CHAPTER - V I I

CMAHGING DETERHIMANTS OF HEALTH AND ITS IWAGT ON HEALTH STATUS

Introduction

The earlier di~cussions had highlighted the

changing composition of determinants of health on health

status of the less developed and developed nations. Generally,

health s t a t u s is improved by nutti determinants at different

composition of resource mix and manpower mix at various points

of time, The aulti detar~inants constant changing role in

promoting health is visualized more in less developed

countries than its counterparts. This is mainly because of

interaction among determinants. The speed at which these

determinants promotes health depends on the rational mix of

social, economic, demographic and health services factors. In

case of advanced nations the h e a l t h status increase is

inevitable and depends on the influence of acceptance of

health technology i , e . , health service factors rate of change

in their health progress is determined by the rate of

acceptance and rote of medical technology e , bio-medical

mechanisms of diseases. So, this technology had h e l p e d in

promoting, preventing and curs of diseases significantly

during the last century in advanced countries.

No good use of this technology had been applied by

less developed countries as transfer of technology is most

costlier. These countries are poor and so they opted for low

Percentage Change on Resul t r of the Descriptive Statistics (Mean and Standard Deviation) an the Progress of Health Detersinants in Less Developed, Developed and Sample Nations: 1975 and 1990.

Health Less Developed Nations Developed Hations Sample Nations Year Develop- ...................... ------------------ ----------------

sent Hean S.D, neon S.D. Mean S.D. Determinants

_-------C---CI-----------------------------------*-------------------w---------

i990-75 FGNP f OPD OCSP UPTP AL 1 T PPtjW PFED PHE PHY OUHP BEDP GGNP

Source: Coaputed from Secondary Data.

Note: Rates of Change 1990-75 UN, Population Report, 1991: 38; 1990 and 75 are caIculatad from UN and Uorld Developaent Report, 1976 k 1993.

PGNP POPD DCSP UPTP ALtT PPSW FPED PHE PHY QUHP BEDP GGHP

- Per Capita Gross National Product in US $

- Population Density per Sq,k r , - Daily Calorie Supply Per capita - Urban Popuiatfon to Total Population (in percentage) - Aduit Literacy - Percentage of People Covered Under Protected Uater Supply - Percentage af PeopIe Covered Under Exoreta Disposal - Par capita Health Expenditure $n US 9 - Percentage of Doctors Per Lakh Populatfon, - Other Health Workers Per Llakh Population - Beds Per Lakh Population. - Govarnaent Expenditure to GNP (in percentage)

Average Annual Rate of Change on Results of the Descriptive Statistics (Mean and Standard Deviation) on the Progress of Health Doterainants in

Less Developed, Developed and Sarple Nations: 1975 and 1990.

_____- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - * - - - - - - - - - - - - - - - - - - - - - - - -

Health Less Developed Nations Developed N~tions Sample Nations Year Deter- ---------------------- ------..---------_- _---------------

minants Hean 3. D, Hean S.D, naen S.D. ...............................................................................

1990-75 PGHP POPD DCSP UPTP ALIT P f SU PPED PHE PHY OUHP BEDP GGNP

Source: Computed from Secondary Dota.

PGNP - Per Capita Groaa National Product in US 9 POPD - Population Density per Sq,km. DCSP - Doily Calorie Supply Pet capita UPTP - Urban Population to Total Population (in percentage) ALIT - Adult Literacy PPSV - Percentage of People Covered Under Protected Water Supply PPED - Percentage of People Covered Under Excreta Disposal PHE - Per capita Health Expenditure in US S PHY - Percentage af Doctors Per takh Population, Ow? - Other Health Yorkers Per Lakh Population BEDP - Beds Per Lakh Population. GGNP - Government Expenditure to GNP (in percentage)

cost technology in reducing mortality and morbidity from

CORImunicable and preventable diseases, which are stiil

unacceptably high in many countries in Africa, Asia and Latin

America . Due to high cost expiasion in advanced countries

after 1970's had made to think in these lens developed

countries about low cost approach more intensively. Added to

it in advanced countries high rate of morbidity experienced by

them had caused serious doubt on t h e minds of less developed

countries. The rethinking in adopting low cost technology

is mainly attributed to the impact made by the increase in

a ¶\t literacy on health improvement in less developing

countries. More notably the impact of increase in female

literacy had much influence in promoting health progress among

women and children. The cost of educating them is much lower

and its impact is highly remarkable on health progress, This

behavfoural change as Like capital good generates benefits

over the years and so this approach had gained momentum in

adopting in less developed nations. The same way, a set of

determinants are considered which actively generates mutti

fold benefits over years in developing nations. The

percentage change and average annual rate of change values for

the year 1990-1975 for two different categories of nation's

such as less developed, developed and sampie nations are given

in the table 7.1 and 7.2.

Results and Dfscussion

Table 7 . 1 and 7.2 g i v e s the results of the - ' .-

Percentage change that had happened ta these deterainants and

average annual rate of change are also worked out for clear

understanding on these determinants changing cornpiexion over

the years in less developed, developed and sample nations.

The fast change in the case of less davekoped countries had

occurred for t h r e e major.determinants, during 1975 and 1990.

The determinants are as follaws: t i ) Physician per lakh

population mean value is 103.44 while the average annuai rate

of change as 6,89. The standard devfatian value for above

said determinant is 100 and its carrasponding average annual

rate of change as 6.66; (ii) The adult literacy registered

with mean value of 87.34 (5.82) and standard deviation is 4.72

(0.31) and (iii) Other health workers per Iakh population

registered mean value of 77.89 (5.19) with standard deviation

va lue of 58.44 (3.89). The moderately changing determinants

during this period are population density per sq.ka.,

percentage of urban population to total population, per capita

h e a l t h expenditure in US $ and percentage of beds par lakh

population etc. The less changed determinants happens to be

percentage of people covered under protected water supply w i t h

mean value of 34.04 ( 2 . 2 6 ) and standard deviation value as

21.51 (1.43) and per capita gross national product in US 8

mean value of 33.29 ( 2 . 2 2 ) with standard deviation as 20-14

(1.38). T h e very poorly changed determinants are percentage

of people covered under excreta disposal and d a i l y calorie

supply per capita.

