The article, “How do economic, environmental, social, and health factors affect health outcomes? Insights from 21 developing and emerging economies”, authored by Tiken Das, is a significant contribution to the understanding of public health in the context of developing and emerging economies. Published in Regional Science Policy & Practice, this study addresses a critical gap in existing literature, which often lacks comprehensive macro-level data analysis for these specific regions.
Purpose and Scope: The core objective of this study is to investigate the intricate impact of various economic, environmental, social, and health factors on key health outcomes. These outcomes are measured by the Crude Death Rate (CDR), Infant Mortality Rate (IMR), and Life Expectancy at Birth (LEB). The research spans a 20-year period from 2000 to 2019 and includes 21 countries from South Asia, Southeast Asia, BRICS (Brazil, Russia, India, China, and South Africa), and ASEAN (Association of Southeast Asian Nations) regions. A unique aspect of this study is its examination of three distinct health outcomes separately, integrating a wide array of economic, environmental, social, and health-related inputs.
Methodology: The study employs panel regression analysis and innovatively develops two indices: the Health Input Augmenting Index (HIAI) and the Health Outcome Incidence Index (HOAI). These indices are constructed using the Z-score method to ensure comparability across diverse indicators. The HOAI incorporates CDR, IMR (inversely), and LEB, while the HIAI comprises factors such as current health expenditure, domestic government health expenditure, out-of-pocket expenditure, carbon dioxide emissions, GDP per capita, urban population, and the proportion of the population aged 65 and above. The econometric model utilizes a log-log Cobb Douglas approach, and the robustness of the findings is confirmed through additional regressions that exclude countries with comparatively higher GDP per capita, such as Russia and Singapore.
Key Findings: The research yields several important insights into the complex determinants of health outcomes:
- A noteworthy finding is the lack of a consistent relationship between the HIAI, HOAI, and Gross Domestic Product (GDP) per capita, underscoring the significant influence of non-economic factors on health outcomes.
- The study reveals two distinct clusters of countries when analyzing the interrelationship between HOII and HIAI. The larger cluster demonstrates a significant relationship, suggesting that health augmenting inputs play a greater role in improving health outcomes.
- Regional variations are pronounced:
- In ASEAN countries, an increase in health expenditure as a percentage of GDP (FF) was associated with improvements in CDR and IMR. However, rising out-of-pocket (OOP) expenditures (HH) were linked to deteriorating health outcomes. Conversely, rising incomes (II) in ASEAN countries were linked to declining IMR.
- In BRICS nations, higher health expenditure (FF) led to adverse effects on CDR, IMR, and LEB. Furthermore, the non-health factor of GDP per capita (II) negatively influenced CDR, IMR, and LEB in BRICS countries.
- The study emphasizes that the elasticity of non-health determinants in affecting health outcomes was more pronounced than that of health inputs.
Significance and Policy Implications: This study offers valuable insights for policymakers striving for sustainable growth and societal development. The findings suggest that:
- Public Health Expenditure (PHE) should increase with national income and development, ensuring its efficient and optimal use through proper governance, transparency, and accountability.
- Efforts are needed to reduce out-of-pocket health expenditures, especially in developing countries, possibly through state-sponsored health schemes.
- Greater emphasis should be placed on enhancing non-health factors, such as reducing carbon dioxide emissions, improving income, and developing better health facilities in urban areas, due to their considerable importance in shaping health status.
Reference:
Das, T. (2025). How do economic, environmental, social, and health factors affect health outcomes? Insights from 21 developing and emerging economies. Regional Science Policy & Practice, 17, 100163. https://doi.org/10.1016/j.rspp.2024.100163
