Why do some countries do better or worse in life expectancy relative to income? An analysis of Brazil, Ethiopia, and the United States of America

International Journal for Equity in Health

Hailay Abrha Gesesew¹  James Macinko²  Jennie Popay³  Clare Bambra⁴  Elsa Regina Justo Giugliani⁵  David Sanders⁶  Toby Freeman⁷  Fran Baum⁷  Connie Musolino⁷ 

[1]Department of Public Health, Flinders University, Adelaide, Australia

[2]Department of Epidemiology, Mekelle University, Mekelle, Ethiopia

[3]Departments of Health Policy and Management and Community Health Sciences, UCLA, Los Angeles, CA, USA

[4]Division of Health Research, Lancaster University, Lancashire, UK

[5]Institute of Population Health Sciences, Newcastle University, Newcastle, UK

[6]Pediatrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

[7]School of Public Health, University of the Western Cape, Cape Town, South Africa

[8]Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, Australia

关键词: Population health;    Social determinants of health;    Policy;    Life expectancy;    Civil society;   

DOI  :  10.1186/s12939-020-01315-z

来源: Springer

【 摘 要 】

BackgroundWhile in general a country’s life expectancy increases with national income, some countries “punch above their weight”, while some “punch below their weight” – achieving higher or lower life expectancy than would be predicted by their per capita income. Discovering which conditions or policies contribute to this outcome is critical to improving population health globally.MethodsWe conducted a mixed-method study which included: analysis of life expectancy relative to income for all countries; an expert opinion study; and scoping reviews of literature and data to examine factors that may impact on life expectancy relative to income in three countries: Ethiopia, Brazil, and the United States. Punching above or below weight status was calculated using life expectancy at birth and gross domestic product per capita for 2014–2018. The scoping reviews covered the political context and history, social determinants of health, civil society, and political participation in each country.ResultsPossible drivers identified for Ethiopia’s extra 3 years life expectancy included community-based health strategies, improving access to safe water, female education and gender empowerment, and the rise of civil society organisations. Brazil punched above its weight by 2 years. Possible drivers identified included socio-political and economic improvements, reduced inequality, female education, health care coverage, civil society, and political participation. The United States’ neoliberal economics and limited social security, market-based healthcare, limited public health regulation, weak social safety net, significant increases in income inequality and lower levels of political participation may have contributed to the country punching 2.9 years below weight.ConclusionsThe review highlighted potential structural determinants driving differential performance in population health outcomes cross-nationally. These included greater equity, a more inclusive welfare system, high political participation, strong civil society and access to employment, housing, safe water, a clean environment, and education. We recommend research comparing more countries, and also to examine the processes driving within-country inequities.

【 授权许可】

CC BY