Effect of Income and Income Distribution on Population Health in Nigeria: A Multi-Level Approach
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Abstract
This study focuses on the effect of income and income distribution on population health in Nigeria using the multi-level approach of econometric analysis with data from Nigerian Demographic and Health Survey, (2013) and annual abstract of statistics from National Bureau of Statistics (2013). The findings show that absolute income has significant effect on population health in Nigeria with significant variations in absolute income of the population. It is equally evident that relative income has insignificant effect on population health with no substantial differences in relative income of the population in Nigeria. The Gini coefficient and the Pietra inequality indices mimic each other for both absolute and relative income. The Gini coefficient expresses a near maximum inequality for the population health due to absolute income and near perfect equality of the population health due to relative income. The policy in a nutshell is hinged on the need for better and effective way of improving income and to promote quality health care for the public, private and the ordinary citizens of Nigeria.
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References
References
Akpan, E.S., Riman, H. B. (2010). Causality between Poverty, Health Expenditure and Health Status: Evidence from Nigeria using VECM. European Journal of Economics, Finance and Administrative Sciences, 27, 1450-2275.
Antai, D. (2011). Regional Inequalities in Under-5 Mortality in Nigeria: a Population-Based Analysis of Individual and Community-Level Determinants. Population Health Metrics, 9:6.
Bassey, J.U. et al., (2010). Poverty, Health Expenditure, and Health Status: a Long Term Perspective with Evidence from Nigeria. http://ssrn.com/abstract=1540303.
Blakely, T.A., Lochner, K., and Kawachi, I. (2002). Metropolitan area Income Inequality and Self- Rated Health- a Multi-level Study. Social Science and Medicine, 54 (1), 65 – 77.
Braveman, P, and Tarimo, E. (2002). Social Inequalities in health within countries: not only an issue for affluent nations. Social Sciences & Medicine 54, 1621 – 1635.
Browne, W. & Rasbash, J. (2004). `Multilevel Modelling', in Hardy, M. and Bryman, A. (eds.), Handbook of data analysis, Sage Publications.
Chiang, T. (1999). Economic Transition and the Changing Relation Between Income Inequality And Mortality in Taiwan: Regression Analysis. British Medical Journal 319, 1162-1165.
CIA-World Fact Book, (2012). CIA-World Fact Book.
De Maio, F., G. (2008). Ecological Analysis of the Health Effects of Income Inequality and Homicide Rates in Canada and the United States. Canadian Journal of Public Health, 43(2), 219-236.
De Vogli, R., Mistry, R., and Gnestto, R. (2005). Income Inequality and Life Expectancy: Evidence from Italy. In Vafaei, A. (2008). Relationship between Income Inequality and Health: Ecological Canadian Study. (Msc thesis). Queen’s University Ontario, Canada.
Deaton, A. (2005). Health, Inequality, and Economic Development. Journal of Economic Lit, 41,113-158.
Duleep, H. O. (1995). Mortality and Income Inequality among Economically Developed Countries. In Vafaei, A. (2008). Relationship between Income Inequality and Health: Ecological Canadian Study. (Msc thesis) Queen’s University Ontario, Canada.
Fidell, G. and Tabachnick, L. S. (2007). Using Multivariate Statistics (5th ed.). Boston ; Montreal: Pearson/A & B.
Gerdtham, U. and Johannesson, M. (1991). Absolute Income, Relative Income, Income Inequality and Mortality.
Holtgrave, D. R., and Crosby, R. A. (2003). Social Capital, Poverty and Income Inequality as Predictors of Gonorrhea, Syphilis, Chlamydia and AIDS Case Rates in the United States. In Vafaei, A. (2008) Relationship between Income Inequality and Health: an Ecological Canadian Study. (Msc thesis), Queen’s University Ontario, Canada.
Holtgrave, D. R., and Crosby, R. A. (2004). Social Determinants of Tuberculosis Case Rates in the United States. In Vafaei, A. (2008). (Msc thesis), Queen’s University Ontario, Canada.
Ichoku, H. E. (2005). Income Redistributive Effects of the Healthcare Financing System in Nigeria. Research Paper submitted to Poverty and Economic Policy Research Network, University of Laval.
Joint United Nations Programme on HIV/AIDS, (2013).
Kahn, R.S. Wise P.H., Kennedy, B.P., and Kawachi, I. (2000). State Income Inequality, Household Income, and Maternal Mental and Physical Health. In Vafaei, A. (2008) Relationship between Income Inequality and Health : Ecological Canadian Study. (Msc thesis), Queen’s University Ontario, Canada.
