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Wage inequality, the health system, and infant mortality in wealthy industrialized countries, 1970-1996

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  • Macinko, James A.
  • Shi, Leiyu
  • Starfield, Barbara

Abstract

This pooled, cross-sectional, time-series study assesses the impact of health system variables on the relationship between wage inequality and infant mortality in 19 OECD countries over the period 1970-1996. Data are derived from the OECD, World Value Surveys, Luxembourg Income Study, and political economy databases. Analyses include Pearson correlation and fixed-effects multivariate regression. In year-specific and time-series analyses, the Theil measure of wage inequality (based on industrial sector wages) is positively and statistically significantly associated with infant mortality rates--even while controlling for GDP per capita. Health system variables--in particular the method of healthcare financing and the supply of physicians--significantly attenuated the effect of wage inequality on infant mortality. In fixed effects multivariate regression models controlling for GDP per capita and wage inequality, variables generally associated with better health include income per capita, the method of healthcare financing, and physicians per 1000 population. Alcohol consumption, the proportion of the population in unions, and government expenditures on health were associated with poorer health outcomes. Ambiguous effects were seen for the consumer price index, unemployment rates, the openness of the economy, and voting rates. This study provides international evidence for the impact of wage inequalities on infant mortality. Results suggest that improving aspects of the healthcare system may be one way to partially compensate for the negative effects of social inequalities on population health.

Suggested Citation

  • Macinko, James A. & Shi, Leiyu & Starfield, Barbara, 2004. "Wage inequality, the health system, and infant mortality in wealthy industrialized countries, 1970-1996," Social Science & Medicine, Elsevier, vol. 58(2), pages 279-292, January.
    • Handle: RePEc:eee:socmed:v:58:y:2004:i:2:p:279-292
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    2. Ki-tae Kim, 2019. "Which Income Inequality Influences Which Health Indicators? Analysis of the Income Inequality Hypothesis with Market and Disposable Gini Indicators," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 146(3), pages 473-485, December.
    3. Wu, Wen-Chieh & Cheng, Hui-Pei, 2010. "Symmetric mortality and asymmetric suicide cycles," Social Science & Medicine, Elsevier, vol. 70(12), pages 1974-1981, June.
    4. Celeste, Roger Keller & Nadanovsky, Paulo, 2010. "How much of the income inequality effect can be explained by public policy? Evidence from oral health in Brazil," Health Policy, Elsevier, vol. 97(2-3), pages 250-258, October.
    5. Celeste, Roger Keller & Nadanovsky, Paulo & Ponce de Leon, Antonio & Fritzell, Johan, 2009. "The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults," Social Science & Medicine, Elsevier, vol. 69(10), pages 1468-1475, November.
    6. Chung, Haejoo & Muntaner, Carles, 2006. "Political and welfare state determinants of infant and child health indicators: An analysis of wealthy countries," Social Science & Medicine, Elsevier, vol. 63(3), pages 829-842, August.
    7. Lin, Shin-Jong, 2006. "The effects of economic instability on infant, neonatal, and postneonatal mortality rates: Evidence from Taiwan," Social Science & Medicine, Elsevier, vol. 62(9), pages 2137-2150, May.
    8. Siddiqi, Arjumand & Hertzman, Clyde, 2007. "Towards an epidemiological understanding of the effects of long-term institutional changes on population health: A case study of Canada versus the USA," Social Science & Medicine, Elsevier, vol. 64(3), pages 589-603, February.
    9. Abdul Karim, Syahirah & Eikemo, Terje A. & Bambra, Clare, 2010. "Welfare state regimes and population health: Integrating the East Asian welfare states," Health Policy, Elsevier, vol. 94(1), pages 45-53, January.
    10. Chung, Haejoo & Muntaner, Carles, 2007. "Welfare state matters: A typological multilevel analysis of wealthy countries," Health Policy, Elsevier, vol. 80(2), pages 328-339, February.
    11. Celia Dana BESCIU & Armenia ANDRONICEANU, 2017. "The link between social inequalities, health’ system characteristics and R&D expenditure- worldwide evidence," Romanian Statistical Review, Romanian Statistical Review, vol. 65(2), pages 21-41, June.
    12. Katarina Rosicova & Andrea Madarasova Geckova & Jitse Dijk & Jana Kollarova & Martin Rosic & Johan Groothoff, 2011. "Regional socioeconomic indicators and ethnicity as predictors of regional infant mortality rate in Slovakia," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 56(5), pages 523-531, October.
    13. Fabrizio Carmignani & Sriram Shankar & Eng Tan & Kam Tang, 2014. "Identifying covariates of population health using extreme bound analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(5), pages 515-531, June.
    14. Wilkinson, Richard G & Pickett, Kate E., 2006. "Income inequality and population health: A review and explanation of the evidence," Social Science & Medicine, Elsevier, vol. 62(7), pages 1768-1784, April.
    15. Moon Fai Chan & Wai I Ng & Iat Kio Van, 2010. "Socioeconomic instability and the availability of health resources: their effects on infant mortality rates in Macau from 1957–2006," Journal of Clinical Nursing, John Wiley & Sons, vol. 19(5‐6), pages 884-891, March.
    16. Wang, Shaobin & Wu, Jun, 2020. "Spatial heterogeneity of the associations of economic and health care factors with infant mortality in China using geographically weighted regression and spatial clustering," Social Science & Medicine, Elsevier, vol. 263(C).
    17. Zheng, Hui, 2012. "Do people die from income inequality of a decade ago?," Social Science & Medicine, Elsevier, vol. 75(1), pages 36-45.
    18. Wu Weilun, 2022. "The Impact of Income Inequality on Mortality: A Replication Study of Leigh and Jencks (Journal of Health Economics, 2007)," Economics - The Open-Access, Open-Assessment Journal, De Gruyter, vol. 16(1), pages 229-242, January.
    19. Moore, Spencer & Teixeira, Ana C. & Shiell, Alan, 2006. "The health of nations in a global context: Trade, global stratification, and infant mortality rates," Social Science & Medicine, Elsevier, vol. 63(1), pages 165-178, July.
    20. Christina Stacy & Brady Meixell & Tanaya Srini, 2019. "Inequality Versus Inclusion in US Cities," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 145(1), pages 117-156, August.

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