Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries?: A time-series, ecological analysis of 48 countries from 1993 to 2013

Abstract

Inequalities in infant mortality rates (IMRs) are rising in some low- and middle-income countries (LMICs) and decreasing in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMRs. We estimated country-level fixed-effects panel regressions for 48 LMICs (142 country observations). Slope and Relative Indices of Inequality in IMRs (SII and RII) were calculated from Demographic and Health Surveys between 1993 and 2013. RII and SII were regressed on government expenditure (total, health and non-health) and redistribution, controlling for gross domestic product (GDP), private health expenditures, a democracy indicator, country fixed effects and time. Mean SII and RII was 39.12 and 0.69, respectively. In multivariate models, a 1 percentage point increase in total government expenditure (% of GDP) was associated with a decrease in SII of -2.468 [95% confidence intervals (CIs): -4.190, -0.746] and RII of -0.026 (95% CIs: -0.048, -0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were non-significant for GDP, government redistribution, and private health expenditure. Understanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.

Global trends in incidence and death of neonatal disorders and its specific causes in 204 countries/territories during 1990–2019

“…The reasons involved the improvement of mental health care, health infrastructure, and poverty elimination [ 45 , 46 ]. However, the relatively slow trends occurred in low- and middle-SDI areas were also related to the high non-health government expenditure [ 47 ]. Meanwhile, substantial heterogeneity in trends were observed between regions and countries.…”

The health effects of wage setting institutions: How collective bargaining improves health but not because it reduces inequality

“…All dependent variables are measured on a log‐scale. These measures are often used as broad indicators of population health within societies, and infant mortality is viewed as a proxy for the degree of health equity or the health of vulnerable groups (Baker et al, 2018). Of course, wage‐setting institutions would not be expected to affect every specific cause of mortality in the same way and so I conduct a falsification analysis where the dependent variable is two cause‐specific outcomes that theoretically should not be correlated with wage‐setting institutions.…”

“…Wage‐setting institutions and health may also be correlated with other macro‐economic and socio‐demographic features of the society, such as GDP per capita adjusted for purchasing power parities (logged) (Pritchett & Summers, 1996); public expenditure on social benefits other than social transfers in kind (%GDP) (Stuckler et al, 2010); share of seats in parliament won by parties classified as left in the most recent election (Navarro et al, 2006); total health expenditure (%GDP) (Reeves et al, 2015); total general government expenditure (%GDP) (Baker et al, 2018); share of population with total medical coverage, either through public programmes or primary private insurance (Avendano & Kawachi, 2014); population size (logged); proportion of the population aged 15 years or younger; and the proportion of the population aged 65 years. All models also adjust for time dummies to control for temporal correlation in mortality trends.…”

Economic Crisis Impact and Social Determinants of Perinatal Outcomes and Infant Mortality in Greece

“…The socio-economic determinants of the observed effects have little been studied. In times of economic growth, socio-economic factors seem to be in developed countries of less importance for perinatal and infant health [ 33 , 34 , 35 ], but it is questionable whether that is true in times of financial crises. Studies from the USA and Argentina documented an increased risk of adverse birth outcomes in deprived and unemployed populations during the recession [ 36 , 37 ].…”