As far the developed nations concern between 1975

and 1980 the inajar change had occurred for these following

determinants: (i) per capita health expenditure in US 4 mean

value of 434.54, t h e average annuai rats of change is 28-96

and standard deviation value of 359.52 with average annual

rate of change 23.97; i i i ) the determinant per capita gross

national product in US 9 133.25 (8.88) an maan value and

214.13 (14.28) as standard deviation; ( i i i ) the determinant

physicians per lakh population with mean value of 56.22 (3,751

and standard deviation as 4.94 C0.33), The other moderately

changed determinants are percentage of government expendikure

te GNP, other health workers per lakh population, percentage

of beds par lakh population, percentage of people cowered

under protected water supply and excre ta disp~sai and

percentage of urban popukation to total population. The Iffast

changed determinants are: Percentage of adult literacy eean

vafue l o 6.i7 (0.41) while standard deviation is -31.37 ( -

2-09>, daily calorie supply per capita mean value as 4 * 1 7

(0.28) and standard deviation as 9.26 (0.62) and the

determinant population density per Sq.ka. with mean 2 . 5 9

(0.17) and standard deviation 14.35 (0.96).

In the case of sample nations far the period between

1975 and 1990 determinants such per capita expenditure in US

$, per capita gross national product in US 8 and percentaga of

people covered under e x c r e t a disposal had experienced high

ra te of change in their mean and standard deviation v a l u e s .

The average annual rate of change for these determinants to

sample nations during this period was aiso high, The moderate

rate of change had occurred for percentage of gcverment

expenditure to GNP, physician per lakh population, popuiation

density per sq. km., percentage of adut t I iteracy and

percentage of other health rorker per lakh population, The

lawest level of ;hangs occurred far sample nations are

percentage of Peapie covered under protected water suppiy,

percentage of urban population to t~tat popu1ation, dally

caiorie supply per capita and beds per lakh pcpulaticn. From

the above dfscussion it is clear that co~pletely different set

of determinants change had rasulted in fast change in the

health status of the people, The favourable change of

deterainants coapfexion is seen In the case o f developed

nations. For further investigation s lu l t ip le regression are

used to assess these determinants impact on health status of

these nations and subsequent dis~ussions about thfs follou~:

The changing role of health determinants importance

at different paints of time far less developed and devel~ped

nat ions exhibited the changing complexion of determinants very

ciearly on health indicators such as infant Mortality rate and

Life Expectancy at birth. in the year 1975, the i n f a n t

mortality rate had negative influence for the folkowing

determinants (see table 7.3). They are as fcilows: Per capita

gross national product (-2.181) daily calorie supply per

capita (-0.648); percentage of adult literacy (-2.412)%

percentage af doctors per lakh population ( -3 ,041) ; percentage

of othez health workers per lakh population ( - 0 . 1 3 4 ) and

Percentage of government expenditure to GNP (-1.093). The

determinants such as percentage of people covered by the

protected water supply, percentage of people covered under

excreta disposal, per capita health expenditure In US and

percentage of beds per l a k h population are positively related

to infant mortality Tat% in less deve)oped countries far the

Year 1975, This unexpected lign is mainly attributed to the

fai !,.:re of the third world ;duntries governments. As the above

said deteratinants are mostly provided by them at insufficient

i e v e l s with inherited anomaly in their distribution system.

The wastage of funds in providing these services had not

resulted in getting down the infant mortality rate in l e s s

developed countries. The R~ value is 0.403 which inpi l e s that

the determinants considered in this node1 on the whole had

expiajned to AO per cent. The determinants such as percentage

of adult Iiteracy ( - 2 . 4 1 2 ) and percentage of other health

workers per iakh population ( -Q.134) had expected sign with

one per cent level of significance. On the other hand, the

determinants such as popuiation density per Sq.Km and

Percentage of peopie covered under excreta disposat had

positive sign and insignificant. The determinant percentage of

peopie covered under protected water supply had one per cent

level of significance which attributes the insuffioiemt water

supply in third world countries and more specifically in rural

areas had caused serious health repercussion. A s this

deterninant had registered the positive sign, same way

percentage of beds per lakh population also registered with a

positive sign with five per cent level of significance. This

implies that poar maintains af hospitals is the main reason

for increase of infant mortality rate in less developed

countries due to increased demand for bed service. The

determinant urban Population to total population (3.1211 had . --

positive impact on infant mortality rate with five per oent

B%#rwria Rnuttr af CCh2gt%ng w l r r i m of b \ t a hC.enimnta oa tkrlth 3tatw indicator (Infant brtaiitar h t r j ie tots Dsvelm CePmtrin: 1975 and 1990

_-----------------------------------------------*-----------."---*-*---'-.~--*-.-~---------~----*---.-

[nftnt bboliati ty Rate ----------------.----------------.------------*-"-- 1975 1940 C h g s

Sf , Variable Disctiption sy&\ -----------.--------------------------------------- We, b b b

(f(Eb) (331 IS) ------.-----------------------------.---------------.----------.-.----.--*-w-.---------.--.*----..----

1. Pet capita Grwr Ltiml W -2. iS1 ft ,# -0.421 Prodact ia US $ l iogt (1.274) (1.281) *a*#

40,329)

3, Dpiiy Qlorio Supply DCSP -04SICB wwt -0,418 te5 -0.026 fsr capita 10,418f (0,201) (0.07L)

7. Permtale of F ~ p l ~ l e COI1wtd WED 0,012 -3*w , -1.343 ,, Excratr DI ~ p t o l l (0,481 l <l,ljai f0.8241

8, Per capita Hbslltk f x p d f 3 9 t e PtB OaQ3 tii*Ol 2,949 ,

fa V 3 (tog) t0,6191 (1.W) -1*3a *BE#* ( O , r n )

