Centre for the Study of Regional Development, School of Social Sciences (SSS), Jawaharlal Nehru University (JNU), New Delhi, India.
Department of Economics, The University of Western Australia (M251), Perth, Australia.
PLoS One. 2019 Mar 19;14(3):e0213139. doi: 10.1371/journal.pone.0213139. eCollection 2019.
To advance the goal of "Grand Convergence" in global health by 2035, this study tested the convergence hypothesis in the progress of the health status of individuals from 193 countries, using both standard and cutting-edge convergence metrics.
The study used multiple data sources. The methods section is categorized into two parts. (1) Health inequality measures were used for estimating inter-country inequalities. Dispersion Measure of Mortality (DMM) is used for measuring absolute inequality and Gini Coefficient for relative inequality. (2) We tested the standard convergence hypothesis for the progress in Infant Mortality Rate (IMR) and Life Expectancy at Birth (LEB) during 1950 to 2015 using methods ranging from simple graphical tools (catching-up plots) to standard parametric (absolute β and σ-convergence) and nonparametric econometric models (kernel density estimates) to detect the presence of convergence (or divergence) and convergence clubs.
The findings lend support to the "rise and fall" of world health inequalities measured using Life Expectancy at Birth (LEB) and Infant Mortality Rate (IMR). The test of absolute β-convergence for the entire period and in the recent period supports the convergence hypothesis for LEB (β = -0.0210 [95% CI -0.0227 - -0.0194], p<0.000) and rejects it for IMR (β = 0.0063 [95% CI 0.0037-0.0089], p<0.000). However, results also suggest a setback in the speed of convergence in health status across the countries in recent times, 5.4% during 1950-55 to 1980-85 compared to 3% during 1985-90 to 2010-15. Although inequality based convergence metrics showed evidence of divergence replacing convergence during 1985-90 to 2000-05, from the late 2000s, divergence was replaced by re-convergence although with a slower speed of convergence. While the non-parametric test of convergence shows an emerging process of regional convergence rather than global convergence.
We found that with a current rate of progress (2.2% per annum) the "Grand convergence" in global health can be achieved only by 2060 instead of 2035. We suggest that a roadmap to achieve "Grand Convergence" in global health should include more radical changes and work for increasing efficiency with equity to achieve a "Grand convergence" in health status across the countries by 2035.
通过 2035 年实现全球卫生领域的“大融合”目标，本研究通过标准和前沿融合指标，检验了 193 个国家个体健康状况的进展是否符合融合假设。
本研究使用了多种数据源。方法部分分为两部分。（1）使用健康不平等指标来估计国家间的不平等程度。死亡率分散度量（DMM）用于衡量绝对不平等，基尼系数用于衡量相对不平等。（2）我们使用从简单的图形工具（赶超图）到标准参数（绝对β和σ收敛）和非参数计量经济学模型（核密度估计）的方法，检验了 1950 年至 2015 年期间婴儿死亡率（IMR）和出生时预期寿命（LEB）进展的标准收敛假设，以检测是否存在收敛（或发散）和收敛俱乐部。
研究结果支持使用出生时预期寿命（LEB）和婴儿死亡率（IMR）衡量的世界健康不平等的“兴衰”。整个时期和近期的绝对β收敛检验均支持 LEB 的收敛假设（β=-0.0210[95%置信区间-0.0227 至-0.0194]，p<0.000），而 IMR 的收敛假设则被拒绝（β=0.0063[95%置信区间 0.0037-0.0089]，p<0.000）。然而，结果还表明，近年来各国健康状况的收敛速度有所放缓，从 1950-55 年至 1980-85 年的 5.4%，降至 1985-90 年至 2010-15 年的 3%。尽管基于不平等的收敛指标显示，在 1985-90 年至 2000-05 年期间，发散取代了收敛，但从 2000 年代后期开始，尽管收敛速度较慢，但发散被重新收敛所取代。虽然收敛的非参数检验显示出区域收敛而不是全球收敛的新兴过程。
我们发现，按照目前的进展速度（每年 2.2%），全球卫生领域的“大融合”只能在 2060 年实现，而不是 2035 年。我们建议，实现全球卫生“大融合”的路线图应包括更激进的变革和提高效率的工作，以实现到 2035 年各国健康状况的“大融合”。
