Poverty, Income, and Unemployment as Determinants of Life Expectancy: Empirical Evidence from Panel Data of Thirteen Malaysian States
Background: The primary indicator of public health, which all nations aim to prolong, is life expectancy at birth. Uncovering its socioeconomic determinants is key to extending life expectancy. This study examined the determinants of life expectancy in Malaysia.
Methods: This observational study employs secondary data from various official sources of 12 states and one federal territory in Malaysia (2002-2014). Panel data of 78 observations (13 cross-sections at six points in time) were used in multivariate, fixed-effect, regressions to estimate the effects of socioeconomic variables on life expectancy at birth for male, female and both-gender.
Results: Poverty and income significantly determine female, male, and total life expectancies. Unemployment significantly determines female and total life expectancies, but not male. Income inequality and public spending on health (as a percentage of total health spending) do not significantly determine life expectancy. The coefficients of the multivariate regressions suggest that a 1% reduction in poverty, 1% reduction in unemployment, and around USD 23.20 increase in household monthly income prolong total life expectancy at birth by 17.9, 72.0, and 16.3 d, respectively. The magnitudes of the effects of the socioeconomic variables on life expectancy vary somewhat by gender.
Conclusion: Life expectancy in Malaysia is higher than the world average and higher than that in some developing countries in the region. However, it is far lower than the advanced world. Reducing poverty and unemployment and increasing income are three effective channels to enhance longevity.
2. Kontis V, Bennett JE, Mathers CD, Li G, Foreman K, Ezzati M (2017). Future life expectancy in 35 industrialised countries: projections with a Bayesian model en-semble. Lancet, 389 (10076): 1323-1335.
3. Rasella D, Aquino R, Barreto ML (2013). Impact of income inequality on life ex-pectancy in a highly unequal developing country: the case of Brazil. J Epidemiol Community Health, 67 (8): 661-666.
4. Crémieux P-Y, Ouellette P, Pilon C (1999). Health care spending as determinants of health outcomes. Heal Econ, 8 (4): 627-639.
5. Kabir M (2008). Determinants of life expec-tancy in developing countries. J Dev Areas, 41 (2): 185-204.
6. Biggs B, King L, Basu S, Stuckler D (2010). Is wealthier always healthier? The impact of national income level, inequality, and poverty on public health in Latin Ameri-ca. Soc Sci Med, 71 (2): 266-273.
7. Mondal MNI, Shitan M (2014). Relative im-portance of demographic, socioeconomic and health factors on life expectancy in low- and lower-middle-income countries. J Epidemiol, 24 (2): 117-124.
8. Mondal MNI, Shitan M (2013). Impact of socio-health factors on life expectancy in the low and lower middle income coun-tries. Iran J Public Health, 42 (12): 1354-1362.
9. Lin R-T, Chen Y-M, Chien L-C, Chan C-C (2012). Political and social determinants of life expectancy in less developed coun-tries: A longitudinal study. BMC Public Health, 12 (1): 85.
10. Wilkinson RG (1992). Income distribution and life expectancy. BMJ, 304 : 165-168.
11. Mackenbach JP, Hu Y, Looman CW (2013). Democratization and life expectancy in Europe, 1960-2008. Soc Sci Med, 93: 166-175.
12. Chetty R, Stepner M, Abraham S, et al (2016). The Association Between Income and Life Expectancy in the United States, 2001-2014. JAMA, 315 (16): 1750-66.
13. Norström F, Janlert U, Hammarström A (2017). Is unemployment in young adult-hood related to self-rated health later in life? Results from the Northern Swedish cohort. BMC Public Health, 17 (1): 529.
14. Urbanos-Garrido RM, Lopez-Valcarcel BG (2015). The influence of the economic crisis on the association between unem-ployment and health: an empirical analy-sis for Spain. Eur J Heal Econ, 16 (2): 175-184.
15. Drydakis N (2015). The effect of unem-ployment on self-reported health and mental health in Greece from 2008 to 2013: A longitudinal study before and during the financial crisis. Soc Sci Med, 128 : 43-51.
16. Sede P, Ohemeng W (2015). Socio-economic determinants of life expectancy in Nigeria (1980 - 2011). Health Econ Rev, 5 (2): 1-11.