9. P e t a m t r y of Docttvtr pt PHI -0,049 -3.912 -3gM1 ,@I, Lakh ?-lation ti4g1 (1.795) (0.844) 11.7411

l e v e l o f s i ~ n i f i - a n ~ e , This implisn ovarcrouding and

insufficient civic services suppiy a:a m 2 i n reasons f a r this

t r e n d . O n e interestzr.; aspssr is - -at t h e p e r c e n t a g e o f adult

literacy (-2.412) determinnnt h;: major rare i n getting down

the infant sor'a1ity rate in t z s s deveioped countries. The

p s r c e n t a g e d 2 6 i 1 1 e a f infa?+- mOrtaiity rate is 2.412 far e v e r y

one per c e n t increas; 0 % adult iitezacy. As t h e same say,

percertage of other health workers per l a k h pupufation

determinants' increase of o n e per cent deciires infant

morza!ity rate by 0 . ? 3 4 per cent. This shews the front iine

workers direct act-,in had resulted fur this decline, The

economic determinant the per capita a t ~ s s national product in

-15 $ ( - 2 , 2 8 1 ) had negative sign w i t h significanca Level of ten

per cent. Here, due tc this d e t e r m i r a n t the ~eciint of infant

narrai ity rate is 2 , 281 p e r cen t for e v p r y increz -e of cne

duilar p e r capita income. O n the whois, in less deveicped

ccuntries the adult literacy r a t 2 (-2.412) and percentage af

other heaith workers per lakh popuiation (-0.134) are t w o

major determinants which had caused for the decline in infant

mortality rate. The other determinants such as Urban

populatjon to total population and beds per lakh popuhation

are main cause for adverse health status in ! e s s developed

countries in 1975.

As far the year 1990 (see table 7.31, the LnfanC

mortality rate's impact on the determinants is considerably

high, The determinants such as Popuiatian Density per Sq.Km,,

Urban population to total population, per capita health

expenditure in U5 are three d a t e r ; n i n l z i l t s which " a c t g o t

* ~ n s x p o c t a d s i g n o f which, pet cayita health expenditure in US

5 determinant aione is signiftzznt at one per cent ievel, the

rest are insignificant among expe-;ed sign. The determinants

such as per c a p i t a gross nationat product in US L and

percentage of doctors per iazfh popuiation are insignificant

even a c 20 3sr cen t level, which are suppose to be the main

determinants in enhancing health status in less developing

count:ies. On the contrary, the determinants such as

p e r c e - t a g e of people covered under excreta disposal ( - 3 . 3 4 E 1 ;

percentage af aduit !iteracy (-3.142); daily calorie supply

par capi fa i -0.416) and percentage of athor heal th worker-s. per

iaki popuiatio-, (-1.298) are the main determirants in

improving the health situat:an in Less deveioped cocn-ries, On

the who!@ the ~ o d e i explains 62 per cent, which irng:ies that

t h e detarminants inc!udsd in this mcdel hoids goad.

T h e change va lue (1940 and 1975) ( s e e table 7 - 3 )

had expiained the real impact 04 these determinants on health

status indicator. The model explained to 42 per cent. The

determinant ucban population to total population alone had

positive sign and significant at one per cent level. tlhi l e

t h e rest i i determinants had expected sign, The

deterainants such as percentage of adult iiteracy C-4.91if and

population density per sq.km. (-2.417) are two wajor

determinants which had high influence on infant mortatity rate

with one p e r cent ievel significant in less developed

countries. The insignificant deterainants are daily calorie

supply per caaita 1-0.9201 and percentage of peopie covered

under ?r3s3stea <dater sup7ly 1-0.108) in less developed

cuun tr i e s . The deserminants such as pe . ce- tage af people

covered un:er excreta disposai ( - 1 . 3 4 3 ) ; perchntage of doctors

per iakh population (-3.912) and percentage of other health

G - ~ t k e r s per iakh popuiation (-2.740) are the next naln

determinants in ~ r o m o t i n g health s t a t u s in less developed

covntrses. As thase indf ators a?e also significant at five

per c e n t ieyei w i t h s x p e c t a d sign.

In s u ~ ing up the health status indicator fiafant

aortaltty rate) was much influenced by adult riteracy in 1975,

1990 and between 1975 and 1990. On tho cantracy urban

population to total population had negative impact on health

status indicator. Ancther interesting thing is the

deterainazts like daily calorie suppiy per capita, percentage

of beds per lakh pcpulatian and percentage af gove rnaen t

expenditure to GNF had expected sign but they are significant

at ten per cent ievef, The determinant per capita gross

national product in US $ had very less effect an ~nfant

morta'ity rate even in change period.

A s far as the beveioped natians, the health status

indicator Cineant mortality :-ate) had negative impact for the

determinants considered of which per capita health expenditure

in US $ had unexpected sign with one per cent levei of

sl nif icance. The determinants like see table 7 . 4 ) ,

infant lbrtality h t e -----------_---"-----------------"----------------

! 9-75 1990 P6;lnla 51. Yariabie liiscrlption ~ ~ ~ b ~ i --------------------------------------------"----- ko * b b b

!SE3) tc&) i S b ) ---------------------*--------------------------------------------------------------------------------

I , Per ~ ~ p i t s Srws fiaiim! P r G -3,413 -0.621 -J.041 ,t,

F7ad;:i. i n tiS I c log) !2.3011 (1,2SI) (0.5413 1

5. &tt :itetag (in Per c m l ) &it -2.129 0,576 -2 ,44 (0. A91 (1.,93) ~ l , ~ j ~ ~ ~

'3, Percmiag.1 of Doctors pr PH -2.84% , 1,421 -3.713 Lakh Pap~,rtian ( iogi (0,842) ID, 621 t t P , % I )

10. Percentage of Other Heai%C WP -1.i97 9gs -OaW 1 8 s -2.%2 ss Yorkers Per h k h Popuiatim t)o#) iD.%) (0.285) 11.207)

i l . Percmtage of Lds Per h9,h Pagui;rti:a (tog)

12, Percentage of Coverment Gr;glP -2.104 trtt -0.920 -I.QIB Expenditure ?a GWP i i o ~ f 10.5191) (0,363) iQ.9"LQ)

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - m - - - - - - - - - - - - - - - ~ - - - - - - - - -