Kaplan, G.A., Pamuk, E.R., Lynch, J.N., and Cohen, B.(1996). Inequality in Income and Mortality in the United States. British Medical Journal, 312(7037), 999-1003.
Kawachi, I., Kennedy, B. P., and Wilkinson, R. G. (1999). Income Inequality and Health. The Society and Population Health Reader Volume 1. 1st ed. New York, NY: New Press.
Kennedy, B.P., Lochner, K., and ProthrowStith, D. (1991). Homicide in Urban Canada. Canadian Journal of Sociology, 16(4), 397-410.
Kawachi. I. and Kennedy, B. P. (1997). The Relationship of Income Inequality to Mortality. Does the Choice of Indicator Matter? Social Science and Medicine, 45, 1121 – 1127.
Kennedy, B.P., Kawachi, I and Prothrow-Stith, D. (1996). Income Distribution and Mortality: Cross Sectional Ecological Study of the Robin Hood Index in the United States. In Vafaei, A. (2008). Relationship between Income Inequality and Health: Ecological Canadian study. (Msc thesis), Queen’s University Ontario, Canada
Larrea, C., and Kawachi, I. (2005). Does Economic Inequality Affect Child Malnutrition? The Case of Ecuador. Social Science & Medicine, 60, 165-178.
Li, H., and Zhu, Y. (2004). Income, Income Inequality and Health: Evidence from China. Department of Economics. The Chinese University of Hong Kong, Shatin, China.
Mellor, J.M., and Milyo, J. (2002). Re-examining the Evidence of an Ecological Association between Income Inequality and Health. Journal of Health Politics, Policy and Law, 26 (3): 487 - 522
Mellor, J.M., and Milyo, J. (2002). Income Inequality and Individual Health: Evidence from the Current Population Survey. Journal of Human Resources 37(3): 510-39.
Messias, E. (2003). Income Inequality, Illiteracy Rate, and Life Expectancy in Brazil. American Journal of Public Health 93(8): 1294-6.
Muller, A. (2000). Education, Income Inequality, and Mortality: A Multiple Regression Analysis. British Medical Journal, 324 (7328), 23 – 25.
National Demographic and Household Surveys (2013).
National Health Strategies Development Plan, (2010). National Health Strategies Development Plan, 2010-2015.
Nwosu, E. O. (2012). Empirical Investigation of Socioeconomic Health Inequalities in Nigeria: Evidence from Demographic and Health Surveys. Unpublished Ph.D dissertation, Department of Economics, University of Nigeria, Nsukka.
Osler, M., Prescott, E. and Gronbaek, M.. (2003). Income Inequality and Ischaemic Heart Disease in Danish men and women. International Journal of Epidemiology. 32(3): 375-380.
Osler, M., Prescott, E., Gronbaek, M., Christensen, U. et al., (2002). Income Inequality, Individual Income, and Mortality in Danish Adults. In Vafaei, A. (2008) Relationship between Income Inequality and Health: Ecological Canadian Study. (Msc thesis), Queen’s University Ontario, Canada.
Pinheiro, J.C. & Bates, D.M. (2000). Mixed-Effects Models in S and S-PLUS, Springer.
Qi, G. (2008). Income Inequality and Health in Ontario: A Multilevel Analysis (Masters dissertation), University of Ottawa, Ontario, Canada.
Regidor, E., Calle, M.E., Navarro, P., and Dominguez, V. (2003). Trends in the Association between Average Income, Poverty and Income Inequality and Life Expectancy in Spain. Social Science & Medicine 56(5): 961-71.
Regidor, E., Navarro, P., Dominguez, V., and Rodriguez, C. (1997). Inequalities in Income and Long Term Disability in Spain: Analysis of Recent Hypotheses Using Cross Sectional Study Based on Individual Data. BMJ 315(7116): 1130-5.
Rogders, G.B. (1979). Income Inequality as Determinants of Mortality: An International Cross-Section Analysis. Population Studies. 33, 343-351.
Shi, L.Y., Starfield, B., Kennedy, B., and Kawachi, I. (1999). Income Inequality, Primary Care, and Health Indicators. Journal of Family Practice, 48(4): 275-84.
Sorlie, P.D., Backlund, E., and Keller, J.B. (1995). U.S Mortality by Economic, Demographic, and Social Characteristics: The National Longitudinal Mortality Study. American Journal of Public Health,85, 949-56.
Stanistreet, D., Scott-Samuel, A., and Bellis, M.A. (1999). Income Inequality and Mortality in England. Journal of Public Health Medicine, 21 (2): 205-7.
