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What Determines Health Status of Population in Pakistan?

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Abstract

This paper empirically examines factors related to social, economic, demographic and health care services that affect health status in Pakistan. The analysis is conducted using ARDL bound testing approach on annual data ranging from 1960 to 2014. It is estimated that health spending has a significant impact on health status, specifically, development health spending and income are robust predictors of health status for the population in Pakistan and is seen to affect female life expectancy positively in both the short and in long run, however, it is important to note that the impact of income per capita is relatively stronger than that of public health spending. Total fertility rate (fr) appears to have a significant effect on child mortality rate (cmr) with a negative sign both in the short and in long-run. This result is especially important for developing countries like Pakistan where population growth is high and infant deaths are frequent. Bidirectional causality exists between infant and child mortality and fertility rate; these results are supported by the modern economic theory of population. The effect of medical personnel availability on health status, particularly in reducing infant and child mortality, remains statistically non-significant despite the bidirectional causal relationship between this variable and the infant and child mortality. Nutrition appears to be causally related to life expectancy and child mortality. Thus, it is important for the Government of Pakistan to design its policies based on the development targets in addition to the growth targets that have been set in place for the country.

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References

  • Abbas, F., & Hiemenz, U. (2013). What determines public health expenditures in Pakistan? Role of income, urbanization and unemployment. Economic Change and Restructuring, 46, 341–362.

    Article  Google Scholar 

  • Abbas, F., & Khan, I. A. (2014). Fertility-infant mortality causality nexus: Empirical analysis using data from Pakistan. Asian Profile, 42(1), 11–22.

    Google Scholar 

  • ADB. (1997). Social sector issues in Pakistan: An overview. Manila: Asian Development Bank.

    Google Scholar 

  • Anand, S., & Ravallion, M. (1993). Human development in poor countries: On the role of private income and public services. Journal of Economic Perspectives, 7(1), 133–150.

    Article  Google Scholar 

  • Asteriou, D. (2006). Applied econometrics: A modern approach using E-views and Microfit. New York: Palgrave McMillan.

    Google Scholar 

  • Banister, J., & Zhang, X. (2005). China, economic development and mortality decline. World Development, 33(1), 21–41.

    Article  Google Scholar 

  • Barros, P. P. (1998). The black box of health care expenditure growth determinants. Health Economics, 7, 533–544.

    Article  Google Scholar 

  • Benefo, K., & Scultz, T. P. (1996). Fertility and child mortality in Cote d’Ivoire and Ghana. World Bank Economic Review, 10(1), 123–158.

    Article  Google Scholar 

  • Bidani, B., & Ravallion, M. (1997). Decomposing social indicators using distributional data. Journal of Econometrics, 77, 125–139.

    Article  Google Scholar 

  • Bishai, D. M. (1995). Infant mortality time series are random walks with drift: Are they cointegrated with socioeconomic variables? Health Economics, 4, 157–167.

    Article  Google Scholar 

  • Bishai, D., Opuni, M., & Poon, A. (2007). Does the level of infant mortality affect the rate of decline? Time series data from 21 countries. Economics and Human Biology, 5, 74–81.

    Article  Google Scholar 

  • Brenner, M. H. (1979). Fetal, infant and maternal mortality during periods of economic instability. International Journal of Health Services, 3(2), 145–159.

    Article  Google Scholar 

  • Brown, J., & Pollitt, E. (1996). Malnutrition, poverty and intellectual development. Scientific American, 2, 38–43.

    Article  Google Scholar 

  • Brown, R. L., Durbin, J., & Evans, J. M. (1975). Techniques for testing the constancy of regression relations over time. Journal of the Royal Statistical Society, 37, 149–163.

    Google Scholar 

  • Catalano, R., & Serxner, S. (1992). Neonatal mortality and the economy revisited. International Journal of Health Services, 22(2), 275–286.