Canstant 31 ,293 9. W 21.450

&, of Observations 35 35 5

kt*: t , r i , isr, rrxr & trr*r xenoCes 1,2,5,10 and 23 per mt level of significance,

194

percentage doctors per lakh population (-2.840); urban

population to total popuiation 1-2.901) and adult literacy < -

2.129) had high coefficient values in expected sign with one

per cent ievei of significance, The determinant daily calorie

supply per capita (-1.830) had negative sign with two per cent

level of significance. The role of this determinant in

declining infant mortality rate is that the increased food

availability makes to avert malnutrition diseases among women

in general and infants at particular. The health service

determinants such as percentage of other health workers per

Iakh popuiation - 1 . 9 7 and percentage of beds per lakh

population (-3.981) had the expected sign with five per cent

level of significance. The determinant: percentage of beds

per fakh population had highest coefficient value (-3.981),

which implies the health infrastructural facility availability

in advanced countries are reiativeiy nore than the less

developed nations. The determinant: percentage of government

expenditure to GNP coefficient value is ( -2.104) which inplies

one per cent increase of government expenditure ta GNP

decreases infant uiortatity by two per cent. The other

determinants such as per capita gross national product in US $

( - 3 . 4 1 3 ) ; percentage of people covered under the protected

water supply (-3.032); population density per sq,km. 1-1.921)

and percentage of people covered under excreta disposak ( -

5 . 6 5 0 ) had high coefficient value with expected sign and

significant at 10 to 20 per cent leuel. On the whale the

model had explained to 6 I per cent.

For 1990 (see table ?.4), in developed nation the

determinants such as percentage of government expenditure to

GWP (-0.9201, percentage of other health uofkers per lakh

population (-0.563) and daily calorie supply per capita ( -

0.701) had expected sign with two, five and ten per cent

levels of significance respectively. The determinants such as

per capita gross national product in US $ (-0.821) and

percentage of people covered under excreta disposal (-0.391)

had got negative sign and they are insignificant, As the same

way, percentage of adult literacy and percentage of people

covered under protected water supply had got unexpected

positive sign and insignificant. On the whole the model

explains 42 per cent of variation on health status indicator

(infant mortality rate) in developed nations for 1990.

The change value between 1975 and 1990 had shown

<see table 7.4) that the determinant: urban population to

total population had highest coefficient vafua (4 .211) with

positive sign at ten per cent level of significanoe. The

determinant percentage of government expenditure to GNP < -

1.010) had even through got negative sign and it is

insignificant. The most remarkable determinants uhich had

impact on infant mortaIity are percentage 0 4 doctors per iakh

population (-3,713) ; percentage of beds per takh popuiation ( -

1.980) and per capita health expenditure in US 9 (-0.421) had

expected sign with one per cent level of significance. The

determinants such as percentage of other health workers per

lakh population (-2.962); percentage of people covered under

excreta disposal (-8.277); per capita grass national preduct

in US $ i-i-041) and adult literacy (-2.434) had got expected

sign with two and five per cent ievels o f signifitance

respectiveiy.

Hence, for deveicped countries per capita health

evpsnditurc in US 8 and percantage of beds per lakh popuiation

are the main determinants in influencing infant nortailty

reduction during 1975 to 1990 in deveioped countries. ;En this

2 considered model the coefficient of deterninatian ( R ) is

0.706 which implies that the percantage change of d e t e r m i n a n t s

impact i s explained by 71 p e r cent of variation on t h e h e a l t h

status indicator. The high value (0.706) fon the

developed nations confirms the goodness o f fit of' the madel.

in the case of sample nations, for the year 1975 the

determinants such as d a i l y caiorie supply per capita and urban

population to total population had unexpected signs w3th no

significance and five per cent level of s f g n i i i c a n c e

respectively (see table 7.5). The najor determinants such ors

percentage of government expenditure to GNP (-3.879);

percentage of adutt literacy C-3.614); percentage of other

health workers per lakh poputatfon (-3,149) and papufation

density per sq.km. (-2.4623 had got negat ive sign and

significant at one per cent level, The determinant such at

percentage of beds per iakh population - 1 . 2 percentage

of people covered under protected water suppiy and percentage

of people covered under excreta disposal had got expected sign

lnfmt nartailty Rate

I , Per cap4 ta Gross Natimi PW Product in US 4 (log) -O*m I,*N

(0,529)

2. Paputation Demfty per Sq.hs, POPD -2.462 , (0.591 1

3. baf ly Calorie Suppl J DCSP 0.019 '~Qo? t i tan -0.89 Per capita (0.142) i0.718f (3.863)

4, Urban Population to Total UPtP 3.784 , i.949, 'aig4 trr

Paputation (in percent) (0.721 ) (0.847) (0,

5, Adult tite~acy (in Pat cent) AtiT -3.614 , -1.627 -2.244 , (0.312) 10.342) to, 832)

6. Permtage of People Cwared PPW -0.413 tr,l -1.041 0. %2 Under Protaeted Y ~ t e r Sogrply (0.212 t (0, $24) . (0.390)

7, Percentage of Peqle hered PPED -21192 ,i*, -0,604 Under Excreta Bi~posaI (1.194) 10.815)

8, Per capita KealthExpmditme Pa 3.124 -2.629 , in tlSS (log) (1,710) 11,023)

9. Percentage of Doctors per WT -0n810 , t , f l -3.247 , U l h Popfation (lag) fO.598) 11,021)

-1*6m a,*, (0.401)

10. Percentage of Mher Health MI' -3.149 , -2.129 -0. ,:a32 Yarkers Per Lokh Population (log) (1.019) (5.9431 (0. i831f*

11. Percentage of Beds Per DEW -1,126 ,,, -3.642 0.850 LPkh Pop~latim <log) (0.4%) (1.743) (1 ,W)

12. Percentage of Governrent CW -3,8?Q , -1.692 ,,, Expenditure to GWP (log) (1.420) (0.741)

-j*i26 *S8% (0.820)

-----_--_-__--_.-_-----------------------------------------------------------------*-----"-------"------

Cmtant 261.124 i 79.263 81,861

Mote; 1, t t , tit, rtrt L rsirll denotes 1,2,5,10 and 20 pt c a t level ot r i g n i t i a ~ ~ e ,

.and they are significant at ten per cent level. The

determinants such as per capita gross national product in US $

(-2.132) and percentage of doctors per lakh population ( -

0.810) had marginal impact on infant martality r a t e in the

sample nations for the year 1975. On t h e whole t h e R~ value

is 0.398 which implies that 40 per cent of variation on infant

mortality rate is due to the determinants included in the

model for sample nations in 1975.

