Health-income inequality: the effects of the Icelandic economic collapse

International Journal for Equity in Health

Dagný Ósk Ragnarsdóttir¹  Tinna Laufey Ásgeirsdóttir¹ 

[1] Department of Economics, University of Iceland, Oddi v/Sturlugötu, 101 Reykjavík, Iceland

关键词: Iceland;    Crisis;    Economic conditions;    Health-income inequalities;    Decomposition;    Concentration index;   

Others  :  1146598
DOI  :  10.1186/1475-9276-13-50

 received in 2013-11-21, accepted in 2014-02-06,  发布年份 2014

【 摘 要 】

Introduction

Health-income inequality has been the focus of many studies. The relationship between economic conditions and health has also been widely studied. However, not much is known about how changes in aggregate economic conditions relate to health-income inequality. Nevertheless, such knowledge would have both scientific and practical value as substantial public expenditures are used to decrease such inequalities and opportunities to do so may differ over the business cycle. For this reason we examine the effect of the Icelandic economic collapse in 2008 on health-income inequality.

Methods

The data used come from a health and lifestyle survey carried out by the Public Health Institute of Iceland in 2007 and 2009. A stratified random sample of 9,807 individuals 18–79 years old received questionnaires and a total of 42.1% answered in both years. As measures of health-income inequality, health-income concentration indices are calculated and decomposed into individual-level determinants. Self-assessed health is used as the health measure in the analyses, but three different measures of income are used: individual income, household income, and equivalized household income.

Results

In both years there is evidence of health-income inequality favoring the better off. However, changes are apparent between years. For males health-income inequality increases after the crisis while it remains fairly stable for females or slightly decreases. The decomposition analyses show that income itself and disability constitute the most substantial determinants of inequality. The largest increases in contributions between years for males come from being a student, having low education and being obese, as well as age and income but those changes are sensitive to the income measure used.

Conclusions

Changes in health and income over the business cycle can differ across socioeconomic strata, resulting in cyclicality of income-related health distributions. As substantial fiscal expenditures go to limiting the relationship between income and health, the business-cycle effect on equality, which has up until now not received much attention, needs to be considered.