17. Wilkinson RG, Pickett KE (2006). Income inequality and population health: A review and explanation of the evidence. Soc Sci Med, 62 (7): 1768-1784.
18. Rasiah R, Tumin M, Hameed LM, Ndoma I (2016). Civil Society Organizations in Opposi-tion to Healthcare Commercialization: Protecting Access for the Poor and Middle Class in Malay-sia. Nonprofit Volunt Sect Q, June 2016: 0899764016654571.
19. Nwagbara VC, Rasiah R (2015). Rethinking health care commercialization: evidence from Malaysia. Global Health, 11 (1): 44.
20. DoSM (2015). Household Income and Basic Amenities Survey Report 2014.; 2015. https://newss.statistics.gov.my/newss-por-talx/ep/epFreeDownloadContentSearch.seam
21. Department of Statistics Malaysia (2019). Available from: https://www.dosm.gov.my/v1/index.php?r=column/ctheme&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09&bul_id=MDMxdHZjWTk1SjFzTzNkRXYzcVZjdz09. Published 2019. Accessed February 21, 2019.
22. Economic Planning Unit. Available from: http://www.data.gov.my/data/organization/about/economic-planning-unit-epu
23. Ministry of Health Malaysia. Available from: www.moh.gov.my
24. Hameed LBM (2014). An inquiry into privat-isation’s impact on healthcare services in Malaysia. 2014. Available from: http://studentsrepo.um.edu.my/4626/
25. Rajan K, Kennedy J, King L (2013). Is wealthier always healthier in poor coun-tries? The health implications of income, inequality, poverty, and literacy in India. Soc Sci Med, 88 : 98-107.
26. Leu J, Yen IH, Gansky SA, Walton E, Adler NE, Takeuchi DT (2008). The association between subjective social status and men-tal health among Asian immigrants: In-vestigating the influence of age at immi-gration. Soc Sci Med, 66 (5): 1152-1164.
27. Wilkinson RG (1999). Health, hierarchy, and social anxiety. Ann N Y Acad Sci, 896 : 48-63.
28. Ruhe A-K, Wager J, Hirschfeld G, Zernikow B (2016). Household income determines access to specialized pediatric chronic pain treatment in Germany. BMC Health Serv Res, 16 (1): 140.
29. Larson K, Halfon N (2010). Family Income Gradients in the Health and Health Care Access of US Children. Matern Child Health J, 14 (3): 332-342.
30. Reeves MJ, Rafferty AP (2005). Healthy life-style characteristics among adults in the United States, 2000. Arch Intern Med, 165 (8): 854-857.
31. Qi V, Phillips SP, Hopman WM (2006). De-terminants of a healthy lifestyle and use of preventive screening in Canada. BMC Public Health, 6 : 275.
32. Marmot M (2005). Social determinants of health inequalities. Lancet, 365 (9464): 1099-1104.
33. de Andrade LOM, Filho AP, Solar O, et al (2014). Social determinants of health, uni-versal health coverage, and sustainable development: Case studies from Latin American countries. Lancet, 385 (9975): 1343-1351.
34. Ruge-Murcia FJ (2004). The inflation bias when the central bank targets the natural rate of unemployment. Eur Econ Rev, 48 (1): 91-107.
35. Judge K (1995). Income Distribution And Life Expectancy : A Critical Appraisal. BMJ, 311 (7015): 1282-1287.
36. Messias E (2003). Income Inequality, Illitera-cy Rate, and Life Expectancy in Brazil. Am J Public Health, 93 (8): 1294-1296.
37. Regidor E, Calle ME, Navarro P, Domínguez V (2003). Trends in the as-sociation between average income, pov-erty and income inequality and life expec-tancy in Spain. Soc Sci Med, 56 (5): 961-971.
38. Fosu AK (2017). Growth, inequality, and poverty reduction in developing coun-tries: Recent global evidence. Res Econ, 71 (2): 306-336.
39. Barro R (2000). Inequality and Growth in a Panel of Countries. J Econ Growth, 5 (1): 5–32.
Copyright (c) 2020 Iranian Journal of Public Health
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.