In 1990, percentage of urban population to total

popuiation, population density per sq.km. and daily calorie

supply per capita, had got u n e x p e c t e d signs and t h e y are

signif icsnt at one and 20 per cent levels (see tabla 7.51.

The per oapita Gross National Product in US S C-1.49L) and

percentage of people covered under excreta disposal ( -2 .192 )

had got positive signs and significant at ten per cent l e v e l .

The major determinants such as percentage of dactors per lakh

population (-3.247 f and percentage of peap le covered under

protected water supply ( -1 .041) had got negative signs at one

per cent Ievel of significant. The determinant per capita

health expenditure in US $ had gat a high coefficient v a l u e of

(-2.629) with two per cent tevel of signif icanca. The rest of

the determinants such as percentage of beds per lakh

population (-3,642); percentage of other health worker per

lakh population (-2.129); percentage of government expenditure

to GNP (-1.692) and percentage of adult ltteracy rate (-1.627)

are significant at five per cent level. The whole model

explains 41 per cent of variation on health status indicator

for 1990 in sample nations.

As far the change value between 1975 and 1990 (see

table 7.5>, f o r the whoie set of sample nations the

determinants such as percentage of urban population to total

population, percentage of peopie covered under protected water

supply and percentage of beds per lakh popuiatian had got

unexpected signs and they are also insignificant, The

determinants like percentage of peaple covered under excreta

disposal, daily calorie supply per capita, per capita gross

national praduct in US S and per capita health expenditure in

US 9 had got negative signs and are significant at ten and 20

per cent l e v e l s . Only two determinants such as percentage of

doctors per lakh population (-1.670) and percentage of

government expenditure to GNP ( -1.126) are at ten per cent

leveI of significance. The main determinants in enhancing

health status in sample nations is peroentage of other health

workers per lakh population (-0.432) at two per cent level of

significance and adult literacy (-2.244) with one per cent

Level of significance with expected sign. The model explains

38 per cent of variation an health status indicator. The

2 coefficient of determination (R ) is 0,382 f o r the percentage

of change value between the considered t w o points of time

(1975 & 1990) for the sample nations on infant mortality rate.

For better understanding on the role of health

determinants nature in promoting health status another

reliable health status indicator (Life Expectancy at Birth) is

used. As this indicator is not rightly asseased in most of

the less deveioped nations, yet it is used as one.of the best

available indicator to assess the health progress. For the

year 1975 (see table 7 . 6 ) , in less developed countries the

determinants which negatively associated are as follows: per

capita gross national product in US $, percentage of urban

populatian to total population and population density per oq.

km, with above ten per cent level of sf gnif icance. This shows

that the above said determinants had caused serious down trend

of health progress in Less developed countries. The other

deterninants had positive impact on life expectancy at birth.

The most prominent determinants are percentage of peapla

covered under e x c r e t a disposal, daily calorie supply per

capsta, percentage of government expenditure to GNP,

percentage of doctors per lakh population and per capita

health expenditure in US and these determinants are

significant at one, two and five per cent level. The other

contributing determinants such as percentage af adult literacy

( 4 , 9 0 2 ) ; percentage of beds per lakh paputation (3.089) and

percentage of other health workers per lakh population (3.032)

had expected sign with ten and 20 per cent levels of

significance. On the whale the considered determinants in the

model explains 34 per cent on the health status indicator

(Iffe expectancy at birth) for $975 in less deveioped nations.

In 1990 (see table 7.6), the health status indicator

(Life Expectancy at Birth) had got more number of determinants

with positive sign than in 1975. Only two determinants had

lkgtrssim Remit8 of Ckrnffnf Ccrpiexim of Hrrltt k t e m i m t r on h l t h Status Indtaator (Litc E~pectanc~ at Birth) In k t s iDmloprd Cwntrlnr IBfS rvui idW

--------------------------------------------.--------------------------------*------------------------

Life Expctanq at Birth

1975 1990 Change SI. Variable Disctiption Spbol ------------------------------------------------------- Wo. b b b

(SEb) tSEb) 1SPb) -------------..------------------------------------------------*-------------------------------------- 1. Per a p f ta Gross l h t i m l PW 0.611 , 2.627 ,,

Product in US 4 f log) (0.268) Cl,oSa,

3, Dpf l y Calorie Supply Per capiia

4, UrbanPaplatian toTotni UPR -4,632 ,,, -7.492 ,, Pgrolation i ia percent) (2,194) (3.081 )

5. Adut t litaraey (in Per cent) &If 4b902 f t , , 3@261 is,, 4.919 ,*,

(2,699) (1,912) (2. I#)

6. Permtap at People Cavered PPSV Under Protected kter Supply

1*081 t*t*l (0.820)

11197 t*,,, (0,880

' 3-298 ,,* (1,682)

7. Percentage of Psaple Witted PPED 0.989 , 2,629 , W r Excreta Disposal (0.3411 ) (0,$49)

4*920 tt*tt (3,189)

8. Pn capita Health Expmdittue PHE 0*623 1,t 0,418 tti h (log) (0.310) 10,194)

3-m *,as (2.OQ2)

9, Percentage of Doctors par PHY OmgM st, 0,718 ,, h k h Poplatioa (log) (0. W) (0,3041

5.926 #,, ( 2 4 6 ? 4 ?

