IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v88y2013icp98-107.html
   My bibliography  Save this article

Is wealthier always healthier in poor countries? The health implications of income, inequality, poverty, and literacy in India

Author

Listed:
  • Rajan, Keertichandra
  • Kennedy, Jonathan
  • King, Lawrence

Abstract

Standard policy prescriptions for improving public health in less developed countries (LDCs) prioritise raising average income levels over redistributive policies since it is widely accepted that ‘wealthier is healthier’. It is argued that income inequality becomes a significant predictor of public health only after the ‘epidemiological transition’. This paper tests this theory in India, where rising income levels have not been matched by improvements in public health. We use state-, district-, and individual-level data to investigate the relationship between infant and under-five mortality, and average income, poverty, income inequality, and literacy. Our analysis shows that at both state- and district-level public health is negatively associated with average income and positively associated with poverty. But, at both levels, controlling for poverty and literacy renders average income statistically insignificant. At state-level, only literacy remains a significant and negative predictor. At the less aggregated district-level, both poverty and literacy predict public health but literacy has a stronger effect than poverty. Inequality does not predict public health at state- or district-levels. At the individual-level, however, it is a strong predictor of self-reported ailment, even after we control for district average income, individual income, and individual education. Our analysis suggests that wealthier is indeed healthier in India – but only to the extent that high average incomes reflect low poverty and high literacy. Furthermore, inequality has a strong effect on self-reported health. Standard policy prescriptions, then, need revision: first, alleviating poverty may be more effective than raising average income levels; second, non-income goods like literacy may make an important contribution to public health; and third, policy should be based on a broader understanding of societal well-being and the factors that promote it.

