A global comparison of the impacts of social, economic, and political determinants on population health

本論文從全球性觀點出發，以國家層級為研究分析單位，探討長期全球社會、經濟及政治因素與人口健康之關連的研究，包括兩大部分： 一、分析國家治理與人口健康之相關：共收集到149個國家在1996年至2010年的資料；結果顯示，在控制經濟發展與疾病防治程度之影響後，好的國家治理有助於延長平均餘命及降低兒童死亡率。 二、分析較低發展國家中，民主化程度與人口健康之相關：共收集到120個國家在1970年至2004年的資料；結果顯示，社會經濟發展仍為提升平均餘命及降低兒童死亡率之主要因子，國家的民主化也有助於延長國家人民平均餘命及降低兒童死亡率。 本研究結果建議未來推動全球衛生改善方案時，應倡導並促進國家的治理與民主化。This dissertation aims to investigate the associations between social, economic, and political determinants and population health on a global scale, including two parts: 1. Association between governance and population health: We obtained data between 1996 and 2010 for 149 countries. Good governance is significantly associated with higher life expectancy and lower under-five mortality, taking into account factors of development (mainly urbanization and economy) and disease control (mainly hygienic conditions and immunization rates). 2. Association between democracy and population health in less developed countries: We obtained data between 1970 and 2004 for 120 less developed countries. We found significantly lagged effect of democracy and three socioeconomic factors—economy, educational environment, and nutritional status—on increased life expectancy at birth and decreased under-five mortality rates. Changes in political regime toward or away from democratic authority exerts persistently effects on under-five mortality rates decrease during the subsequent 1−10 years while the effects are more predictive for life expectancy increase after a lag of 3+ years. The findings of this dissertation suggest global health practice on promoting a country’s need for better governance and democracy.中文摘要 ................................................................................................. i Abstract ................................................................................................ ii Table of Contents.................................................................................. iii List of Figures ....................................................................................... v List of Tables......................................................................................... vii List of Abbreviations Used .................................................................... ix 1. Introduction ....................................................................................... 1 1.1 Background....................................................................................... 1 1.2 International perspectives ................................................................. 4 1.3 Studies on determinants of health................................................... 10 1.4 Governance issue on population health .................................. 15 1.5 Limitation and unanswered questions in previous studies .............. 17 2. Objectives ........................................................................................ 21 3. Materials and Methods ..................................................................... 23 3.1 Studied countries ........................................................................... 23 3.2 Association between governance and population health.................. 26 3.3 Association between political regime and population health ........... 32 4. Results.............................................................................................. 38 4.1. Representativeness of studied countries ........................................ 38 4.2 Association between governance and population health.................. 42 4.3 Association between political regime and population health ........... 50 5. Discussion ........................................................................................ 68 5.1 Key findings ................................................................................... 68 5.2 Political determinants: governance and democracy ......................... 69 5.3 Socioeconomic determinants........................................................... 72 5.4 Lag and bi-directional effects ......................................................... 74 5.5 MDG and post-2015 agenda........................................................... 75 5.6 Limitations...................................................................................... 81 5.7 Strengths ....................................................................................... 86 6. Conclusion and Recommendations ................................................... 88 7. References........................................................................................ 91 Appendix .............................................................................................. I Part 1. Lin RT, Chien LC, Chen YM, Chan CC. “Governance matters: an ecological association between governance and child mortality” International Health 2014 ...................................................................... I Part 2. Lin RT, Chen YM, Chien LC, Chan CC. “Political and social determinants of life expectancy in less developed countries: a longitudinal study” BMC Public Health 2012 Jan; 12:85.............................................. II Part 3. Lin RT, Chan CC. “Warmer climate and workers’ health and productivity in Taiwan” Global Health Action 2009 Nov; 52-57.............. III Part 4. Lin RT, Chan CC. “Global climate change and implications for emerging infectious diseases” Journal of Healthcare Quality 2009 Jul;3(4):4-8. 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