    Article  Google Scholar 

  • Cheung, W.-W., Sharma, S., & Shield, M. P. (1986). A time series model of the demographic transition: Discussion paper series No. 86–28. Carbondale: Southern Illinois University at Carbondale.

    Google Scholar 

  • Chowdhury, A. K., Alauddin, M., Atiqur, R. K., & Chen, L. C. (1976). The effect of child mortality experience on subsequent fertility: In Pakistan and Bangladesh. Population Studies, 30(2), 249–261.

    Article  Google Scholar 

  • Chowdhury, A. R. (1988). The infant mortality-fertility debate: Some international evidence. Southern Economic Journal, 54(3), 666–674.

    Article  Google Scholar 

  • Cremieux, P. Y., Ouellette, P., & Pilon, C. (1999). Health care spending as determinants of health outcomes. Health Economics, 8, 627–639.

    Article  Google Scholar 

  • Dickey, D. A., Bell, W. R., & Miller, R. B. (1986). Unit root in time series models: Tests and implications. American Statistics, 40(1), 12–26.

    Google Scholar 

  • Dickey, D. A., & Fuller, W. A. (1981). Likelihood ratio statistics for autoregressive time series with a unit root. Econometrica, 49(4), 1057–1072.

    Article  Google Scholar 

  • Engle, R. F., & Granger, C. W. (1987). Co-integration and error correction: Presentation, estimation and testing. Econometrica, 55(2), 251–276.

    Article  Google Scholar 

  • FAO (2015). Food and Agriculture Organization of United Nations, Statistical Database online. www.fao.org.

  • Farag, M., et al. (2013). Health expenditures, health outcomes and the role of good governance. International Journal of Health Care Finance and Economics, 13, 33–52.

    Article  Google Scholar 

  • Fayissa, B., & Gutema, P. (2005). The determinants of health status in Sub-Saharan Africa. The American Economist, 49(2), 60–66.

    Article  Google Scholar 

  • Feeney, G., & Alam, I. (2003). New estimates and projections of population growth in Pakistan. Population Development Review, 29(3), 483–492.

    Article  Google Scholar 

  • Feldstein, M. (1967). Economic analysis for health service efficiency. Oxford: Oxford University Press.

    Google Scholar 

  • Filmer, D., & Pritchett, L. (1999). The impact of public spending on health: Does money matter? Social Science and Medicine, 49, 1309–1323.

    Article  Google Scholar 

  • Flegg, A. T. (1982). Inequality of income, illiteracy and medical care as determinants of infant mortality in underdeveloped countries. Population Studies, 36(3), 441–458.

    Article  Google Scholar 

  • Gbesemete, K. P., & Jonsson, D. (1993). A comparison of empirical models on determinants of infant mortality: A cross national study of Africa. Health Policy, 24, 155–174.

    Article  Google Scholar 

  • GOP. (2011). Economic survey of Pakistan 2010–2011. Islamabad: Economic Advisor’s Wing, Ministry of finance.

    Google Scholar 

  • GOP. (2015). Economic survey of Pakistan 2011–2012. Islamabad: Economic Advisor’s Wing, Ministry of Finance.

    Google Scholar 

  • Greenidge, K., & Stanford, S. (2007). What are the determinants of health status in Latin America and the Caribbean?. Working paper Series central Bank of Barbados.

  • Grossman, M. (1972). The demand for health. New York: National Bureau of Economic Research (NBER).

    Google Scholar 

  • Hadley, J. (1982). More medical care, better health. Washington DC: Urban Institute.

    Google Scholar 

  • Hanmer, L., Lensink, R., & Howard, W. (2003). Infant and child mortality in developing countries: Analyzing the data for robust determinants. Journal of Development Studies, 40(1), 101–118.

    Article  Google Scholar 

  • Harris, R., & Sollis, R. (2003). Applied time series modeling and forecasting. Chichester: Wiley.