LO. Percentage of Other tlealtb OW 3*082 rtlrtr 5,927 , Umkets Per h k h Populatfoa (101) (1,9461 (2.321)

4a209 t , (1.981)

11, Percentage of Bods Per BEEP Lnkh Population (Iu)

3-089 #St* t 1,626)

4*329 tt* (1.918)

ill ~ 3 . 2 ~

12. Percmta~~ of Sovetnaeat W Expenditure to W (lot)

2469a it* (1.209)

,, to,?#)

2*890 ,ttrr fi.946) -------_-------------------------------------------------------------------------------------------

~ o l u t ~ t 45.19 53.210 8.030

M e : I , s i , ?fs, t t ~ t I ?ttlt denotes 1,2,5,10 and 20 per mt lwei of s ipi t icaue,

the negative inf\uence on life expectancy at birth. They

are: po~uiatfon density per Sq.Km (-3.194) and percentage of

urban popuiation to total population (-4.632) with five and

ten per cent ievels of significance. On the contrary, in less

developed countries, the determinants such as percentage of

other health workers per lakh population ( 5 . 9 2 7 ) ; percentage

of people covered under excreta disposal (2.629); daily

calorie supply per capita (0.739) and per capita grass

national product in US O (0.671) are more contributing

determinants in enhancing the life expectancy at birth in teas

develaped nations with one per cent level of significance. The

next I e v e l important determinants are percentage of government

expenditure to GNP (1 .936) and percentage of doctors per iakh

population (0.718) with two per cent level of significance.

The determinants: percentage of beds per lakh population

(4.329) and per capfta health expenditure in US $ (0.418) had

five per cent level of significance on the fife expectancy at

birth with anticipated sign. The determinant percentage of

adult literacy (3.261) with ten per cant Level of significance

with expected sign. Here, the contribution by the determinants

such as percentage of other health workers per iakh

population; percentage of people covered under excreta

disposal; daily calorie supply per capita and per capita gross

national product in US $ are at one per cent ievel of

significant in less developed countries in enhancing life

expectancy at birth in 1980. On the whole, it can be seen

from ihe table 7.6 that the coefficient of determination

$amely. R~ is 0.459 which implies that the determlnsnts

included in the model explain 46 per cent of the variation in

health status indicator. The moderate R~ value confirms the

goodness of fit of the model.

As far as the change value concern (see tabte 7.6)

the determinants such as daily calorie supply per capita

(1.023) with no significance; population density per Sq.Km ( -

8.912) and percentage of urban population to total population

(-7.492) with unexpected sign with one and two per cent level

of significance, On the contrary, the determinants such as

percentage of beds per lakh population ( 7 , 3 6 0 ) ; percentage o f

other health workers per lakh population (4.209) and per

capita g ~ o s s national product in US 9 (2,627) with anticipated

sign and significant at two per cent level. These above said

determinants are the major contributing determinants to life

expectancy at birth in less developed countries. The next

important other determinants are: percentage of doctors per

lakh population (5.926); percentage of adult literacy (4.919)

and percentage of people covered under protected water supply

(3.298) had got anticipated sign with five per cent level of

significance, The determinants such as per capita health

expenditure to GHP (2.890) and percentage of people covered

under excreta disposal (4 ,920) with positive sign and

significant at 20 per cent levels. In this model, the

2 coefficient of determinant (R ) is 0.510 which implies that

the change value between 1975 and 1990 of the considered

determinants included in t h e model explains 51 per cent of

variation in health status indicatar.

R~~ressim IksaJt8 d Chllngiag Cmpltrim of Health Rtmfnanta on k l t h Status ladicatar (Life Explrctancy a t Birth) i n krriopd Natiar: 1975 and 1W

____----------------------------------"--------------------------------*-----------------*-----------. Life Expectancy at Birth

1975 $990 Change '31. Variable Discription Syrbol ------------------------------------------------------- No. b b b

(SEb) (SEb) (SEb)

1 , Pet capitaGross ktiml PQYP 21940 * ¶ *

-0.492 Ptoduct in US $ ( l o t ) (1,3121 (0.391 ) 04621 t f l f J

(0,390)

2. Population Density pet Sg.ins. POPD 1.202 ,, -0,923 t * t t 0.319 (0,491) (0,448) to. 148)

3. Dai ly Calorie Supply DCSP 2.968 -IeM2 t r r r 1.829 111

Per capita I f ,142) (0.7431 10,746)

4. Urban Population to Total UP?? -1,490 -3.920 trr 0.292 1s Populatian f i n percent) (0.627) 11.7111 (0.120)

5, Adult Literacy (in Per cent) ALlT 0.629 0.347 0.762 ,, 10.812) 10.949) (0.307)

6. Percantnpe of People Covered PPSU 3*240 * * s t 1.126

Wet Protected Uater Suppiy (1.723) (0.629) *I

i0.791)

7. Percentage of Peopie Coveted PPED M e t Excreta Disposal

5*920 ,f,, (3,129t

1*210 i r r t (0.659)

01671 tr t t (0.398)

8. Per capita olaenlth Expenditure PHE 1,927 , 0.916 I

in US$ frog) (0,720) (0.320) 2+982 I t

(1.2601

9, Percentage of Doctors pet PHY 2.702 , l*l-m It**** 7.920

Lakh Population ( lo#) i1,041) 10.741 3 (3.199)

1O. Percentage of Other Health OWP 3.927 ,, 1,921 , 6.312 ts

Yorkers Per Lhh Population f t o $ ) (1,5481 (0,410) 13.920 t

I i . Percentage of Beds Per BW 0,739 , 5.427 gl 2*m 1, takh Popuiatian (lo;) (1.241) (0.260) (2.301)

12. Percentage of Government GGWP Expenditure to O(P t lo#)

4a201 *,,, (2.287)

2.Qa3 I,*% (1.827)

3*931 **1 f 1.728)

--------*--------------------------------------------------------------------*--------------*-------*

Canstant 61.790 75.23 13.4.40

Note: 1 , fS, t r l , tr*t & t t r r r denotes 1,2,5,10 a d 20 per mt level of significancea

In the case of less developed nations, invariably

the considered determinants coefficient values in 1990 had

shown an improvement in t h e value and h i g h significance over

1975. The determinant, per capita gross national product in

US 9 which had an unexpected sign in 1975 had changed to

positive sign with one per cent tevel of significance in 1990.

