Abstract
Objectives
This ecological study examined the relationship between neoliberal capitalist ideology (hereafter, neoliberal ideology) and non-communicable diseases (NCD) mortality in 124 countries, focusing on the degree to which climate culpability and physical inactivity are implicated in explaining that relationship.
Methods
The economic freedom of the world index of the Fraser Institute (representing neoliberal ideology), CO2 emissions (metric tons/capita) from the World Bank (representing climate culpability), and the World Health Organization’s age-adjusted physical inactivity and NCD mortality data were used. Covariates included gross domestic product (GDP)/capita, the country-level prevalence of obesity (n = 123), tobacco smoking (n = 111), and alcohol consumption (n = 61).
Results
Neoliberal ideology was associated with NCD mortality after controlling for GDP/capita, physical inactivity, and obesity, and this association was most pronounced in less culpable countries. The association between neoliberal ideology and NCD mortality remained statistically significant even after further controlling for tobacco smoking and alcohol consumption. Neoliberal ideology was associated with NCD mortality, after controlling for GDP, climate culpability, and tobacco smoking, regardless of physical inactivity. When alcohol consumption was introduced, physical inactivity moderated the association between neoliberal ideology and NCD mortality.
Conclusion
Neoliberal ideology was consistently associated with NCD mortality. Also, NCD mortality appears to be most severe in countries that are less culpable for global climate change. Our findings offer preliminary evidence-based support for a shift in thinking toward the fundamental determinants of health and calls for an upstream shift in climate change mitigation interventions to improve population health through the creation of equitable global political and economic systems.
Résumé
Objectifs
Notre étude écologique porte sur le lien entre l’idéologie capitaliste néolibérale (ci-après dénommée « idéologie néolibérale ») et la mortalité due aux maladies non transmissibles (MNT) dans 124 pays, et en particulier sur la mesure dans laquelle la culpabilité climatique et la sédentarité peuvent expliquer ce lien.
Méthode
Nous avons utilisé l’indice de liberté économique dans le monde de l’Institut Fraser (pour représenter l’idéologie néolibérale), les émissions de CO2 (en tonnes métriques par habitant) selon la Banque mondiale (pour représenter la culpabilité climatique) et les données sur la sédentarité et la mortalité due aux MNT de l’Organisation mondiale de la santé, rajustées selon l’âge. Nos covariables ont été le produit intérieur brut (PIB) par habitant et, par pays, la prévalence de l’obésité (n = 123), du tabagisme (n = 111) et de la consommation d’alcool (n = 61).
Résultats
L’idéologie néolibérale était associée à la mortalité due aux MNT après prise en compte du PIB par habitant, de la sédentarité et de l’obésité, et cette association était la plus prononcée dans les pays les moins coupables. L’association entre l’idéologie néolibérale et la mortalité due aux MNT est demeurée significative même après l’apport d’ajustements pour tenir compte des effets de tabagisme et de la consommation d’alcool. L’idéologie néolibérale était associée à la mortalité due aux MNT après prise en compte du PIB, de la culpabilité climatique et du tabagisme, quels que soient les niveaux de sédentarité. Quand la consommation d’alcool était introduite, la sédentarité réduisait l’association entre l’idéologie néolibérale et la mortalité due aux MNT.
Conclusion
L’idéologie néolibérale était uniformément associée à la mortalité due aux MNT. Par ailleurs, la mortalité due aux MNT semble être la plus grave dans les pays les moins coupables à l’égard du changement climatique mondial. Nos constatations présentent des preuves préliminaires à l’appui d’une évolution de la pensée sur les déterminants fondamentaux de la santé et appellent à intervenir en amont pour atténuer le changement climatique, en vue d’améliorer la santé des populations par la création de systèmes politiques et économiques mondiaux équitables.
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Data availability
Data available in a public (institutional, general, or subject-specific) repository that issues datasets with DOIs (non-mandated deposition). See the Methods section of the manuscript to obtain access to the datasets used in this study. Data are also provided in the supplementary material.
Code availability
Not applicable.
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Acknowledgements
The authors thank Shawn Hakimi (PhD student at Queen’s University) for assisting data preparation and Dr. Richard Larouche (Assistant Professor at the University of Lethbridge) for providing input on an earlier draft of this article.
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EL and JM conceived the study. EL obtained datasets and led the analysis and interpretation of data. EL led the writing of the manuscript with substantial support from JM. All authors were responsible for revising the manuscript critically for important intellectual content. All authors read and approved the final manuscript.
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Lee, EY., Masuda, J. The ‘freedom’ to pollute? An ecological analysis of neoliberal capitalist ideology, climate culpability, lifestyle factors, and population health risk in 124 countries. Can J Public Health 112, 877–887 (2021). https://doi.org/10.17269/s41997-021-00530-7
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DOI: https://doi.org/10.17269/s41997-021-00530-7