Subramanian, S.V., and Kawachi, I. (2003a). The Association between State Income Inequality and Worse Health is not Confounded by Race. International Journal of Epidemiology, 32, 1022-1028.
Subramanian, S.V., and Kawachi, I. (2004). Income Inequality and Health: What have we Learned so far? Epidemiologic Reviews, 26, 78-91.
Subramanian, S.V., Kawachi, I., and Kennedy, B.P. (2001). Does the state you live in make a difference? Multilevel Analysis of SELF-rated health in the US. Social Science and Medicine, 53(1), 9-19.
Szwarcwald, C. L, de Andrade, C.L.T., and Bastos F.I. (1999). Income Inequality and Health: the Case of Rio de Janeiro. Cadernos de Saude Publica, 15(1) 15-28.
Szwarcwald, C.L., de Andrade, C.L.T., and Bastos F.I. (2002). Income Inequality and Homicide Rates in Rio De Janeiro, Brazil. American Journal of Public Health 89(6): 845-80.
USAID, (2012). United States Aid for International Development.
Vafaei, A. (2008). Relationships between Inequality and Health: an Ecological Canadian Study. (Masters Thesis), Queen’s University, Canada.
Vafaei, A., Rosenberg, M. W., Pickett, W. (2010). Relationships between Income Inequality and Health: a Study of Rural and Urban Regions of Canada. Queen’s University, Canada.
Veenstra, G. (2002a). Social Capital and Health (Plus Wealth, Income Inequality and Regional Health Governance). Social Science & Medicine 54(6): 849-68.
Veenstra, G. (2003). Economy, Community, and Mortality in British Columbia, Canada. Social Science and Medicine, 56, 1807-1816.
Wagataff, A., and van Doorslaer, E. (2000). Income Inequality and Health: What Does the Literature Tell Us? Annual Rev. Public Health. 21 Affluence: 543 – 67.
Walberg, P., Mckee, M., Shkolnikov, V., Chenet, L., and Leon, D.A. (1998). Economic Change, Crime, and Mortality Crisis in Russia. British Medical Journal, 317(7154), 312-318.
Waldman, R.J. (1993). Income-distribution and infant mortality. Quarterly Journal of Economics, 107(4), 1283-1302.
Wilkinson, R. G. and Pickett, K. E. (2006). Income Inequality and Population Health: A Review and Explanation of the Evidence. Social Science and Medicine, 62, 1768 – 1784.
Wilkinson, R.G. (1994). The Epidemiological Transition: from Material Scarcity to Social Disadvantage? Daedalus, 123 (4), 61- 77.
Wilkinson, R.G. (1996). Unhealthy Societies: the Afflictions of Inequality. London: Routledge.
WHO, (2007). World Health Report
World Bank, (2012). World Development Report.
Akpan, E.S., Riman, H. B. (2010). Causality between Poverty, Health Expenditure and Health Status: Evidence from Nigeria using VECM. European Journal of Economics, Finance and Administrative Sciences, 27, 1450-2275.
Antai, D. (2011). Regional Inequalities in Under-5 Mortality in Nigeria: a Population-Based Analysis of Individual and Community-Level Determinants. Population Health Metrics, 9:6.
Bassey, J.U. et al., (2010). Poverty, Health Expenditure, and Health Status: a Long Term Perspective with Evidence from Nigeria. http://ssrn.com/abstract=1540303.
Blakely, T.A., Lochner, K., and Kawachi, I. (2002). Metropolitan area Income Inequality and Self- Rated Health- a Multi-level Study. Social Science and Medicine, 54 (1), 65 – 77.
Braveman, P, and Tarimo, E. (2002). Social Inequalities in health within countries: not only an issue for affluent nations. Social Sciences & Medicine 54, 1621 – 1635.
Browne, W. & Rasbash, J. (2004). `Multilevel Modelling', in Hardy, M. and Bryman, A. (eds.), Handbook of data analysis, Sage Publications.
Chiang, T. (1999). Economic Transition and the Changing Relation Between Income Inequality And Mortality in Taiwan: Regression Analysis. British Medical Journal 319, 1162-1165.
CIA-World Fact Book, (2012). CIA-World Fact Book.
De Maio, F., G. (2008). Ecological Analysis of the Health Effects of Income Inequality and Homicide Rates in Canada and the United States. Canadian Journal of Public Health, 43(2), 219-236.
De Vogli, R., Mistry, R., and Gnestto, R. (2005). Income Inequality and Life Expectancy: Evidence from Italy. In Vafaei, A. (2008). Relationship between Income Inequality and Health: Ecological Canadian Study. (Msc thesis). Queen’s University Ontario, Canada.
