DOES BETTER INCOME DISTRIBUTION REDUCE INFANT MORTALITY? THE CASE OF TURKEY

Abstract

While the linkage between economic conditions and health indicators is largely discussed previously, much less is known about how income inequality affects the infant mortality rates (IMR) in Turkey. Using a city-level data from 2014 to 2019 estimates the impact of income inequality and socio-economic factors on infant mortality rates. To identify what factors are associated with the IMRs, the ordered probit, the random effect, and the fixed effect approaches are used. An endogeneity problem between the IMRs and independent variables which are related to medical factors is predicted. To tackle down the endogeneity problem, an instrumental variable approach is used. The estimation results show that income inequality is an important factor which has impact on infant mortalities. The results confirm that there is an inverse association between health service availability and infant mortality rates.

Keywords

• : Healthcare
• Panel Data Analysis
• Health Economics
• Infant Mortality

GELİR DAĞILIMININ BEBEK ÖLÜM HIZI ÜZERİNE ETKİSİ: TÜRKİYE ÖRNEĞİ

Abstract

Ekonomik koşullar ve sağlık göstergeleri arasındaki bağlantı daha önce büyük ölçüde tartışılırken, gelir eşitsizliğinin Türkiye'deki bebek ölüm oranlarını (IMR) nasıl etkilediği hakkında görece sınırlı sayıda çalışma yer almaktadır. Bu çalışma, Türkiye'de gelir eşitsizliğinin IMR üzerindeki etkisini tahmin etmeyi amaçlamaktadır. Bu doğrultuda, 2014-2019 yılları arasında şehir düzeyinde bir veri setinin kullanılması ile gelir eşitsizliği ve sosyo-ekonomik faktörlerin bebek ölüm oranları üzerindeki etkisini analiz etmektedir. Bebek ölüm oranları üzerinde hangi faktörlerin ilişkili olduğunu belirlemek için Probit, Rassal etki ve sabit etki yöntemleri kullanılmaktadır. Bebek ölüm oranları ile bağımsız değişkenler olarak modelde yer alan tıbbi faktör arasında bir içsellik sorunu tahmin edilmektedir. İçsellik sorununun çözümü için araç değişken yaklaşımı kullanılmaktadır. Tahmin sonuçları, gelir eşitsizliğinin sağlık sonuçları üzerinde etkisi olan önemli bir faktör olduğunu göstermektedir. Sonuçlar, sağlık hizmetlerine erişim ile bebek ölüm oranları arasında negatif bir ilişki olduğunu doğrulamaktadır.

Keywords

• Sağlık sistemi, Panel Veri Analizi, Sağlık Ekonomisi, Bebek Ölümleri.

References

1. Avendano, Mauricio (2012) Correlation or causation? Income inequality and infant mortality in fixed effects models in the period 1960–2008 in 34 OECD countries, Social Science & Medicine, Volume 75, Issue 4, Pages 754-760, https://doi.org/10.1016/j.socscimed.2012.04.017.
2. Barenberg AJ, Basu D, Soylu CS. The effect of public health expenditure on infant mortality: evidence from a panel of Indian states, 1983-1984 to 2011-2012. Jof Dev Stu. 2017;53(10):1765–84.
3. Cesur, R., Güneş P. M., Tekin E., Ulker, A. (2017). The value of socialized medicine: The impact of universal primary healthcare provision on mortality rates in Turkey, Journal of Public Economics, Volume 150, Pages 75-93, https://doi.org/10.1016/j.jpubeco.2017.03.007.
4. Çelik, T. & A.B. Altun & B. Kerkez, & S. Tatlı & C. Özer (2012), “Hatay ilinde 2009 ve 2010 yıllarında bebek ölüm hızları ve nedenleri”, Ege Tıp Dergisi, 51(2), 111-116.
5. Çukur, A. & Bekmez, S. (2011). The Relationship between Income, Income Inequality and Health in Turkey: Evidence from Panel Data Analysis . Gaziantep University Journal of Social Sciences , 10 (1) , 21-40 . Retrieved from https://dergipark.org.tr/en/pub/jss/issue/24244/257054.
6. Detollenaere, J., Desmarest, A. S., Boeckxstaens, P., & Willems, S. (2018). The link between income inequality and health in Europe, adding strength dimensions of primary care to the equation. Social Science & Medicine, 103-110.
7. Ehntholt, A., Cook, D. M., Rosenquist, N. A., Muennig, P., & Pabayo, R. (2020). State- and county-level income inequality and infant mortality in the USA in 2010: a cohort study. International Journal of Public Health, 65:769–780.
8. Fritzell, J., Rehnberg, J., Bacchus Hertzman, J. et al. Absolute or relative? A comparative analysis of the relationship between poverty and mortality. Int J Public Health 60, 101–110 (2015). https://doi.org/10.1007/s00038-014-0614-2