【 授权许可】

   
2014 Ásgeirsdóttir and Ragnarsdóttir; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Marmot M, Wilkinson RG: Social determinants of health. Oxford: Oxford University Press; 1999.
• [2]Ruhm CJ: Are recessions good for your health? Q J Econ 2000, 115:617-650.
• [3]van Doorslaer E, Wagstaff A, Bleichrodt H, Calonge S, Gerdtham UG, Gerfin M, Geurts J, Gross L, Hakkinen U, Leu RE, Odonnell O, Propper C, Puffer F, Rodriguez M, Sundberg G, Winkelhake O: Income-related inequalities in health: some international comparisons. J Health Econ 1997, 16:93-112.
• [4]van Doorslaer E, Koolman X: Explaining the differences in income-related health inequalities across European countries. Health Econ 2004, 13:609-628.
• [5]Ásgeirsdóttir TL, Ragnarsdóttir DÓ: Determinants of relative and absolute concentration indices: evidence from 26 European countries. Int J Equity Health 2013, 12:53.
• [6]Neumayer E: Recessions lower (some) mortality rates: evidence from Germany. Soc Sci Med 2004, 58:1037-1047.
• [7]Gerdtham UG, Ruhm CJ: Deaths rise in good economic times: evidence from the OECD. Econ Hum Biol 2006, 4:298-316.
• [8]Tapia Granados JA: Recessions and mortality in Spain, 1980–1997. Eur J Popul 2005, 21:393-422.
• [9]Tapia Granados JA, Ionides EL: Mortality and macroeconomic fluctuations in contemporary Sweden. Eur J Popul 2011, 27:157-184.
• [10]Lin SJ: Economic fluctuations and health outcome: a panel analysis of Asia-Pacific countries. Appl Econ 2009, 41:519-530.
• [11]Economou A, Nikolaou A, Theodossiou I: Are recessions harmful to health after all? Evidence from the European Union. J Econ Stud 2008, 35:368-384.
• [12]Gerdtham UG, Johannesson M: Business cycles and mortality: results from Swedish microdata. Soc Sci Med 2005, 60:205-218.
• [13]Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M: The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet 2009, 374:315-323.
• [14]Kunst AE, Bos V, Lahelma E, Bartley M, Lissau I, Regidor E, Mielck A, Cardano M, Dalstra JA, Geurts JJ, Helmert U, Lennartsson C, Ramm J, Spadea T, Stronegger WJ, Mackenbach JP: Trends in socioeconomic inequalities in self-assessed health in 10 European countries. Int J Epidemiol 2005, 34:295-305.
• [15]Dalstra JAA, Kunst AE, Geurts JJM, Frenken FJM, Mackenbach JP: Trends in socioeconomic health inequalities in the Netherlands, 1981–1999. J Epidemiol Commun H 2002, 56:927-934.
• [16]Gravelle H, Sutton M: Income related inequalities in self assessed health in Britain: 1979–1995. J Epidemiol Commun H 2003, 57:125-129.
• [17]Vallejo-Torres L, Morris S: The contribution of smoking and obesity to income-related inequalities in health in England. Soc Sci Med 2010, 71:1189-1198.
• [18]Kachi Y, Inoue M, Nishikitani M, Tsurugano S, Yano E: Determinants of changes in income-related health inequalities among working-age adults in Japan, 1986–2007: time-trend study. Soc Sci Med 2013, 81:94-101.
• [19]Lahelma E, Rahkonen O, Huuhka M: Changes in the social patterning of health? The case of Finland 1986–1994. Soc Sci Med 1997, 44:789-799.
• [20]Kondo N, Subramanian SV, Kawachi I, Takeda Y, Yamagata Z: Economic recession and health inequalities in Japan: analysis with a national sample, 1986–2001. J Epidemiol Commun H 2008, 62:869-875.
• [21]Asgeirsdottir TL, Zoega G: On the economics of sleeping. Mind Soc 2011, 10:149-164.
• [22]Guðjónsdóttir GR, Kristjánsson M, Ólafsson Ö, Arnar DO, Getz L, Sigurðsson JÁ, Guðmundsson S, Valdimarsdóttir U: Immediate surge in female visits to the cardiac emergency department following the economic collapse in Iceland: an observational study. Emerg Med J 2012, 29:694-698.
• [23]McClure CB, Valdimarsdottir UA, Hauksdottir A, Kawachi I: Economic crisis and smoking behaviour: prospective cohort study in Iceland. BMJ Open 2012., 2doi:10.1136/bmjopen-2012-001386
• [24]Ásgeirsdóttir TL, Corman H, Noonan K, Ólafsdóttir Þ, Reichman NE: Was the economic crisis of 2008 good for Icelanders? Impact on health behaviors. Econ Hum Biol 2013. doi:10.1016/j.ehb.2013.03.005
• [25]Jónsdóttir S, Ásgeirsdóttir TL: The effect of job loss on body weight during an economic collapse. Eur J Health Econ 2013. doi:10.1007/s10198-013-0494-z
• [26]Benediktsdottir S, Danielsson J, Zoega G: Lessons from a collapse of a financial system. Econ Policy 2011, 26:183-235.
• [27]Okun MA, Stock WA, Haring MJ, Witter RA: Health and subjective well-being: a meta-analysis. Int J Aging Hum Dev 1984, 19:111-132.
• [28]Connelly JE, Philbrick JT, Smith GR Jr, Kaiser DL, Wymer A: Health perceptions of primary care patients and the influence on health care utilization. Med Care 1989, 27:S99-109.
• [29]Idler EL, Angel RJ: Self-rated health and mortality in the NHANES-I Epidemiologic Follow-Up-Study. Am J Public Health 1990, 80:446-452.
• [30]Wannamethee G, Shaper AG: Self-assessment of health status and mortality in middle-aged British men. Int J Epidemiol 1991, 20:239-245.
• [31]Idler EL, Kasl S: Health perceptions and survival - do global evaluations of health-status really predict mortality. J Gerontol 1991, 46:S55-S65.
• [32]Idler EL, Kasl SV: Self-ratings of health - do they also predict change in functional ability. J Gerontol B-Psychol 1995, 50:S344-S353.
• [33]Burström B, Fredlund P: Self rated health: is it as good a predictor of subsequent mortality among adults in lower as well as in higher social classes? J Epidemiol Commun H 2001, 55:836-840.
• [34]Gerdtham UG, Johannesson M, Lundberg L, Isacson D: A note on validating Wagstaff and van Doorslaer’s health measure in the analysis of inequalities in health. J Health Econ 1999, 18:117-124.
• [35]Idler EL, Benyamini Y: Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 1997, 38:21-37.
• [36]McCallum J, Shadbolt B, Wang D: Self-rated health and survival: a 7-year follow-up-study of Australian elderly. Am J Public Health 1994, 84:1100-1105.
• [37]Kaplan GA, Camacho T: Perceived health and mortality: a 9-year follow-up of the human-population laboratory cohort. Am J Epidemiol 1983, 117:292-304.
• [38]Wagstaff A, van Doorslaer E: Measuring inequalities in health in the presence of multiple-category morbidity indicators. Health Econ 1994, 3:281-291.
• [39]Kakwani N, Wagstaff A, van Doorslaer E: Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econometrics 1997, 77:87-103.
• [40]Wagstaff A: The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ 2005, 14:429-432.
• [41]Obesity http://www.who.int/topics/obesity/en/ webcite
• [42]StataCorp: Stata Statistical Software: Release 11. College Station, TX: StataCorp LP; 2009.
• [43]New entrants at tertiary and doctorate level (5 or 6) http://www.statice.is/temp_en/Dialog/varval.asp?ma=SKO04122&ti=New%20entrants%20at%20the%20tertiary%20and%20doctorate%20level%20by%20narrow%20field,%20citizenship,%20sex%20and%20age%201997-2010&path=../Database/skolamal/hsNemendur/&lang=1&units=Number webcite
• [44]Asgeirsdottir TL: Do body weight and gender shape the work force? The case of Iceland. Econ Hum Biol 2011, 9:148-156.
• [45]Ásgeirsdóttir TL, Ragnarsdóttir DÓ: Business cycles, hypertension and cardiovascular disease: evidence from the icelandic economic collapse. Blood Pressure 2013. doi:10.3109/08037051.2013.862913
• [46]Lindeboom M, van Doorslaer E: Cut-point shift and index shift in self-reported health. J Health Econ 2004, 23:1083-1099.
• [47]Delpierre C, Lauwers-Cances V, Datta GD, Lang T, Berkman L: Using self-rated health for analysing social inequalities in health: a risk for underestimating the gap between socioeconomic groups? J Epidemiol Commun H 2009, 63:426-432.