides the indoor air pollution factor by applying the generalized ordered logit (gologit) methodology for Turkey. Gologit results indicate that age, marital status, gender are important factors affecting general health status, as well as education and income. The increase in income and education levels rises the probability of good general health status. In addition, concerning indoor air pollution, natural gas used by households as fuel for heating affects health positively, while coal affects health negatively. As a result, to improve the level of health in society, it is necessary to eliminate or reduce discrimination in socioeconomic status. The study findings point out the importance of policies on education reconstruction, income distribution and clean environment, improvement of health status and reduction of health inequalities.

Keywords

• Health Status
• Socio Economic Status
• Indoor Air Pollution
• Generalized Ordered Logit

References

1. Achia, T.N.O., A. Wangombe, N. Khadioli (2010). A Logistic Regression Model to Identify Key Determinants of Poverty Using Demographic and Health Survey Data. European Journal of Social Sciences, 13(1), 38-46.
2. Alptekin, D. (2018). Sağlığın Sosyal Belirleyicileri. Nurşen Adak (Ed.), Sağlık Sosyolojisi içinde (s.7895).http://www.egitim.club/wp-content/uploads/2017/06/Sa%C4%9Fl%C4%B1k-Sosyolojisi-17.pdf.
3. Aydın,K., (2019). Yaşam Koşulları ve Sağlık Hastalık Algıları. Sosyoloji Araştırmaları Dergisi , 22(1), 32-68.
4. Auster, R., Leveson, I. ve Sarachek, D. (1969). The Production of Health: An Exploratory Study. Journal of Human Resources, 4(4), 411-436.
5. Barro, R. ve Sala-I-Martin, X. (1995). Economic Growth. New York: McGraw-Hill.
6. Benzeval, M., J. Taylor, J. ve Judge, K. (2000). Evidence on the Relationship Between Low Income and Poor Health: Is the Government Doing Enough?. Fiscal Studies, 21(3), 375-399.
7. Beyaz Sipahi, B. (2021). Türkiye’de Obezite Üzerine Sosyoekonomik Faktörlerin Etkisi ve Gelir Eşitsizliği. Ankara Üniversitesi SBF Dergisi, 76 (2) , 547-573 . DOI: 10.33630/ausbf.822558
8. Blaxter, M. (2004). Health. Polity Press, USA.

