IDEAS home Printed from https://ideas.repec.org/a/lus/reveco/v70y2019i1p69-98n4.html
   My bibliography  Save this article

Area Deprivation and its Impact on Population Health: Conceptual Aspects, Measurement and Evidence from Germany

Author

Listed:
  • Karmann Alexander

    (Faculty of Business and Economics, Technische Universität Dresden, Dresden, Sachsen, Germany)

  • Weinhold Ines

    (Faculty of Business and Economics, Technische Universität Dresden, Dresden, Germany)

  • Wende Danny

    (Faculty of Business and Economics, Technische Universität Dresden, Dresden, Germany)

Abstract

Empirical evidence demonstrates associations between socioeconomic or environmental area deprivation and public health. To measure such structural effects, deprivation indices have been developed in the UK initially. Meanwhile their application is increasingly discussed in Germany, however with little attempts to adapt the concept to national conditions. In this paper, we develop a model of area deprivation differentiating between material, social and ecological deprivation effects. We apply structural equation modelling to endogenously estimate the latent deprivation dimensions as well as their relative impact on the health outcome, accounting for potential measurement errors and controlling for health care infrastructure. We use data at the level of German municipal associations (n=4,491) for the years 2013 and 2016, if available. We find that differences in material (βmaterial=−0.168, p

Suggested Citation

  • Karmann Alexander & Weinhold Ines & Wende Danny, 2019. "Area Deprivation and its Impact on Population Health: Conceptual Aspects, Measurement and Evidence from Germany," Review of Economics, De Gruyter, vol. 70(1), pages 69-98, April.
    • Handle: RePEc:lus:reveco:v:70:y:2019:i:1:p:69-98:n:4
    DOI: 10.1515/roe-2019-0001
    as