Suggested Citation

  • Rajan, Keertichandra & Kennedy, Jonathan & King, Lawrence, 2013. "Is wealthier always healthier in poor countries? The health implications of income, inequality, poverty, and literacy in India," Social Science & Medicine, Elsevier, vol. 88(C), pages 98-107.
  • Handle: RePEc:eee:socmed:v:88:y:2013:i:c:p:98-107
    DOI: 10.1016/j.socscimed.2013.04.004
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953613002153
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2013.04.004?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Bertola, Giuseppe, 1993. "Factor Shares and Savings in Endogenous Growth," American Economic Review, American Economic Association, vol. 83(5), pages 1184-1198, December.
    2. Anne Case & Christina Paxson, 2005. "Sex differences in morbidity and mortality," Demography, Springer;Population Association of America (PAA), vol. 42(2), pages 189-214, May.
    3. Bruno S. Frey, 2018. "Economics of Happiness," SpringerBriefs in Economics, Springer, number 978-3-319-75807-7, October.
    4. Mahfuz Kabir, 2008. "Determinants of life expectancy in developing countries," Journal of Developing Areas, Tennessee State University, College of Business, vol. 41(2), January-M.
    5. John Knight & Ramani Gunatilaka, 2011. "Does Economic Growth Raise Happiness in China?," Oxford Development Studies, Taylor & Francis Journals, vol. 39(1), pages 1-24.
    6. Zimmerman, Frederick J., 2008. "A commentary on "Neo-materialist theory and the temporal relationship between income inequality and longevity change"," Social Science & Medicine, Elsevier, vol. 66(9), pages 1882-1894, May.
    7. Krueger, Alan B. & Schkade, David A., 2008. "The reliability of subjective well-being measures," Journal of Public Economics, Elsevier, vol. 92(8-9), pages 1833-1845, August.
    8. Lant Pritchett & Lawrence H. Summers, 1996. "Wealthier is Healthier," Journal of Human Resources, University of Wisconsin Press, vol. 31(4), pages 841-868.
    9. Kennedy, Jonathan J. & King, Lawrence P., 2011. "Understanding the conviction of Binayak Sen: Neocolonialism, political violence and the political economy of health in the central Indian tribal belt," Social Science & Medicine, Elsevier, vol. 72(10), pages 1639-1642, May.
    10. Dollar, David & Kraay, Aart, 2002. "Growth Is Good for the Poor," Journal of Economic Growth, Springer, vol. 7(3), pages 195-225, September.
    11. Frey, Bruno S & Stutzer, Alois, 2000. "Happiness, Economy and Institutions," Economic Journal, Royal Economic Society, vol. 110(466), pages 918-938, October.
    12. Roberto Perotti, 1993. "Political Equilibrium, Income Distribution, and Growth," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 60(4), pages 755-776.
    13. K S James & T S Syamala, 2010. "Income, Income Inequality and Mortality - An Empirical Investigation of the Relationship in India, 1971-2003," Working Papers 249, Institute for Social and Economic Change, Bangalore.
    14. Kawachi, I. & Kennedy, B.P. & Lochner, K. & Prothrow-Stith, D., 1997. "Social capital, income inequality, and mortality," American Journal of Public Health, American Public Health Association, vol. 87(9), pages 1491-1498.
    15. Ram, Rati, 2006. "Further examination of the cross-country association between income inequality and population health," Social Science & Medicine, Elsevier, vol. 62(3), pages 779-791, February.
    16. Hilke Brockmann & Jan Delhey & Christian Welzel & Hao Yuan, 2009. "The China Puzzle: Falling Happiness in a Rising Economy," Journal of Happiness Studies, Springer, vol. 10(4), pages 387-405, August.
    17. Sudhir Anand & Martin Ravallion, 1993. "Human Development in Poor Countries: On the Role of Private Incomes and Public Services," Journal of Economic Perspectives, American Economic Association, vol. 7(1), pages 133-150, Winter.
    18. Easterlin, Richard A., 2016. "Happiness, Growth, and the Life Cycle," OUP Catalogue, Oxford University Press, number 9780198779988 edited by Hinte, Holge & Zimmermann, Klaus F..
    19. Biggs, Brian & King, Lawrence & Basu, Sanjay & Stuckler, David, 2010. "Is wealthier always healthier? The impact of national income level, inequality, and poverty on public health in Latin America," Social Science & Medicine, Elsevier, vol. 71(2), pages 266-273, July.
    20. World Bank, 2013. "World Development Indicators 2013," World Bank Publications - Books, The World Bank Group, number 13191.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. cyrine hannafi & Christophe Muller, 2016. "The Poverty-Economic Growth-Health Triangle," EcoMod2016 9587, EcoMod.
    2. Ousmane Traoré, 2021. "The relationship between health poverty and income poverty in Sub-Saharan African countries: evidence from index correlations," SN Business & Economics, Springer, vol. 1(10), pages 1-19, October.
    3. Nor Fatimah Che Sulaiman & Ishak Yussof & Mohd Azlan Shah Zaidi & Noorasiah Sulaiman, 2017. "Long Run Relationship between Income Inequality and Economic Growth: Evidence from Malaysia," International Journal of Academic Research in Business and Social Sciences, Human Resource Management Academic Research Society, International Journal of Academic Research in Business and Social Sciences, vol. 7(6), pages 73-88, June.
    4. Rabia Liaqat & Maimoona Waseem & Hafiz Muhammad Abubakar Siddique & Muhammad Tariq Majeed, 2021. "Health Outcomes Of Poverty: Evidence From Around The Globe," Bulletin of Business and Economics (BBE), Research Foundation for Humanity (RFH), vol. 10(3), pages 43-55.
    5. Moon, Graham & Aitken, Grant & Roderick, Paul & Fraser, Simon & Rowlands, Gill, 2015. "Towards an understanding of the relationship of functional literacy and numeracy to geographical health inequalities," Social Science & Medicine, Elsevier, vol. 143(C), pages 185-193.
    6. Clément, Matthieu & Levasseur, Pierre & Seetahul, Suneha & Piaser, Lucie, 2021. "Does inequality have a silver lining? Municipal income inequality and obesity in Mexico," Social Science & Medicine, Elsevier, vol. 272(C).