The determinants such as population density per sq.km, and

urban population to total population even though gat negative

sign w i t h high coefficient values i n 1975 had receded in 1990.

Unfortunately, the determinant adult literacy coefficient

value in 1975 was 4.902 and it decl ined to 3.261, both

significant at 2.0 per cent Level. Same way, the determinant,

percentage of government expenditure to GNP had improved over

1975 to 1990 in significance but the coefficient value

declined, The determinant daily calorie supply per capita

had shown a slight decline in the coefficient value from 1975

to 1990. On the other hand, the significance level had

improved from two per cent in 1975 to one per cent level in

1990 The rest of the determinants had got the anticipated

sign in both the periods but the coefficient values had shown

high value i n 1990 o v e r 1875.

As far as the developed natians concern the heaith

status i n d i c a t o r (Life expectancy at birth) is more accurate

and dependable (see table 7.7). Here, this indicator interacts

well with considered determinants. Unexpectedly, the

determinant: percentage Q& urban population to total

population with two per cent level of significance. The

determinants percentage adutt literacy had got positive sign

with no significance. On the contrary, the main determinants

such as daily calorie supply per capita (2.968); percentage of

doctors per lakh population (2.702) and per capita health

expenditure in US 9 (1.927) are with expected sign and

significant at one per cent level, The second level important

determinants are percentage of other health workers per lakh

population (3.927); Percentage of beds per lakh popuiatian

(2.779) and population density per Sq.Km (1.2021 with

anticipated sign and significant at two per cent l e v e l in

developed nations. The determinants like per capita grass

national product in US 9 (2,900); percentage of people covered

under excreta disposal (5.920); percentage of government

expenditure to GMP (4.201) and percentage of people covered

under protected water supply (3.240) are significant at five

and ten per cent levelsi The unexpected thing is the economic

determinant per capita gross nationai product in US t had

lesser impact on the life expectancy at birth in devetoped

nations in 1975. Uhile, the deterainants such as daily calorie

supply per capita, percentage af doctors per takh population

and per capita health expenditure in US $ happens to be the

ma3n determinants in enhancing life expectancy at birth in

developed nations. The coefficient of determination R value

is 0.479 and this moderate value explains the model ta 48 per

cent of change occurs due to the considered determinants on

life expectancy at birth in 1975 for developed nations.

In the case of 1990 (see table 7 . 6 , four major

determinants registered with unanticipated sign. They are per

capita gross national product in US $, population density per

S q . K m . , daily calorie supply per capita and percentage of

urban population to total population, These determfnants are

mostly as to go well with the considered health status

indicator in developed nations, The determinants like adult

literacy C0.347) with no significance, percentage of people

covered under excreta disposal (1,210) and percentage of

people covered under protected water supply (1.126) with

anticipated sign but significant at ten per cent level only.

On the contrary, the unexpected determinants such as

percentage of other health workers per lakh population

9 2 ; percentage of beds per lakh population (0.739) and

per capita health expenditure in US 9 10.916) are more

contributing determinants in developed nations with expected

sign and significant at one per cent level. The very unusual

thing is that the determinant percentage of doctors per lakh

population eventhough positive but its coefficient value is

(1.179) and significant at 20 per cent level which is suppose

to be the main deter~Snant in the developed nations. In

developed nations for the year 1990, the coefficient of

determination ( R ~ ) value is 0.321, which implies that the

considered determinants included in the equation explains to

32 per cent.

As far the developed nations concern between two

points of time ti975 and 1990) the interaction of considered

determinants had positive impact on the health status

indicators ( l i f e expectancy at birth) (nee table 7.7). The

unusual way, the percentage of doctors per iakh popuIatfon

determinant had positive coefficient (7,920) but whioh is not

significant. The determinants such as percentage of other

health workers per lakh population (6.312); percentage of beds

per lakh population (5.427); per capita health expenditure in

US $ (2.982); percentage of people covered under protected

water supply (1.960); daily calorie supply per capita (1.829);

percentage of adult literacy (0.762) and percentage of urban

population to totat population (0.292) had anticipated sign

with two per cent level of significance. Actually these abave

said determinants had contributed much in raising the l i f e

expectancy at birth in developed nations during 1975 and 1990,

The other partly supporting determinants during this period

are percentage of government expenditure to GHP (3.93%);

popuiation density per Sq.Km (0.319); percentage of people

covered under excreta disposal (0,671) and per capita gross

national product in US $ (0.621) with anticipated sign at

five, ten and 20 per cent levels of significance respectively.

The determinants. such as percentage of doctors per lakh

population and per capita of gross national product in US 9

are two determinants which had been given priority aver the

years in developed nations but its contribution is less in

enhancing the life expectancy at birth in developed nations

over 25 years time. The value of R~ is 0.319 and it explains

the variation on the health status indicator (life expectancy

at birth) far the percentage change value for t h o periods

between 1975 and 1890 for the considered determinants in

developed nation to 32 per cent.

As far the developed nations, only one determinant

percentage of urban population to totaI population had got

unexpected sign in 1975. On the contrary, the determinants

such as per capita gross national product in US 9 , populatton

density per Sq.km,, daily calorie supply per capita and

percentage of urban population to total population had got

unanticipated sign in 1990. One interesting thing is the

determinant adult iiterscy the coefficient value had receded

from 1975 to 1990 with positive sign but with na significance

on life expectancy at birth, But the rest six determinants

had shown an improved strength in the coefficient value with

anticipated sign in 1975 over 1990 with high significant

levels.