    Download full text from publisher

    File URL: https://doi.org/10.1515/roe-2019-0001
    Download Restriction: For access to full text, subscription to the journal or payment for the individual article is required.
    File URL: https://libkey.io/10.1515/roe-2019-0001?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. Buchner, Florian & Goepffarth, Dirk & Wasem, Juergen, 2013. "The new risk adjustment formula in Germany: Implementation and first experiences," Health Policy, Elsevier, vol. 109(3), pages 253-262.
    2. Alex Fenton & Amanda Fitzgerald & Ruth Lupton, 2013. "The Distribution of Local Government Finance by Local Authority-Level Deprivation," CASE - Social Policy in a Cold Climate Research Note 005, Centre for Analysis of Social Exclusion, LSE.
    3. Eddy van Doorslaer & Xander Koolman, 2004. "Explaining the differences in income‐related health inequalities across European countries," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 609-628, July.
    4. Singh, G.K. & Kogan, M.D., 2007. "Widening socioeconomic disparities in US childhood mortality, 1969-2000," American Journal of Public Health, American Public Health Association, vol. 97(9), pages 1658-1665.
    5. Lawlor, D.A. & Smith, G.D. & Patel, R. & Ebrahim, S., 2005. "Life-course socioeconomic position, area deprivation, and coronary heart disease: Findings from the British women's heart and health study," American Journal of Public Health, American Public Health Association, vol. 95(1), pages 91-97.
    6. James P. Smith, 1999. "Healthy Bodies and Thick Wallets: The Dual Relation between Health and Economic Status," Journal of Economic Perspectives, American Economic Association, vol. 13(2), pages 145-166, Spring.
    7. Louise Sheiner, 2014. "Why the Geographic Variation in Health Care Spending Cannot Tell Us Much About the Efficiency or Quality of Our Health Care System," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 45(2 (Fall)), pages 1-72.
    8. Singh, G.K., 2003. "Area Deprivation and Widening Inequalities in US Mortality, 1969-1998," American Journal of Public Health, American Public Health Association, vol. 93(7), pages 1137-1143.
    9. Dirk Göpffarth & Thomas Kopetsch & Hendrik Schmitz, 2016. "Determinants of Regional Variation in Health Expenditures in Germany," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 801-815, July.
    10. repec:dau:papers:123456789/10510 is not listed on IDEAS
    11. Bauhoff, Sebastian, 2012. "Do health plans risk-select? An audit study on Germany's Social Health Insurance," Journal of Public Economics, Elsevier, vol. 96(9-10), pages 750-759.
    12. Siegel, Martin & Vogt, Verena & Sundmacher, Leonie, 2014. "From a conservative to a liberal welfare state: Decomposing changes in income-related health inequalities in Germany, 1994–2011," Social Science & Medicine, Elsevier, vol. 108(C), pages 10-19.
    13. Buehn, Andreas & Farzanegan, Mohammad Reza, 2013. "Hold your breath: A new index of air pollution," Energy Economics, Elsevier, vol. 37(C), pages 104-113.
    14. Wen, Ming & Browning, Christopher R. & Cagney, Kathleen A., 2003. "Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health," Social Science & Medicine, Elsevier, vol. 57(5), pages 843-860, September.
    15. Macintyre, Sally & Ellaway, Anne & Cummins, Steven, 2002. "Place effects on health: how can we conceptualise, operationalise and measure them?," Social Science & Medicine, Elsevier, vol. 55(1), pages 125-139, July.
    16. Louise Sheiner, 2014. "Why the Geographic Variation in Health Care Spending Cannot Tell Us Much About the Efficiency or Quality of Our Health Care System," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 49(2 (Fall)), pages 1-72.
    17. Andreas Buehn & Alexander Karmann & Friedrich Schneider, 2009. "Shadow Economy and Do-it-Yourself Activities: The German Case," Journal of Institutional and Theoretical Economics (JITE), Mohr Siebeck, Tübingen, vol. 165(4), pages 701-722, December.
    18. Krieger, N. & Chen, J.T. & Waterman, P.D. & Rehkopf, D.H. & Subramanian, S.V., 2003. "Race/Ethnicity, Gender, and Monitoring Socioeconomic Gradients in Health: Comparison of Area-Based Socioeconomic Measures - The Public Health Disparities Geocoding Project," American Journal of Public Health, American Public Health Association, vol. 93(10), pages 1655-1671.
    19. Oliver Reich & Cornelia Weins & Claudia Schusterschitz & Magdalena Thöni, 2012. "Exploring the disparities of regional health care expenditures in Switzerland: some empirical evidence," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(2), pages 193-202, April.
    Full references (including those not matched with items on IDEAS)