9. Bloom, D., Canning, E.D. ve Sevilla, J. (2004). The Effect of Health on Economic Growth: A Production Function Approach. World Development, 32(1), 1-13.
10. Bolsoy, N. ve Sevil, Ü. (2006). Sağlık Hastalık ve Kültür Etkileşimi. Atatürk Üniversitesi Hemşirelik Yüksek Okulu Dergisi, 9(3):78-87, http://dergipark.gov.tr/download/article-file/29326.
11. Breysse, P.N., Diette, G.B., Matsui, E.C., Butz, A.M., Hansel, N.N. ve McCormack, M.C. (2010). Indoor Air Pollution and Asthma in Children. Proceeding of the American Thoracic Society, 7(2): 102–106. https://doi.org/10.1513/pats.200908- 083RM
12. Currie, J. ve Walker,R. (2011). Traffic Congestion and Infant Health: Evidence from E-Z Pass. American Economic Journal: Applied Economics, 3(1), 65-90.
13. Cutler, D. ve Leras-Muney, A. (2006). Education and Health: Evaluating Theories and Evidence. NBER Working Paper Series, working paper: 12352.
14. Dahlgren, G. ve Whitehead, M. (1991). Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute of Futures Studies.
15. Deaton, S.A. ve Paxson, H.C. (1998). Ageing and Inequality in Income and Health. American Economic Review, Papers and Proceedings, 88(2), 248-253.
16. Deaton, A. (2001). Inequalities in Income and Inequalities in Health. in F. Welch (ed.), The Causes and Consequences of Increasing Inequality, Chicago: U. Chicago Press, 285–313.
17. Deaton, A. (2006). Global Patterns of Income and Health: Facts, Interpretations and Policies. NBER Working Paper Series, working paper:12735.
18. Dionisio, K.L., Howie, S., Fornace, K.M., Chimah, O., Adegbola, R.A. ve Ezzati, M. (2008). Measuring the Exposure of Infants and Children to Indoor Air Pollution from Biomass Fuels in The Gambia. Indoor Air, 18, 317-327. https://doi.org/10.1111/j.1600-0668.2008.00533.x.
19. Doornbos, M.M. (2001). Professional Support for Family Caregivers of People with Serious and Persistent Mental Illnesses. Journal of Psychosocial Nursing Mental Health Service, 39(12), 38-45.
20. Etiler, N. (2016). Gender Differences in Self-Rated Health and their Determinants in Turkey: A Further Analysis of Turkish Health Survey. Turkish Journal of Public Health, 14(3), 152-166
21. Ettner, L.S. (1996). New Evidence on the Relationship Between Income and Health. Journal of Health Economics, 15(1), 67-85.
22. Ezzati, M. (2005). Indoor Air Pollution and Health in Developing Countries. Lancet 366(9480): 104-106. https://doi.org/10.1016/S0140- 6736(05)66845-6
23. Fogel, R.W. (1994). The Relevance of Malthus for the Study of Mortality Today: Long Run Influences on Health, Mortality, Labor Force Participation and Population Growth. NBER Historical Working Paper No: 54, National Bureau of Economic Research, Cambridge, MA. http://www.nber.org/papers/h0054.pdf
24. Frijters, P., Haisken-DeNew, J.P. ve Shields, M.A. (2005). The Causal Effect of Income on Health: Evidence from German Reunification, Journal of Health Economics, 24(5), 997-1017.
25. Fu, V. (1998). Estimating Generalized Ordered Logit Models. Stata Technical Bulletin 44: 2730. In Stata Technical Bulletin Reprints, 8, 160-164. College Station, TX: Stata Press.
26. Gao X, Yu, Q., Gu, Q., Chen, Y., Ding, K., Zhu, J. ve Chen, L. (2009). Indoor Air Pollution from Solid Biomass Fuels Combustion in Rural Agricultural Area of Tibet. China, Indoor Air, 19(3), 198-205. https://doi.org/10.1111/j.1600-0668.2008.00579.x
27. Giovanis, E. (2014). Relationship between Well-Being and Recycling Rates: Evidence from Life Satisfaction Approach in Britain. Journal of Environmental Economics and Policy, 3(2), 201-214
28. Gönç, Ş. T. (2013). Toplumsal Eşitsizlikler ve Sağlık. O. Elbek (Ed.), Kapitalizm Sağlığa Zararlıdır içinde (s.57-71). İstanbul: Hayy Kitap.
29. Grossman, M. (1972). The Demand for Health: A Theoretical and Empirical Investigation. New York: NBER Books.
30. Grossman, M. ve Kaestner, R. (1997). Effects of Education on Health. in J.R. Berhman, N. Stacey (ed.), The Social Benefits of Education, Ann Arbor: University of Michigan Press, 69124.
31. Grossman, M., (2000). The Human Capital Model. in A.J. Culyer, J.P. Newhouse (ed.). Handbook of Health Economics, Elsevier, Amsterdam, 1, 347-408
32. Hajdu T. ve Hajdu,G. (2015). Reduction of Income Inequality and Subjective Well-Being in Europe. Economics: The Open-Access, Open-Assessment E-Journal, 8(2014-35), 1-29.
33. Halliday, T.J. ve Park,M. (2009). Household Size, Home Health Care and Medical Expenditures. University of Hawaii at Manoa, Department of Economics, Working Paper, No:200916. http://www.economics.hawaii.edu/research/workingpapers/WP_0916.pdf.
34. Herzer D. ve Nunnenkamp,P. (2015). Income Inequality and Health: Evidence from Developed and Developing Countries. Economics: The Open-Access. Open-Assessment E-Journal,9(2015-4), 1-57.
35. Karaoğlan, D. ve Tansel,A. (2017). Determinants of Obesity in Turkey: A Quantile Regression Analysis from a Developing Country. MPRA Paper No. 76250. https://mpra.ub.unimuenchen.de/76250/
