低度發展國家政治經濟因子對群體健康的影響

The political and economic determinants of population health: a cross-national study of less developed countries

宋珮瑋(Pei-Wei Sung)

指導教授 ： 莊媖智

臺北醫學大學/公共衛生暨營養學院/公共衛生學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00030

摘要

儘管全球嬰兒和兒童死亡率已大幅下降，但是在低度發展國家嬰兒和兒童死亡率仍然很高，而嬰兒死亡率與兒童死亡率已被公認是代表一國整體健康最敏感的指標。過去的研究證實國家的政治、經濟和衛生指標與群體健康有很高的相關性，且大多數的研究僅採用少數時間點進行資料分析，由於低度發展國家政治、經濟及社會變動較大，特別需要收集長時間的資料，因此本研究將探討1980年到2009年政治、經濟和衛生因子對嬰兒和兒童死亡率的影響，並進一步檢驗政治和經濟因子是否修飾了衛生因子與群體健康之間的關係。
本研究依據現代化理論和依賴理論的基本觀點，建構影響嬰兒和兒童死亡率的重要指標，包括國家內部和外部的因素，並且從國際組織的資料庫取得變項進行資料收集，此外在樣本選擇方面，以國家在世界體系的位置選取72個低度發展國家作為主要的研究對象。在統計分析部分，利用雙變項分析、多變項分析以及時間遲滯模式來檢視政治、經濟和衛生因子對群體健康的影響。
研究結果顯示貪腐控制、每人平均GDP、外債、外資、出口商品集中度、每千人醫師數以及女性初級教育入學率都是嬰兒和兒童死亡率的重要預測因子，其中貪腐控制與嬰兒死亡率有顯著且負向的關係，每人平均GDP、外資、每千人醫師數和女性初級教育入學率，有助於降低嬰兒和兒童死亡率，而外債和出口商品集中度越高，則會顯著增加嬰兒和兒童死亡率。研究進一步發現每千人醫師數和嬰兒與兒童死亡率之間的負向關係，在貪腐控制佳及外債少的國家效果較好。另外，外債在五年的模式中為顯著，而外資和出口商品集中度則是以十年的時間遲滯模式預測較佳。
根據實證分析的結果，本研究提出一些建議，制訂防治貪腐的公共政策，使政治體系運作過程公開且透明化，以及各國政府應擴大醫療人力與增加女性受教育的機會，積極運用健康和教育資源，以降低嬰兒和兒童死亡率。另外須更加重視國際貿易對低度發展國家不對等的影響，並且進一步發展國際法規，給予低度發展國家特殊的權利，以保護國家公共衛生系統，縮短國家之間群體健康的差異。

關鍵字

低度發展國家 ； 嬰兒死亡率 ； 五歲以下兒童死亡率 ； 政治因子 ； 經濟因子 ； 衛生服務

並列摘要

The infant and child mortality rates have fallen significantly worldwide, but they are still high in some less developed countries. Infant mortality and child mortality rates have been recognized as the most sensitive indicators reflecting a nation’s overall health status. Previous studies showed that the political, economic, and health service indicators were highly correlated with infant and child mortality rates; however, most studies collected data at a few time points. Since the political, economic, and societal contexts change rapidly in developing countries, there is a need for collecting longitudinal data to understand the impacts of political, economic, and societal factors on health. This study examined the effects of political, economic and health service indicators on infant and child mortality from 1980 to 2009, and further tested whether the political and economic factors serve as moderators in the relationships between health service factors and population health.
The data of this study were from World Development Indicators, Worldwide Governance Indicators, and UN Commodity Trade Statistics. The sample included 72 less developed countries. According to the modernization theory and the dependency theory, this study included the following variables: voice and accountability, control of corruption, foreign debt, foreign direct investment, commodity concentration, GDP per capita, health expenditure, physician density, skilled birth attendant, and female primary education enrollment. The outcome variables were infant mortality and under-5 child mortality. This study used mixed models and time-lagged models to analyze the data.
The results showed that control of corruption, GDP per capita, foreign direct investment, physician density, and female education were significantly associated with decreased infant and child mortality; while foreign debt and commodity concentration were significantly associated with increased infant and child mortality. Our study further found the impacts of physician density on infant and child mortality rates were stronger in countries with better control of corruption and in countries with lower foreign debt. In terms of time-lagged effects, we found the effects of foreign debt were most significant in 5 years, while the foreign investment and commodity concentration were most significant in 10 years.
Our findings suggested that governments should have good control of corruption in public policy development and implementation. In addition, governments should spend more resources in the provision of health services for people in need. Special attention should be given to laws in international economic relations to address the phenomenon of economic dependency in less developed countries.

並列關鍵字

less developed countries ； infant mortality ； child mortality ； political factors ； economic factors ； health services

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