    Google Scholar 

  • Holden, D., & Perman, R. (1994). Unit roots and cointegration for the economist, Chapter 3. In B. B. Rao (Ed.), Cointegration for the applied economist. New York: St. Martin’s Press.

    Google Scholar 

  • Issa, H., & Ouattara, B. (2005). The effects of private and public health expenditure on infant mortality rates: Does the level of development matters? UK: Department of Economics, University of Wales.

    Google Scholar 

  • Jack, W. (1999). Principles of health economics in developing countries. Washington DC: World Bank Institute (WBI).

    Google Scholar 

  • Jamison, D. T., Moseley, W. H., Measham, A. R., & Bobadilla, J. L. (Eds.). (1993). Disease control priorities in developing countries. New York: Published for the World Bank by Oxford University Press.

    Google Scholar 

  • Johansen, S. (1988). Statistical analysis of cointegrating vectors. Journal of Economic Dynamics and Control, 12, 231–254.

    Article  Google Scholar 

  • Johansen, S., & Juselius, K. (1990). Maximum likelihood estimation and inference on cointegration—With application to the demand for money. Oxford Bulletin of Economics and Statistics, 52, 169–210.

    Article  Google Scholar 

  • Kabir, M. (2008). Determinants of life expectancy in developing countries. The Journal of Developing Areas, 41(2), 185–204.

    Article  Google Scholar 

  • Kimhi, A. (2003). Socio-economic determinants of health and physical fitness in southern Ethiopia. Economics and Human Biology, 1(2), 55–75.

    Article  Google Scholar 

  • Le Franc, E. (1989). Socio-economic determinants of health status. Social and Economics Studies, 38(2), 291–305.

    Google Scholar 

  • Macinko, J., Frederico, C. G., & De Souza, F. M. (2006). Evaluation of the impact of the family health program on infant mortality in Brazil, 1990–2002. Journal of Epidemiology and Community Health, 60, 13–19.

    Article  Google Scholar 

  • MacKinnon, J. G. (1991). Critical values for cointegration tests. In R. F. Engle & C. W. J. Granger (Eds.), Long run economic relationships: Readings in cointegration. Oxford: Oxford University Press.

    Google Scholar 

  • Maddala, G. S. (1992). Introduction to econometrics (2nd ed.). London: McMillan Publication.

    Google Scholar 

  • Malik, S. J., Aftab, S., & Sultana, N. (1994). Pakistan’s economics performance 1947 to 1993: A descriptive analysis. Pakistan: Sure Publishers Karachi.

    Google Scholar 

  • Maturi, A. J., & Curtis, S. L. (1995). The determinants of child mortality in Tanzania. Health Policy and Planning, 10(4), 384–394.

    Article  Google Scholar 

  • McGuire, A., Parkin, D., Hughes, D., & Gerard, K. (1993). Econometric analysis of national health expenditures: Can positive economics help to answer normative questions? Health Economics, 2, 113–126.

    Article  Google Scholar 

  • Messias, E. (2003). Income inequality, illiteracy and life expectancy in Brazil. American Journal of Public Health, 93, 1294–1296.

    Article  Google Scholar 

  • Mills, A., & Gilson, L. (1988). Health Economics for developing countries: A survival kit, Health Economics and Financing Program. Working Paper No. 01/88, LSHTM, London, UK.

  • Murthy, N. R. V., & Ukpolo, V. (1994). Aggregate health care expenditure in the United States: Evidence from cointegration tests. Applied Economics, 26(8), 797–802.

    Article  Google Scholar 

  • Musgrove, P. (1996). Public and private roles in health: Theory and financing patterns. World Bank discussion paper No. 339 Washington DC.

  • Narayan, P. K. (2004). The relationship between fertility and infant mortality rates within the cointegration and granger causality framework: Evidence from China. Asian Profile, 32(1), 1–6.

    Google Scholar 

  • Novignon, J., Olakojo, A. S., & Nonvignon, J. (2012). The effects of public and private health care expenditures on health status in sub-Saharan Africa: New evidence from panel data analysis. Health Economics Review, 2012(2), 22.