In the case of sample nations for the year 1975 <see

table 7.8) the determinants such as percentage of aduit

literacy (3.276); percentage of other health workers per lakh

population coefficient value as (3.267); percentage of doctors

per lakh population (1,621) and per capita, health expenditure

in US $ (0.829) had got anticipated sign with one per cent

level of significance. The next best determinants which had

acted upon health status indicator (Life Expectancy at Birth)

are percentage of beds per lakh population (3.591);

percentage of government expenditure to GHP (2.826) and daily

calorie supply per capita (0.948) had the positive sign with

Rwtrntion Potullr of Ckrngiq Cmpirrion of Mlth Rterrtmts m k l t h Status Indicator (Life Eaprctrnq a t Birth) ia SI.pi, I(ltJm$: 1975 and 1890

___------------------------.-----------------.----------*--------------*-.------*---------------------

Life Expectancy a t Birth

1915 1840 Change S i . Variable Discription Spbol ------------------------------------------------------- Ito, b b b

(SEb 1 (SEb) ( SEb ) -----------------------------------------------------------------.----*------------------------*------

I. Per capita Gross Watiomi P W Product in US 5 ( log)

0*791 t r r t 10.417)

t t i 10,312)

2. Popuiation Density per Sq,lrrs. POPD -4,927 trt -0.966 -2,316 ,gtt

(2,192) (0.410) (1,293)

3. DailyCalorieSuppiy Per capita

4. Urban Population to Total UPfP -1,297 313 -1,847 -2.19i t r r

Population (in percent) (0,6213 (0.441 1 (1.023)

5. Adult Literacy (in Per cent) &LlT 3.276 4,921 (1.021) (2.049f

3.082 rt , (1.498)

6. Percentage of People Cavered PPSU -1.422 11 2.727 .

Under Protected Yater Supply 10,620) 11.021) E t a

(0.908)

7. Percentege of People Covered PPED -1.029 6.239 4.211 t t ,

Under Excreta Di sposat (0.4781 12.441 t (2.082)

8. P o t capita Health Expenditure PHE 0.829 in US1 (lot) 10, 301)

f t t r (0.6'29)

01871 rrrr (0,501)

9. Percentage of Dactora per PHY I,S21 , 3.416 It

Lakh Population f tog) fO.529) ( t . 129) 4-320 11s

(1.792)

10. Permtage of Other Health OW 3.267 , 5.913 , 6.210 @, Workers Per Lakh Popuiatiun t iof) (1,0%2) 12.260) (2.7261

11, Percentage of Beds Per BEDB 3.691 1 E

U r h Popuiatim (log) t 1.749) 2*175 a119

(1.098) 3.i2G rktr

11.792)

12. Percentage of Government GGWP 2*8E rllr f1.491)

rrrtr (1,292)

1q926 *,st Expenditure to GW {log) (1.Mf

_______-_.___-____------------------------------------------------*----------------------*-------------

Cmntant 49.720 56.300 6,580

Mote: t, 1 1 , t t r , *rst & t l l * r denotes 1,2,5,10 2nd 20 per cent level of significance.

two, five and ten per cent l e v e l s of significance. A set of

determinants such as population density per sq.km. ( - 4 . 9 2 7 ) ;

per capita gross national product in US $ ( - 1 . 4 9 8 ) ; percentage

of people covered under protected water supply (-1.422);

percentage of urban population to total population (-1.297)

and percentage of people covered under excreta disposal f-

1.029) had got unexpected sign and significant at ten and 20

per cent levels respectively. On the whoie the model for the

sample nations the R~ value is 0 . 4 6 7 which imp1 ies 47 per cent

was explained by the determinants included in the model.

1n 1990 for the sawpie nations ( s e e table ?.a) , the

determinants such as population density per oq.km. (-0.968)

and percentage of urban population to total population ( -

1.847) had got unanticipated sign with two and five per cent

levels of significance. The main influencing determinants

are: percentage of other health workers per lakh population

f 5,913) ; percentage of doctors per iakh popui ation (3.416)

and percentage of people covered under protected water supply

(2.127) as got expected sign with one per cent level of

significance. The other moderately influencing determinants

such as percentage of people covered under excreta disposal

(6.230); percentage of adult literacy (4.921) and percentage

of beds per lakh population ( 2 . 1 7 5 ) with positive influence on

life expectancy at birth with two and five per cent levels of

significance. The other determinants Like, daiiy caiarie

supply per capita, per capita health expenditure in US J,

percentage of government expenditure to GNP and per capita

gross national product in US $ had expected sign but

significant at ten and 20 per cent levels. The coefficient

of determination ( R ~ ) value is 0.574 which means that the

variation in the life expectancy at birth is explained by 57

per cent by the included determinants in the model for 1990 in

2 sample nations, This moderate CR ) value explains the model

goodness of f it.

As far as the percentage change of Ft2 value between

1975 and 1990 for the sample nations impact on life expectancy

at birth is relatively less (0.401) in coaparing the

determinants of coefficient of 1975 (0.467) and 1990 (0.574)

(see the table 7.8). The determinants such as: percentage of

other health workers per lakh population (6.2iO)i' percentage

of doctors per lakh population (4.320); percentage o f peopie

covered under excreta disposal (4.211); percentage of adult

fiteracy (3.082); percentage of people covered under protected

water suppiy (1.827) had high positive coefficient value on

life expectancy at birth with two and f i v e per cent levels o f

significance respectively. The determinants like population

density per sq-km. (-2.316) and percentage of urban population

to total population (-2.191) had unexpected sign with five and

ten per cent Levels of significance. The same trend is seen

in 1975 and 1990 also. 0n the contrary, the determinants like

per capita gross national product in US 6 , percentage of beds

per lakh population, daily calorie supply per capita, per

capita health expenditure i n US $ and percentage of government

expenditure to GNP had anticipated sign vith moderate

coefficient value and significant at ten and 20 per cent

levels. On the whole the included determinants in the mode1

explalns to 40 per cent.

Conclusion

From the above results it is conoluded that, the

deterainants that are favourable for health status

development in developed countries is completely different

from the less deveioped countries. The social and health

service determinants coefficient vaiues are appreciating from

1975 to 1990 with the anticipated sign and vith the improved

significance. On the other hand, these determinants influence

is much for developed nations in t975, while its

coefficient values and significance had receded in 1990. The

other interesting thing is that the determinants which are

more favourabte in 1975 for health progress in developed

nations had become unfavourable in 1990, From this, it is

clear that invariably, the determinants fnfiuence on health

status over the years in developed and less developed

countries are changing both favourably and unfavourabiy and so

this inf luence must be proper 1 y monitored to understand its

impact and based on which right policies are to be formulated.