Kontodimopoulos Nikolaos
Faculty of Social Sciences, Hellenic Open University, Parodos Aristotelous 18, 26335, Patras, Greece.
Department of Health Economics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527, Athens, Greece.
Res Health Serv Reg. 2022 Jun 22;1(1):2. doi: 10.1007/s43999-022-00003-5.
Social Determinants of Health (SDH) are important in explaining why some countries enjoy better health than others. This empirical study highlights controversies in the literature on the relationship between socioeconomic development and health, and investigates how the relationship might vary in countries with different economic growth.
The sample consists of 172 countries, and recent cross-sectional data was collected from the World Bank's "Data Bank". Population health was proxied with life expectancy, infant mortality and under-five mortality, and sociooeconomic conditions were expressed with GNI/capita, unemployment rate, poverty, Gini index, educational attainment, public spending on health and physician density. Countries were categorized into three groups as low / lower middle-, upper middle- and high-income according to World Bank thresholds. Ordinary least squares regression was used to model the relationships.
The association between socioeconomic conditions and health differed between countries of different economic development. Poverty, educational attainment, income inequality, and physician density were the strongest contributors to health. Higher economic development had a stronger relationship with health in richer countries, and government commitment to health care in poorer ones.
Based on evidence from studies such as this one, researchers and policymakers globally could commit to acting together on SDH, and to aligning resources from different sectors to formulate interventions aiming to improve population health.
健康的社会决定因素（SDH）对于解释为何一些国家的健康状况优于其他国家至关重要。这项实证研究凸显了关于社会经济发展与健康之间关系的文献中的争议，并调查了在经济增长不同的国家中这种关系可能如何变化。
样本包括172个国家，近期的横截面数据取自世界银行的“数据库”。用预期寿命、婴儿死亡率和五岁以下儿童死亡率来代表人口健康状况，并用人均国民总收入、失业率、贫困率、基尼系数、教育程度、卫生公共支出和医生密度来表示社会经济状况。根据世界银行的标准，将国家分为低收入/中低收入、中高收入和高收入三组。使用普通最小二乘法回归对这些关系进行建模。
不同经济发展水平国家的社会经济状况与健康之间的关联存在差异。贫困、教育程度、收入不平等和医生密度是对健康影响最大的因素。在较富裕国家，更高的经济发展与健康的关系更强；在较贫穷国家，政府对医疗保健的投入与健康的关系更强。
基于此类研究的证据，全球的研究人员和政策制定者可以共同致力于健康的社会决定因素，并整合不同部门的资源，以制定旨在改善人口健康的干预措施。