    Article  Google Scholar 

  • Or, Z. (2000). Exploring the effect of health care on mortality across OECD countries. In Labor Market and Social Policy Occasional Paper No. 46. Paris: OECD.

  • Palloni, A., & Rafalimanan, H. (1999). The effects of infant mortality on fertility revisited: New evidence from Latin Americca. Demography, 36, 337–342.

    Article  Google Scholar 

  • Pesaran, M. H., & Shin, Y. (1999). An autoregressive distributed lag modelling approach to cointegration analysis. In S. Strom (Ed.), Econometrics and economic theory in the 20th century: The Ragnar Frisch Centennial Symposium. Cambridge: Cambridge University Press.

    Google Scholar 

  • Pesaran, M. H., Shin, Y., & Smith, R. (2001). Bounds testing approaches to the analysis of level relationships. Journal of Applied Econometrics, 16, 289–326.

    Article  Google Scholar 

  • Phillips, P. C. B., & Perron, P. (1988). Testing for a unit root in time series regressions. Biometrika, 75(2), 335–346.

    Article  Google Scholar 

  • Preston, S. H. (1975). The changing relationship between mortality and level of economic development. Population Studies, 29(2), 231–248.

    Article  Google Scholar 

  • Pritchett, L., & Summers, L. H. (1996). Wealthier is healthier. Journal of Human Resources, 30(4), 841–868.

    Article  Google Scholar 

  • Ramesh, M., & Sam, M. (2007). An assessment of OECD health care system: Using panel data analysis. MPRA paper 6122.

  • Reidpath, D. D., & Allotey, P. (2003). Infant mortality rate as an indicator of population health. Journal of Epidemology and Community Health, 57, 344–346.

    Article  Google Scholar 

  • Repetto, R. (1978). The interaction of fertility and size distribution of income. Journal of development Studies, 14, 22–39.

    Article  Google Scholar 

  • Rodgers, G. B. (1979). Income and inequality as determinants of mortality: An international cross section analysis. Population Studies, 33(2), 343–351.

    Article  Google Scholar 

  • Sachs, J. D. (2004). Health in the developing world: Achieving the millennium development goals. Bulletin of World Health Organization, 82(12), 947–949.

    Google Scholar 

  • Sah, R. (1991). The effect of child mortality changes on fertility choice and parental welfare. Journal of Political Economy, 99, 582–606.

    Article  Google Scholar 

  • Sathar, Z., & Zaidi, B. (2011). Fertility prospects in Pakistan. United Nations Department of Economic and Social Affairs, Population Division Expert Paper No. 2011/7.

  • Schell, C. O., Reilly, M., Rosling, M., Peterson, S., & Ekström, A. M. (2007). Socioeconomic determinants of infant mortality: A worldwide study of 152 low, middle, and high-income countries. Scandinavian Journal of Public Health, 35, 288–297.

    Article  Google Scholar 

  • Schultz, T. P. (2004). Health economics and application in developing countries. Journal of Health Economics, 23(4), 637–641.

    Article  Google Scholar 

  • Schultz, T. W. (1993). Mortality decline in low income world: Causes and consequences. American Economic Association (AEA) Papers and Proceedings, 83, 337–342.

    Google Scholar 

  • Schwert, G. W. (1989). Tests for unit roots: A Monte Carlo investigation. Journal of Business and Economic Statistics, 7, 147–160.

    Google Scholar 

  • Sede, P. I., & Ohemeng, W. (2015). Socio-economic determinants of life expectancy in Nigeria (1980–2011). Health Economics Review, 5, 2. doi:10.1186/s13561-014-0037-z.

    Article  Google Scholar 

  • Sen, A. (1995). Demography and welfare economics. Empirica, 22, 1–21.

    Article  Google Scholar 

  • Sen, A. (1998). Mortality as an indicator of economic success and failure. Economic Journal, 108, 1–25.