    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. Danny Wende, 2019. "Spatial risk adjustment between health insurances: using GWR in risk adjustment models to conserve incentives for service optimisation and reduce MAUP," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(7), pages 1079-1091, September.
    2. Jakub Cerveny & Jan C. van Ours, 2022. "Long-term returns to local health-care spending," Tinbergen Institute Discussion Papers 22-072/V, Tinbergen Institute.
    3. Weden, Margaret M. & Carpiano, Richard M. & Robert, Stephanie A., 2008. "Subjective and objective neighborhood characteristics and adult health," Social Science & Medicine, Elsevier, vol. 66(6), pages 1256-1270, March.
    4. Błażej Łyszczarz, 2018. "Determinanty wydatków na zdrowie w gospodarstwach domowych w Polsce," Gospodarka Narodowa. The Polish Journal of Economics, Warsaw School of Economics, issue 1, pages 137-157.
    5. Hernández-Quevedo, Cristina & Jones, Andrew M. & Rice, Nigel, 2008. "Persistence in health limitations: A European comparative analysis," Journal of Health Economics, Elsevier, vol. 27(6), pages 1472-1488, December.
    6. Maite Blázquez Cuesta & Elena Cottini & Herrarte, A. (Ainhoa), 2012. "GINI DP 39: Socioeconomic Gradient in Health: How Important is Material Deprivation?," GINI Discussion Papers 39, AIAS, Amsterdam Institute for Advanced Labour Studies.
    7. Stafford, Mai & Cummins, Steven & Ellaway, Anne & Sacker, Amanda & Wiggins, Richard D. & Macintyre, Sally, 2007. "Pathways to obesity: Identifying local, modifiable determinants of physical activity and diet," Social Science & Medicine, Elsevier, vol. 65(9), pages 1882-1897, November.
    8. Pilar García-Gómez & Hans van Kippersluis & Owen O’Donnell & Eddy van Doorslaer, 2013. "Long-Term and Spillover Effects of Health Shocks on Employment and Income," Journal of Human Resources, University of Wisconsin Press, vol. 48(4), pages 873-909.
    9. Gerdtham, Ulf-G & Lundborg, Petter & Lyttkens, Carl Hampus & Nystedt, Paul, 2012. "Do Socioeconomic Factors Really Explain Income-Related Inequalities in Health? Applying a Twin Design to Standard Decomposition Analysis," Working Papers 2012:21, Lund University, Department of Economics.
    10. Bilger, Marcel & Carrieri, Vincenzo, 2013. "Health in the cities: When the neighborhood matters more than income," Journal of Health Economics, Elsevier, vol. 32(1), pages 1-11.
    11. Teresa Bago d'Uva & Eddy Van Doorslaer & Maarten Lindeboom & Owen O'Donnell, 2008. "Does reporting heterogeneity bias the measurement of health disparities?," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 351-375, March.
    12. Persson, Sofie & Dahlquist, Gisela & Gerdtham, Ulf-G. & Steen Carlsson, Katarina, 2014. "Childhood Health and Labor Market Outcomes in the Case of Type 1 Diabetes," Working Papers 2014:43, Lund University, Department of Economics.
    13. Dizioli, Allan & Pinheiro, Roberto, 2016. "Health insurance as a productive factor," Labour Economics, Elsevier, vol. 40(C), pages 1-24.
    14. Pilny, Adam & Wübker, Ansgar & Ziebarth, Nicolas R., 2017. "Introducing risk adjustment and free health plan choice in employer-based health insurance: Evidence from Germany," Journal of Health Economics, Elsevier, vol. 56(C), pages 330-351.
    15. Michael Lokshin & Martin Ravallion, 2008. "Testing for an economic gradient in health status using subjective data," Health Economics, John Wiley & Sons, Ltd., vol. 17(11), pages 1237-1259, November.
    16. Miles, Rebecca, 2006. "Neighborhood disorder and smoking: Findings of a European urban survey," Social Science & Medicine, Elsevier, vol. 63(9), pages 2464-2475, November.
    17. Janet Currie & David Slusky, 2020. "Does the Marginal Hospitalization Save Lives? The Case of Respiratory Admissions for the Elderly," NBER Working Papers 26618, National Bureau of Economic Research, Inc.
    18. Virtanen, Marianna & Kivimäki, Mika & Kouvonen, Anne & Elovainio, Marko & Linna, Anne & Oksanen, Tuula & Vahtera, Jussi, 2007. "Average household income, crime, and smoking behaviour in a local area: The Finnish 10-Town study," Social Science & Medicine, Elsevier, vol. 64(9), pages 1904-1913, May.
    19. Wen, Ming & Cagney, Kathleen A. & Christakis, Nicholas A., 2005. "Effect of specific aspects of community social environment on the mortality of Individuals diagnosed with serious illness," Social Science & Medicine, Elsevier, vol. 61(6), pages 1119-1134, September.
    20. Andrew M. Jones & Eddy Van Doorslaer & Teresa Bago D’Uva & Silvia Balia & Lynn Gambin & Cristina Hernández Quevedo & Xander Koolman & Nigel Rice, 2006. "Health and Wealth: Empirical Findings and Political Consequences," Perspektiven der Wirtschaftspolitik, Verein für Socialpolitik, vol. 7(s1), pages 93-112, May.

    More about this item

    Keywords

    area deprivation; health inequality; structural equation modelling;
    All these keywords.

    JEL classification:

    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    Statistics

    Access and download statistics

    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:lus:reveco:v:70:y:2019:i:1:p:69-98:n:4. 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: Peter Golla (email available below). General contact details of provider: https://www.degruyter.com .

    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.