36. Kenkel, S.D. (1995). Should You Eat Breakfast? Estimates form Health Production Functions. Health Economics, 4(1), 15-29.
37. Laden, F., Neas, L.M., Dockery,D.W. ve Schwartz,J. (2000). Association of Fine Particulate Matter from Different Sources with Daily Mortality in Six US Cities. Environmental Health Perspectives, 108(10), 941–947.
38. Limanlı, Ö. (2021). Türkiye’de Sağlık ve Sosyoekonomik Sınıf. İktisadi İdari ve Siyasal Araştırmalar Dergisi, 6(15), 156-171.
39. Long JS ve Freese J (2014). Regression Models for Categorical Dependent Variables Using Stata. 3rd edn. Stata Press, College Station.
40. Lynch, J.W., Smith, G.D., Harper, S., Hillemeier, M., Ross, N., Kaplan, G.A. ve Wolfson, M. (2004). Is Income Inequality a Determinant of Population Health?, Part 1. A Systematic Review. Milbank Quarterly, 82(1), 5-99.
41. Maddala, G.S. (1983). Limited-Dependent and Qualitative Variables in Econometrics. UK: Cambridge University Press.
42. McCullagh, P.(1980).Regression Models for Ordinal Data. Journal of the Royal Statistical Society. Series B (Methodological), 42 (2), 109-142.
43. OECD, (2021). Glossary of statistical terms. https://stats.oecd.org/ glossary/detail.asp?ID=1336. Accessed 11 Jul 2021
44. Or, Z. (2000). Determinants of Health Outcomes in Industrialised Countries: A Pooled, Crosscountry, Time Series Analysis. OECD Economic Studies No. 30, Organization for Economic Cooperation and Development, Paris, France.
45. Ostro, B., Broadwin,R. Green, S., Feng,W.Y. ve Lipsett,M. (2006). Fine Particulate Air Pollution and Mortality in Nine California Counties: Results from CALFINE. Environmental Health Perspectives, 114(1), 29-33.
46. Özdamar, Ö. ve Giovanis, E. (2017). Being Healthy in Turkey: A Pseudo-Panel Data Analysis. Hacettepe University Journal of Economics and Administrative Sciences , 35(1), 89-110.
47. Preston, S.H. (1975). The Changing Relation between Mortality and Level of Economic Development. Population Studies, 29:231–48.
48. Rodgers, G.B. (1979). Income and Inequality as Determinants of Mortality: An International Cross-Section Analysis. Population Studies, 33, 343–51.
49. Rosenzweig, M.R. ve Schultz, T.P. (1991). Who Receives Medical Care? Income, Implicit Prices, and the Distribution of Medical Services among Pregnant Women in the United States. Journal of Human Resources, 26(3), 473-508.
50. Ross, C.E. ve Mirovsky,J. (1995). Does Unemployment Affect Health?. Journal of Health and Social Behavior, 36(3), 230–243.
51. Salas, C. (2002). On the Empirical Association between Poor Health and Low Socioeconomic Status at Old Age. Health Economics, 11(3), 207-220.
52. Schultz, T.P. (1984). Studying the Impact of Household Economic and Community Variables on Child Mortality. Population and Development Review, 10, 215–235.
53. Shima, M., Nitta, Y., Ando, M. ve Adachi, M. (2002). Effects of Air Pollution on the Prevalence and Incidence of Asthma in Children. Archives of Environmental Health, 57(6), 529-535.
54. Strauss, J. ve Thomas, D. (1998). Health, Nutrition, and Economic Development. Journal of Economic Literature, 36(2), 766-817.
55. Sözmen, K., Baydur, H., Simsek, H. ve Ünal, B. (2012). Decomposing Socioeconomic Inequalities in Self Assessed Health in Turkey. International Journal for Equity in Health, 11(1), 73-83. doi:10.1186/1475-9276-11-73
56. Subramanian, S.V. ve Kawachi, I. (2004). Income Inequality and Health: What Have We Learned So Far?. Epidemiologic Reviews, 26, 78-91.
57. Thomas, D. ve Strauss, J. (1997). Health and Wages: Evidence on Men and Women in Urban Brazil. Journal of Econometrics, 77(1), 159-185.
58. Türkkan, A. ve Aytekin, H. (2009). Socioeconomic and Health Inequality in Two Regions of Turkey. Journal of Community Health, 34(4), 346–352. doi:10.1007/s10900-009-9160-x.
59. Van Vliet, P., Knape, M., De Hartog,J., Janssen,N., Hassema,H. ve Brunekreef, B. (1997). Motor Vehicle Exhaust and Chronic Respiratory Symptoms in Children Living Near Freeways. Environmental Research, 74(2), 122-132.
60. Wagstaff, A. ve van Doorslaer, E. (2000). Income Inequality and Health: What Does the Literature Tell Us?. Annual Review of Public Health, 21, 543–67.
61. Wilkinson, R.G. (1992). Income Distribution and Life Expectancy. British Medical Journal 304(6820), 165–168.
62. Wilkinson, R.G. (1996). Unhealthy societies: The Afflictions of Inequality. London and New York: Routledge.
63. Wilkinson, R. G. (1997). Socioeconomic Determinants of Health: Health Inequalities: Relative or Absolute Material Standards?. British Medical Journal, 314 (7080), 591-595.
64. Williams, R. (2006). Generalized Ordered Logit/partial Proportional Odds Models for Ordinal Dependent Variables. Stata Journal, 6, 58-82.
65. Williams, R. (2016). Understanding and Interpreting Generalized Ordered Logit Models. The Journal of Mathematical Sociology, 40(1), 7-20.
66. Wilson, S.H. ve Walker, G.M. (1993). Unemployment and Health: A Review. Public Health, 107(3), 153–162.