Deaton, A. (2005). Health, Inequality, and Economic Development. Journal of Economic Lit, 41,113-158.
Duleep, H. O. (1995). Mortality and Income Inequality among Economically Developed Countries. In Vafaei, A. (2008). Relationship between Income Inequality and Health: Ecological Canadian Study. (Msc thesis) Queen’s University Ontario, Canada.
Fidell, G. and Tabachnick, L. S. (2007). Using Multivariate Statistics (5th ed.). Boston ; Montreal: Pearson/A & B.
Gerdtham, U. and Johannesson, M. (1991). Absolute Income, Relative Income, Income Inequality and Mortality.
Holtgrave, D. R., and Crosby, R. A. (2003). Social Capital, Poverty and Income Inequality as Predictors of Gonorrhea, Syphilis, Chlamydia and AIDS Case Rates in the United States. In Vafaei, A. (2008) Relationship between Income Inequality and Health: an Ecological Canadian Study. (Msc thesis), Queen’s University Ontario, Canada.
Holtgrave, D. R., and Crosby, R. A. (2004). Social Determinants of Tuberculosis Case Rates in the United States. In Vafaei, A. (2008). (Msc thesis), Queen’s University Ontario, Canada.
Ichoku, H. E. (2005). Income Redistributive Effects of the Healthcare Financing System in Nigeria. Research Paper submitted to Poverty and Economic Policy Research Network, University of Laval.
Joint United Nations Programme on HIV/AIDS, (2013).
Kahn, R.S. Wise P.H., Kennedy, B.P., and Kawachi, I. (2000). State Income Inequality, Household Income, and Maternal Mental and Physical Health. In Vafaei, A. (2008) Relationship between Income Inequality and Health : Ecological Canadian Study. (Msc thesis), Queen’s University Ontario, Canada.
Kaplan, G.A., Pamuk, E.R., Lynch, J.N., and Cohen, B.(1996). Inequality in Income and Mortality in the United States. British Medical Journal, 312(7037), 999-1003.
Kawachi, I., Kennedy, B. P., and Wilkinson, R. G. (1999). Income Inequality and Health. The Society and Population Health Reader Volume 1. 1st ed. New York, NY: New Press.
Kennedy, B.P., Lochner, K., and ProthrowStith, D. (1991). Homicide in Urban Canada. Canadian Journal of Sociology, 16(4), 397-410.
Kawachi. I. and Kennedy, B. P. (1997). The Relationship of Income Inequality to Mortality. Does the Choice of Indicator Matter? Social Science and Medicine, 45, 1121 – 1127.
Kennedy, B.P., Kawachi, I and Prothrow-Stith, D. (1996). Income Distribution and Mortality: Cross Sectional Ecological Study of the Robin Hood Index in the United States. In Vafaei, A. (2008). Relationship between Income Inequality and Health: Ecological Canadian study. (Msc thesis), Queen’s University Ontario, Canada
Larrea, C., and Kawachi, I. (2005). Does Economic Inequality Affect Child Malnutrition? The Case of Ecuador. Social Science & Medicine, 60, 165-178.
Li, H., and Zhu, Y. (2004). Income, Income Inequality and Health: Evidence from China. Department of Economics. The Chinese University of Hong Kong, Shatin, China.
Mellor, J.M., and Milyo, J. (2002). Re-examining the Evidence of an Ecological Association between Income Inequality and Health. Journal of Health Politics, Policy and Law, 26 (3): 487 - 522
Mellor, J.M., and Milyo, J. (2002). Income Inequality and Individual Health: Evidence from the Current Population Survey. Journal of Human Resources 37(3): 510-39.
Messias, E. (2003). Income Inequality, Illiteracy Rate, and Life Expectancy in Brazil. American Journal of Public Health 93(8): 1294-6.
Muller, A. (2000). Education, Income Inequality, and Mortality: A Multiple Regression Analysis. British Medical Journal, 324 (7328), 23 – 25.
National Demographic and Household Surveys (2013).
National Health Strategies Development Plan, (2010). National Health Strategies Development Plan, 2010-2015.
Nwosu, E. O. (2012). Empirical Investigation of Socioeconomic Health Inequalities in Nigeria: Evidence from Demographic and Health Surveys. Unpublished Ph.D dissertation, Department of Economics, University of Nigeria, Nsukka.
Osler, M., Prescott, E. and Gronbaek, M.. (2003). Income Inequality and Ischaemic Heart Disease in Danish men and women. International Journal of Epidemiology. 32(3): 375-380.
