The Impact of Carbon Dioxide Emissions on Health Expenditures in Developing Countries

Abstract

Aim: This study aims to measure the long-run effects of changes in carbon dioxide (CO₂) emissions on total (public and private) health expenditures in twenty developing countries over the period 2000–2021. Situated at the intersection of environmental, health, and fiscal policy often sidelined in the literature it seeks to make emission-sensitive budget dynamics visible through a quantitative, cross-country–heterogeneous framework and to provide evidence-based input for policy design. Method: The dataset comprises health expenditures, CO₂ emissions, Gross Domestic Product (GDP), urbanization rate, and labor force participation. Cross-sectional dependence is assessed using the LM test; stationarity is examined with the second-generation CIPS unit root tests. Long-run relationships are verified via the Westerlund cointegration test, and slope heterogeneity is evaluated with the Pesaran–Yamagata test. Long-run coefficients and country-specific elasticities are estimated using the Pedroni Dynamic Ordinary Least Squares Mean Group (DOLSMG) estimator, which accounts for endogeneity and heterogeneity. Robustness checks include alternative weightings and sub-sample analyses. Results: Panel-average estimates indicate that a 1% increase in CO₂ emissions raises health expenditures by approximately 1.18% in the long run. Control variables behave as expected: a 1% rise in GDP increases health expenditures by about 1.39%; urbanization by 4.75%; and labor force participation by 0.38%. Marked cross-country heterogeneity emerges: Saudi Arabia, Russia, India, Türkiye, South Africa, and Vietnam display strong positive CO₂ expenditure elasticities, whereas Egypt, Pakistan, Kazakhstan, and Argentina exhibit negative coefficients. These differences are consistent with reporting practices, fiscal constraints, the breadth of health system coverage, and composition effects linked to the morbidity profile of emissions. An elasticity greater than one implies a disproportionate budgetary burden from rising emissions. Conclusion: CO₂ emissions significantly and strongly increase health expenditures in the long run. These finding positions carbon mitigation not only as an environmental objective but also as a medium-term cost-containment instrument for health policy. Policy implications include: (i) allocating carbon pricing revenues to climate-resilient health infrastructure; (ii) designing coordinated packages that pair emission control with public health investments tailored to country-specific vulnerabilities; and (iii) mitigating pollution intensity associated with urbanization through transport/housing planning and strengthening primary care. Overall, the results underscore the need for integrated, country-specific coordination between environmental policy and health budgeting.

Keywords

• Carbon dioxide emissions
• health expenditures
• developing countries
• DOLSMG

Gelişmekte Olan Ülkelerde Karbondioksit Emisyonlarının Sağlık Harcamaları Üzerindeki Etkisi

Abstract

Amaç: Bu çalışma, 2000 ile 2021 yılları arasında yirmi gelişmekte olan ülkede karbondioksit (CO₂) emisyonlarındaki değişimlerin kamu ve özel toplam sağlık harcamaları üzerindeki uzun dönemli etkisini ölçmeyi amaçlamaktadır. Literatürde çoğu kez geri planda kalan çevre, sağlık ve maliye alanlarının kesişiminde, emisyonlara duyarlı bütçe dinamiklerini ülkeler arası farklılıkları dikkate alan nicel bir yaklaşımla görünür kılmak ve politika tasarımına kanıta dayalı katkı sunmak hedeflenmiştir. Yöntem: Veri seti, sağlık harcamaları, CO₂ emisyonları, kişi başına gayri safi yurtiçi hasıla (GSYH), kentleşme oranı ve işgücüne katılım değişkenlerinden oluşur. Panelde yatay kesit bağımlılığı LM testiyle sınanmış; durağanlık ikinci nesil CIPS birim kök testleriyle incelenmiştir. Uzun dönem ilişki Westerlund eşbütünleşme testiyle teyit edilmiş; eğim heterojenliği Pesaran–Yamagata testiyle değerlendirilmiştir. Uzun dönem katsayılar ve ülke-bazlı esneklikler, içsellik ve heterojenliği gözeten Pedroni DOLSMG tahmincisiyle elde edilmiştir. Sağlamlık için alternatif ağırlıklandırmalar ve alt-örnek kontrolleri uygulanmıştır. Bulgular: Panel-ortalama sonuçlar, CO₂ emisyonlarındaki %1’lik artışın sağlık harcamalarını uzun dönemde yaklaşık %1,18 artırdığını göstermektedir. Kontrol değişkenleri beklenen yöndedir: GSYH’da %1’lik artış harcamaları ~%1,39; kentleşme %4,75; işgücüne katılım %0,38 ölçüsünde yükseltmektedir. Ülke düzeyinde belirgin heterojenlik saptanmıştır: Suudi Arabistan, Rusya, Hindistan, Türkiye, Güney Afrika ve Vietnam’da CO₂–harcama esnekliği pozitif ve güçlü; Mısır, Pakistan, Kazakistan ve Arjantin’de ise negatif katsayılar gözlenmiştir. Bu farklılaşma, raporlama farkları, mali kısıtlar, sağlık sistemi kapsayıcılığı ve emisyonların morbidite profiliyle ilişkili kompozisyon etkileriyle tutarlıdır. Esneklik değerinin birden büyük olması, artan emisyonların sağlık bütçesi üzerinde orantısız yük doğurduğunu ima etmektedir. Sonuç: CO₂ emisyonları sağlık harcamalarını uzun dönemde anlamlı ve güçlü biçimde artırmaktadır. Bu bulgu, karbon azaltımını yalnız çevresel bir hedef değil, aynı zamanda orta vadede maliyet düşürücü bir sağlık politikası aracı olarak konumlandırır. Politika düzeyinde (i) karbon fiyatlaması gelirlerinin iklim dirençli sağlık altyapısına tahsisi, (ii) ülke-özel kırılganlıklara göre eş zamanlı emisyon kontrolü–halk sağlığı yatırımı paketleri, (iii) kentleşmenin kirletici yoğunluğunu azaltacak ulaşım/konut planlaması ve birinci basamak güçlendirmesi önerilir. Bulgular, çevre politikaları ile sağlık bütçelemesi arasında bütüncül, ülkeye özgü bir eşgüdüm gerektirdiğini açıkça göstermektedir.

Keywords

• Karbondioksit emisyonları
• sağlık harcamaları
• gelişmekte olan ülkeler
• DOLSMG

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