    Article  Google Scholar 

  • Sen, A. (2002). Health: Perception versus observation. British Medical Journal, 324, 860–861.

    Article  Google Scholar 

  • Shahbaz, M., et al. (2016). Determinants of life expectancy and its prospects under the role of economic misery: A case of Pakistan. Social Indicators Research, 126(3), 1299–1316.

    Article  Google Scholar 

  • Siddiqui, R., & Mehmood, M. A. (1994). The determinants of health status: A cross country analysis. Pakistan Development Review, 33(4), 745–758.

    Google Scholar 

  • Suwal, J. V. (2001). The main determinants of infant mortality in Nepal. Social Science and Medicine, 53, 1667–1681.

    Article  Google Scholar 

  • Thorton, J. (2002). Estimating a health production function for US: Some new evidence. Applied Economics, 34(2), 59–62.

    Article  Google Scholar 

  • United Nation. (2001). United Nations statement on Food security in Pakistan. Thematic Group on Rural Development and Food Security.

  • UNDP. (2011). Sustainability and equity: A better future for all. Human Development Report 2011, United Nations Development Program, Washington DC.

  • Waldmann, R. (1992). Income distribution and infant mortality. Quarterly Journal of Economics, 107(4), 1283–1302.

    Article  Google Scholar 

  • WHO. (2005). Make every mother and child count, World Health Report 2005. Geneva: World Health Organization.

    Google Scholar 

  • WHO. (2015). World Health Statistics 2007. Geneva, Switzerland: World Health Organization.

    Google Scholar 

  • Woodward, A., & Kawachi, I. (2000). Why reduce health inequalities? Journal of Epidemiology and Community Health, 54, 923–929.

    Article  Google Scholar 

  • World Bank. (1993). World Development report 1993, investing in health. Washington DC: World Bank.

    Book  Google Scholar 

  • World Development Report. (2011). Conflict, security and development. World Bank World Development Report 2011, Washington DC.

  • Yamada, T. (1985). Causal relationships between infant mortality and fertility in developed and less developed countries. Southern Economic Journal, 52(2), 364–370.

    Article  Google Scholar 

  • Younger, S. D. (2001). Cross country determinants of decline in infant mortality: A growth regression approach. Cornel Food and nutrition policy program (CFNPP) working paper No. 130, Cornell University.

  • Zahid, G. M. (1996). Mother’s health seeking behavior and childhood mortality in Pakistan. The Pakistan Development Review, 35(4), 719–731.

    Google Scholar 

  • Zakir, M., & Wunnava, P. V. (1999). Factors affecting infant mortality rates: Evidence from cross sectional data. Applied Economic letters, 6, 271–273.

    Article  Google Scholar 

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Acknowledgements

This paper is a part of first Authors’ Ph.D. research, thus, funding provided by German Academic Exchange Service (DAAD) is highly acknowledged.

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Authors and Affiliations

  1. Independant Researcher and Consultant based in Islamabad, Islamabad, 44000, Pakistan

    Faisal Abbas

  2. Charles H. Dyson School of Applied Economics and Management, Cornell University, 406 Warren Hall, Ithaca, NY, USA

    Faisal Abbas

  3. Department of Economics, University of Kansas, Lawrence, KS, USA

    Haroon Sarwar Awan

  4. Assistant Chief, Poverty Alleviation and Sustainable Development Goals Section, Planning Commission of Pakistan, Pak Secretariat, Islamabad, Pakistan

    Haroon Sarwar Awan

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  1. Faisal Abbas
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Correspondence to Faisal Abbas.

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Appendix

Appendix

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Table 6 Summary statistics of the variables (1960–2014)
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Abbas, F., Awan, H.S. What Determines Health Status of Population in Pakistan?. Soc Indic Res 139, 1–23 (2018). https://doi.org/10.1007/s11205-017-1702-5

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