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. 2021 Apr;112(2):199-209.
doi: 10.17269/s41997-020-00407-1. Epub 2020 Sep 21.

With great inequality comes great responsibility: the role of government spending on population health in the presence of changing income distributions

Tong Liu  1 , Daniel J Dutton  2
Affiliations

With great inequality comes great responsibility: the role of government spending on population health in the presence of changing income distributions

Tong Liu et al. Can J Public Health. 2021 Apr.

Abstract
in English, French

Objectives: To determine the association between provincial government health and social spending and population health outcomes in Canada, separately for men and women, and account for the potential role of income inequality in modifying the association.

Methods: We used data for nine Canadian provinces, 1981 to 2017. Health outcomes and demographic data are from Statistics Canada; provincial spending data are from provincial public accounts. We model the ratio of social-to-health spending ("the ratio") on potentially avoidable mortality (PAM), life expectancy (LE), potential years of life lost (PYLL), infant mortality, and low birth weight baby incidence. We interact the ratio with the Gini coefficient to allow for income inequality modification.

Results: When the Gini coefficient is equal to its average (0.294), the ratio is associated with desirable health outcomes for adult men and women. For example, among women, a 1% increase in the ratio is associated with a 0.04% decrease in PAM, a 0.05% decrease in PYLL, and a 0.002% increase in LE. When the Gini coefficient is 0.02 higher than average, the relationship between the ratio and outcomes is twice as strong as when the Gini is at its average, other than for PAM for women. Infant-related outcomes do not have a statistically significant association with the ratio.

Conclusion: Overall, outcomes for men and women have similar associations with the ratio. Inequality increases the return to social spending, implying that those who benefit the most from social spending reap higher benefits during periods of higher inequality.

RéSUMé: OBJECTIFS: Déterminer l’association entre les dépenses sociales et de santé du gouvernement provincial et les conditions de santé de la population du Canada, séparément pour hommes et femmes, et expliquer le role que l’inégalité salariale pourrait jouer dans la modification de cette association. MéTHODES: Nous avons utilisé les données pour neuf provinces canadiennes, de 1981 à 2017. Les conditions de santé et les données démographiques parviennent de Statistiques Canada, les données sur les dépenses provinciales parviennent de comptes publiques provinciaux. Nous avons modélisé le rapport de dépenses social-à-santé (« le rapport ») sur la mortalité potentiellement évitable (MPE), l’espérance de vie (EV), les années de vie potentielles perdues (AVPP), la mortalité d’enfant et l’incidence d’un poids à la naissance faible. Nous interagissons le rapport avec le coefficient de Gini pour permettre la modification d’inégalité salariale. RéSULTATS: Quand le coefficient de Gini est égal à sa moyenne (0,294), le rapport est associé avec des conditions de santé désirables pour hommes et femmes adultes. Par example, en femmes, une augmentation de 1 % dans le rapport est associé avec une réduction de 0,04 % en MPE, une réduction de 0,05 % en AVPP, et une augmentation de 0,002 % en EV. Quand le coefficient de Gini est 0,02 plus haut que la moyenne, la relation entre le rapport et les résultats est deux fois plus fort que quand le Gini est à sa moyenne, à part la MPE en femmes. Les résultats liés aux nouveau-nés n’ont pas une association statistique significative avec le rapport. CONCLUSION: Globalement, les résultats pour hommes et femmes ont des associations semblables avec le rapport. L’inégalité augmente le retour aux dépenses sociales, insinuant que ceux et celles qui profitent le plus de dépenses sociales récoltent plus de bénéfices pendant des périodes de plus grande inégalité.

Keywords: Canada; Health expenditures; Population health; Social determinants of health.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Health spending, social spending, and the ratio of social-to-health spending trends in Canada (and by province) over time. Left panel: health (gold lines) and social (blue lines) spending per capita in thousands of 2017 dollars for each province over time, national average in bold. Right panel: the ratio of social-to-health spending for each province over time, national average in bold
Fig. 2
Fig. 2
The Gini coefficient over time for each province and its relationship to the social-to-health spending ratio. Left panel: the Gini coefficient by province over time, line of best fit is a median spline. Right panel: the social-to-health spending ratio over the Gini coefficient, line of best fit is a simple regression line
Fig. 3
Fig. 3
The relationship between health outcomes and the social-to-health spending ratio (S/H ratio) in high versus low inequality settings. The blue lines are for men; the red lines are for women. The solid lines are low Gini coefficient settings (0.28); the dashed lines are high Gini coefficients settings (0.32)
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References

    1. Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. Journal of Epidemiology and Community Health. 2010;64(4):284–291. doi: 10.1136/jech.2008.082743. - DOI - PMC - PubMed
    1. Beach CM. Changing income inequality: a distributional paradigm for Canada. Canadian Journal of Economics/Revue Canadienne d’économique. 2016;49(4):1229–1292. doi: 10.1111/caje.12248. - DOI
    1. Bor, J., Cohen, G. H., & Galea, S. (2017). Population health in an era of rising income inequality: USA, 1980–2015. In The Lancet (Vol. 389, Issue 10077, pp. 1475–1490). Lancet Publishing group. 10.1016/S0140-6736(17)30571-8. - PubMed
    1. Bradley EH, Canavan M, Rogan E, Talbert-Slagle K, Ndumele C, Taylor L, Curry LA. Variation in health outcomes: the role of spending on social services, public health, and health care, 2000-09. Health Aff. 2016;35(5):760–768. doi: 10.1377/hlthaff.2015.0814. - DOI - PubMed
    1. Bradley EH, Elkins BR, Herrin J, Elbel B. Health and social services expenditures: associations with health outcomes. BMJ Quality & Safety. 2011;20(10):826–831. doi: 10.1136/bmjqs.2010.048363. - DOI - PubMed