    7. Sunhee Kim & Jaesun Wang, 2019. "Does Quality of Government Matter in Public Health?: Comparing the Role of Quality and Quantity of Government at the National Level," Sustainability, MDPI, vol. 11(11), pages 1-24, June.
    8. Sohini Paul, 2021. "Income Inequality and Individual Health Status: Evidence from India," Journal of Quantitative Economics, Springer;The Indian Econometric Society (TIES), vol. 19(2), pages 269-289, June.
    9. Pickett, Kate E. & Wilkinson, Richard G., 2015. "Income inequality and health: A causal review," Social Science & Medicine, Elsevier, vol. 128(C), pages 316-326.
    10. Ousmane Traoré, 2022. "The effect of income on health: evidence from the poverty gaps analysis method in the sub-Saharan Africa," International Review of Economics, Springer;Happiness Economics and Interpersonal Relations (HEIRS), vol. 69(3), pages 401-432, September.
    11. Ioana van Deurzen & Wim van Oorschot & Erik van Ingen, 2014. "The Link between Inequality and Population Health in Low and Middle Income Countries: Policy Myth or Social Reality?," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-22, December.
    12. Xuejie Ding & Francesco C. Billari & Stuart Gietel-Basten, 2017. "Health of midlife and older adults in China: the role of regional economic development, inequality, and institutional setting," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(8), pages 857-867, November.
    13. Sandhya S. Iyer & K. Seeta Prabhu, 2017. "Economic Growth and Integrated Poverty Index: An Estimate Using Macro-level Aggregates at Subnational Levels in India," Indian Journal of Human Development, , vol. 11(3), pages 289-312, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Biggs, Brian & King, Lawrence & Basu, Sanjay & Stuckler, David, 2010. "Is wealthier always healthier? The impact of national income level, inequality, and poverty on public health in Latin America," Social Science & Medicine, Elsevier, vol. 71(2), pages 266-273, July.
    2. Ioana Pop & Erik Ingen & Wim Oorschot, 2013. "Inequality, Wealth and Health: Is Decreasing Income Inequality the Key to Create Healthier Societies?," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 113(3), pages 1025-1043, September.
    3. Qin Gao & Fuhua Zhai, 2017. "Public Assistance, Economic Prospect, and Happiness in Urban China," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 132(1), pages 451-473, May.
    4. Jiayuan Li & John Raine, 2014. "The Time Trend of Life Satisfaction in China," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 116(2), pages 409-427, April.
    5. Mikucka, Malgorzata & Sarracino, Francesco & Dubrow, Joshua K., 2017. "When Does Economic Growth Improve Life Satisfaction? Multilevel Analysis of the Roles of Social Trust and Income Inequality in 46 Countries, 1981–2012," World Development, Elsevier, vol. 93(C), pages 447-459.
    6. O'Donnell, Gus & Oswald, Andrew J., 2015. "National well-being policy and a weighted approach to human feelings," Ecological Economics, Elsevier, vol. 120(C), pages 59-70.
    7. Aysan, Ahmet Faruk, 2005. "The Role of Efficiency of Redistributive Institutions on Redistribution: An Empirical Assessment," MPRA Paper 17773, University Library of Munich, Germany.
    8. Hania Wu & Tony Tam, 2015. "Economic Development and Socioeconomic Inequality of Well-Being: A Cross-Sectional Time-Series Analysis of Urban China, 2003–2011," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 124(2), pages 401-425, November.
    9. Gareth Davey & Ricardo Rato, 2012. "Subjective Wellbeing in China: A Review," Journal of Happiness Studies, Springer, vol. 13(2), pages 333-346, April.
    10. Fiseha Gebregziabher & Miguel Niño-Zarazúa, 2014. "Social Spending and Aggregate Welfare in Developing and Transition Economies," WIDER Working Paper Series wp-2014-082, World Institute for Development Economic Research (UNU-WIDER).
    11. van Hoorn, Andre, 2016. "Reliability and Validity of the Happiness Approach to Measuring Preferences," MPRA Paper 79977, University Library of Munich, Germany.
    12. Fabio Sabatini & Francesco Sarracino, 2017. "Online Networks and Subjective Well-Being," Kyklos, Wiley Blackwell, vol. 70(3), pages 456-480, August.
    13. Sarracino, Francesco, 2013. "Determinants of subjective well-being in high and low income countries: Do happiness equations differ across countries?," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 42(C), pages 51-66.
    14. Oswald, Andrew J., 2008. "On the curvature of the reporting function from objective reality to subjective feelings," Economics Letters, Elsevier, vol. 100(3), pages 369-372, September.
    15. Gebregziabher, Fiseha & Niño-Zarazúa, Miguel, 2014. "Social spending and aggregate welfare in developing and transition economies," WIDER Working Paper Series 082, World Institute for Development Economic Research (UNU-WIDER).
    16. Xuejie Ding & Francesco C. Billari & Stuart Gietel-Basten, 2017. "Health of midlife and older adults in China: the role of regional economic development, inequality, and institutional setting," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(8), pages 857-867, November.
    17. Bhalotra, Sonia, 2010. "Fatal fluctuations? Cyclicality in infant mortality in India," Journal of Development Economics, Elsevier, vol. 93(1), pages 7-19, September.
    18. Owen O'Donnell & Eddy Van Doorslaer & Tom Van Ourti, 2013. "Health and Inequality," Tinbergen Institute Discussion Papers 13-170/V, Tinbergen Institute.
    19. Tekleselassie, Tsegay Gebrekidan, 2016. "Three essays on the impact of institutions and policies on socio-economic outcomes," Economics PhD Theses 1316, Department of Economics, University of Sussex Business School.
    20. Montizaan, Raymond M. & Vendrik, Maarten C.M., 2014. "Misery Loves Company: Exogenous shocks in retirement expectations and social comparison effects on subjective well-being," Journal of Economic Behavior & Organization, Elsevier, vol. 97(C), pages 1-26.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:88:y:2013:i:c:p:98-107. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.