9. Goli, S. & Jaleel, A. (2014) What cause the decline in maternal mortality in India? Evidence from time series and cross-sectional analyses. Journal of Biosocial Science 46(3), 351–365.CrossRefGoogle ScholarPubMedOpenURL query.
10. Gonzalez, R. M., & Gilleskie, D. (2017). Infant Mortality Rate as a Measure of a Country's Health: A Robust Method to Improve Reliability and Comparability. Demography, 54(2), 701–720. https://doi.org/10.1007/s13524-017-0553-7
11. Gruber, Jonathan, Nathaniel Hendren, and Robert M. Townsend. 2014. "The Great Equalizer: Health Care Access and Infant Mortality in Thailand." American Economic Journal: Applied Economics, 6 (1): 91-107. DOI: 10.1257/app.6.1.91
12. Infant Mortality in the United States, 2018: Data From the Period Linked Birth/Infant Death File pdf icon[PDF – 1 MB] – Rates calculated via CDC WONDER using latest available data by subpopulation (2018).
13. Jaba E, Balan CB, Robu I-B. The relationship between life expectancy at birth and health expenditures estimated by a cross-country and time-series analysis. Procedia Econ and Fin. 2014;15:108–14.
14. Kanamori, M., Kondo, N., & Nakamura, Y. (2021). Infant mortality rates for farming and unemployed households in the Japanese prefectures: An ecological time trend analysis, 1999–2017. Journal of Epidemiology, 31(1), 43–51.
15. Kirigia, J.M., Muthuri, R.D.K., Nabyonga-Orem, J. et al. Counting the cost of child mortality in the World Health Organization African region. BMC Public Health 15, 1103 (2015). https://doi.org/10.1186/s12889-015-2465-z
16. Koçoğlu D, Akın B. Sosyoekonomik eşitsizliklerin sağlıklı yaşam biçimi davranışları ve yaşam kalitesi ile ilişkisi. Dokuz Eylül Üniversitesi Hemşirelik Yüksekokulu Elektronik Dergi 2009;2:145-154.
17. Macinko, J. A., Shi, L., Starfield B. (2004) Wage inequality, the health system, and infant mortality in wealthy industrialized countries, 1970–1996 Social Science & Medicine, 58 (2), pp. 279-292.
18. Navarro V, Muntaner C, Borrell C, et al. Politics and health outcomes. Lancet. 2006 Sep 16;368(9540):1033–7.
19. Pabayo, R., Cook, D.M., Harling, G. et al. State-level income inequality and mortality among infants born in the United States 2007–2010: A Cohort Study. BMC Public Health 19, 1333 (2019). https://doi.org/10.1186/s12889-019-7651-y
20. Reno, R., & Hyder, A. (2018). The Evidence Base for Social Determinants of Health as Risk Factors for Infant Mortality: A Systematic Scoping Review. Journal of Health Care for the Poor and Underserved 29(4), 1188-1208. doi:10.1353/hpu.2018.0091.
21. Siddiqi A, Jones MK, Erwin PC. Does higher income inequality adversely influence infant mortality rates? Reconciling descriptive patterns and recent research findings. Soc Sci Med. 2015 Apr;131:82–8.https://doi.org/10.1016/j.socscimed.2015.03.010.
22. Siddiqi A, Jones MK, Bruce DJ, et al. Do racial inequities in infant mortality correspond to variations in societal conditions? A study of state‑ level income inequality in the U.S., 1992–2007. Soc Sci Med. 2016 Sep;164:49–58. https://doi.org/10.1016/j.socscimed.2016.07.013.
23. SU, D., ESQUEDA, O., LI, L., & PAGÁN, J. (2012). Income Inequality and Obesity Prevalence among OECD Countries. Journal of Biosocial Science, 44(4), 417-432. doi:10.1017/S002193201100071X
24. Szwarcwald C. L., Andrade C. L., Bastos, F. I. (2002) Income Inequality, Residential Poverty Clustering and Infant Mortality: A Study in Rio de Janeiro, Brazil. Social Science & Medicine, 55 (12) (2002), pp. 2083-2092
25. OECD (2022), Infant mortality rates (indicator). doi: 10.1787/83dea506-en (Accessed on 07 April 2022).
26. The World Bank. (2021, April 18). Retrieved from https://data.worldbank.org/indicator/SI.POV.GINI?locations=TR
27. The World Bank. (2022,April 7). Retrieved from https://data.worldbank.org/indicator/SP.DYN.IMRT.IN?locations=TR
28. White, Brandi M.; Horton, Lee S.; and Simpson, Kit N. (2017) "Community-level characteristics of high infant mortality: A tool to identify at-risk communities," Journal of Health Disparities Research and Practice: Vol. 10 : Iss. 2 , Article 2.
29. Yanıkkaya, H., & Selim, S. (2010). The Determinants of İnfant Mortality in Turkey: A Disaggregated Analysis. İktisat İşletme ve Finans Dergisi, 25(286), 61-88.