The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #68347

James Macinko, PhD¹, Leiyu Shi, DrPH, MBA², and Barbara Starfield, MD MPH¹. (1) Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 452, Baltimore, MD 21212, 410-614-6507, jmacinko@jhu.edu, (2) Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, 624 N. Broadway, Room 409, Baltimore, MD 21212

Objectives: To assess the impact of health system variables on the relationship between wage inequality and infant mortality over a 26-year period. Methods: Pooled, cross-sectional, time series analysis of 19 OECD countries over the period 1970-1996. Secondary data are derived from the OECD, World Value Surveys, Luxembourg Income Study, and political economy databases. Analyses include Pearson correlation and fixed-effects multivariate regression. Results: 1) in year-specific and time-series analyses, the Theil measure of wage inequality (based on industrial sector wages) is positively and statistically significantly associated with infant mortality rates-even while controlling for GDP per capita; 2) health system variables (healthcare financing and the supply of physicians) significantly attenuated the effect of wage inequality on infant mortality; 3) in fixed effects multivariate regression models controlling for GDP per capita and wage inequality, variables associated with better health include income per capita, the method of healthcare financing, and physicians per 1,000 population, while the openness of the economy, unemployment rates, the proportion of the population in unions, and government expenditures on health were associated with poorer health outcomes. Ambiguous effects were seen for the consumer price index and voting rates. Conclusions: This study shows a positive association between wage inequality, as measured by the Theil index, and infant mortality rates within wealthy countries. This relationship is partially attenuated by the presence of tax-based health financing, and a greater supply of physicians.

Learning Objectives:

At the conclusion of the session, the participant should be able to:
• describe the differences between Gini coefficients based on household income and the Theil measure of wage inequality;
• suggest elements of a framework of health determinants; and
• discuss ways in which the health system may be able to attenuate potential negative effects of income and wage inequalities on health.

Keywords: Social Inequalities, International

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.