Osler, M., Prescott, E., Gronbaek, M., Christensen, U. et al., (2002). Income Inequality, Individual Income, and Mortality in Danish Adults. In Vafaei, A. (2008) Relationship between Income Inequality and Health: Ecological Canadian Study. (Msc thesis), Queen’s University Ontario, Canada.
Pinheiro, J.C. & Bates, D.M. (2000). Mixed-Effects Models in S and S-PLUS, Springer.
Qi, G. (2008). Income Inequality and Health in Ontario: A Multilevel Analysis (Masters dissertation), University of Ottawa, Ontario, Canada.
Regidor, E., Calle, M.E., Navarro, P., and Dominguez, V. (2003). Trends in the Association between Average Income, Poverty and Income Inequality and Life Expectancy in Spain. Social Science & Medicine 56(5): 961-71.
Regidor, E., Navarro, P., Dominguez, V., and Rodriguez, C. (1997). Inequalities in Income and Long Term Disability in Spain: Analysis of Recent Hypotheses Using Cross Sectional Study Based on Individual Data. BMJ 315(7116): 1130-5.
Rogders, G.B. (1979). Income Inequality as Determinants of Mortality: An International Cross-Section Analysis. Population Studies. 33, 343-351.
Shi, L.Y., Starfield, B., Kennedy, B., and Kawachi, I. (1999). Income Inequality, Primary Care, and Health Indicators. Journal of Family Practice, 48(4): 275-84.
Sorlie, P.D., Backlund, E., and Keller, J.B. (1995). U.S Mortality by Economic, Demographic, and Social Characteristics: The National Longitudinal Mortality Study. American Journal of Public Health,85, 949-56.
Stanistreet, D., Scott-Samuel, A., and Bellis, M.A. (1999). Income Inequality and Mortality in England. Journal of Public Health Medicine, 21 (2): 205-7.
Subramanian, S.V., and Kawachi, I. (2003a). The Association between State Income Inequality and Worse Health is not Confounded by Race. International Journal of Epidemiology, 32, 1022-1028.
Subramanian, S.V., and Kawachi, I. (2004). Income Inequality and Health: What have we Learned so far? Epidemiologic Reviews, 26, 78-91.
Subramanian, S.V., Kawachi, I., and Kennedy, B.P. (2001). Does the state you live in make a difference? Multilevel Analysis of SELF-rated health in the US. Social Science and Medicine, 53(1), 9-19.
Szwarcwald, C. L, de Andrade, C.L.T., and Bastos F.I. (1999). Income Inequality and Health: the Case of Rio de Janeiro. Cadernos de Saude Publica, 15(1) 15-28.
Szwarcwald, C.L., de Andrade, C.L.T., and Bastos F.I. (2002). Income Inequality and Homicide Rates in Rio De Janeiro, Brazil. American Journal of Public Health 89(6): 845-80.
USAID, (2012). United States Aid for International Development.
Vafaei, A. (2008). Relationships between Inequality and Health: an Ecological Canadian Study. (Masters Thesis), Queen’s University, Canada.
Vafaei, A., Rosenberg, M. W., Pickett, W. (2010). Relationships between Income Inequality and Health: a Study of Rural and Urban Regions of Canada. Queen’s University, Canada.
Veenstra, G. (2002a). Social Capital and Health (Plus Wealth, Income Inequality and Regional Health Governance). Social Science & Medicine 54(6): 849-68.
Veenstra, G. (2003). Economy, Community, and Mortality in British Columbia, Canada. Social Science and Medicine, 56, 1807-1816.
Wagataff, A., and van Doorslaer, E. (2000). Income Inequality and Health: What Does the Literature Tell Us? Annual Rev. Public Health. 21 Affluence: 543 – 67.
Walberg, P., Mckee, M., Shkolnikov, V., Chenet, L., and Leon, D.A. (1998). Economic Change, Crime, and Mortality Crisis in Russia. British Medical Journal, 317(7154), 312-318.
Waldman, R.J. (1993). Income-distribution and infant mortality. Quarterly Journal of Economics, 107(4), 1283-1302.
Wilkinson, R. G. and Pickett, K. E. (2006). Income Inequality and Population Health: A Review and Explanation of the Evidence. Social Science and Medicine, 62, 1768 – 1784.
Wilkinson, R.G. (1994). The Epidemiological Transition: from Material Scarcity to Social Disadvantage? Daedalus, 123 (4), 61- 77.
Wilkinson, R.G. (1996). Unhealthy Societies: the Afflictions of Inequality. London: Routledge.
WHO, (2007). World Health Report
World Bank, (2012). World Development Report.