Determinants of Life Expectancy in Eastern Mediterranean Region: A Health Production Function

Document Type : Original Article


1 Department of Health Economics, School of Management and Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Economics, School of Economy, Management, and Social Science, Shiraz University, Shiraz, Iran


Determinants of health or health production function in health economics literature constitute noticeable issues in health promotion. This study aimed at estimating a health production function for East Mediterranean Region (EMR) based on the Grossman theoretical model.
This ecological study was performed using the econometric methods. The panel data model was used in order to determine the relationship between life expectancy and socioeconomic factors. The data for 21 EMR countries between 1995 and 2007 were used. Fixed-effect-model was employed to estimate the parameters based on Hausman test.
In estimating the health production function, factors such as income per capita (β=0.05, P<0.001), education index (β=0.07, P<0.001), food availability (β=0.01, P<0.001), level of urbanisation (β=0.10, P<0.001), and employment ratio (β=0.11, P<0.001) were specified as determinants of health status, proxied by life expectancy at birth. A notable result was the elasticity of life expectancy with respect to the employment rate and its significance level was different between males (β=0.13, P<0.001) and females (β=0.08, P>0.001).
In order to improve the health status in EMR countries, health policymakers should focus on the factors which lie outside the healthcare system. These factors are mainly associated with economic growth and development level. Thus, the economic stabilisation policies with the aim of increasing the productivity, economic growth, and reducing unemployment play significant roles in the health status of the people of the region.


Main Subjects

1. Von Schirnding Y. The World Summit on Sustainable Development: reaffirming the centrality of health. Global Health 2005; 1: 8.
2. Lei H, Li L, Liu X, Mao A. Quantitative study on socioeconomic Determinants of life expectancy in Beijing, China. JEBM 2009; 2: 92-8. doi: 10.1111/j.1756-5391.2009.01022.x
3. Fayissa B, Gutema P. Estimating a health production function for Sub-Saharan Africa (SSA). Appl Econ 2005; 37: 155-64. doi: 10.1080/00036840412331313521
4. World Health Organization. Regional Office for the Eastern Mediterranean. Building the knowledge base on the social determinants of health: review of seven countries in the Eastern Mediterranean Region. WHO. Regional Publications, Eastern Mediterranean Series; 31. 2008.
5. Auster RA, Levenson I, Sarachek D. The Production of Health: An Exploratory Study. J Hum Resour 1969; 4: 411-36. doi: 10.2307/145166
6. Grossman M. The Demand for Health: A theoretical and Empirical Investigation. NBER: New York; 1972.
7. Wise RA. Changing smoking patterns and mortality from chronic obstructive pulmonary disease. Prev Med 1997; 26: 418-21. doi:
8. Khuder SA. Effects of cigarette smoking on major histological types of lung cancer: a meta-analysis. Lung Cancer 2001; 31: 139-48.
9. Pedrick AM. The Health Production Function: The effect of socioeconomic variables on an individual’s health status 2001, the Department of Economics In Partial Fulfillment of the Requirements for the Degree of Bachelor of Arts.
10. Nixon J, Ulmann P. The relationship between health care expenditure and health outcomes: evidence and caveats for a causal link. Eur J Health Econ 2006; 7: 7-18. doi: 10.1007/s10198-005-0336-8
11. Balia S, Jones AM. Mortality, lifestyle and socio-economic status. J Health Econ 2008; 27: 1-26. doi:
12. Rodgers GB. Income and inequality as determinants of mortality: an international cross-sectional analysis. Popul Stud 1979; 33: 343-51. doi: 10.2307/2173539
13. Peltzman S. Regulation and health: the case of mandatory prescriptions and an extension. Managerial  and  Decision  Economics 1987; 8: 41-6. doi: 10.1002/mde.4090080108
14. McAvinchey ID. A comparison of unemployment, income and mortality interaction for five European countries.Appl Econ 1988; 20: 453-71. doi: 10.1080/00036848800000057
15. Babazono A, Hillman A L. A comparison of international health outcomes and health care spending. Int J Technol Assess Health Care 1994; 10: 40-53. doi:
16. Siddiqui R, Mahmood MA. The Determinants of health status: A cross-country analysis. The pakistan development review 1994; 33: 745-58.
17. Barlow R, Vissandjee B. Determinants of national life expectancy. Canadian Journal of Development Studies 1999; 20: 9-28.
18. Cremieux PY, Ouellette P, Pion C. Health care spending as determinants of health outcomes. Health Econ 1999; 8: 627-39.
19. Ngongo K N, Nante N, Chenet L, McKee M. What has contributed to the change in life expectancy in Italy between 1980 and 1992? Health Policy 1999; 48: 1-12.
20. Filmer D, Pritchett L. The impact of public spending on health: does money matter? Soc Sci Med 1999; 49: 1309-23. doi:
21. Miller R D, Frech HE. Is there link between pharmaceutical consumption and improved health in OECD countries? Pharmacoeconomics 2000; 18: 33-45. doi: 10.2165/00019053-200018001-00006
22. Martinez-Sanchez E, Gutierrez-Fisac JL, Gispert R, Regidor E. Educational differences in health expectancy in Madrid and Barcelona. Health Policy 2001; 55: 227-31.
23. Lichtenberg FR. Sources of U.S. longevity increase, 1960-1997. NBER .Working Paper, No.8755. 2002.
24. Thornton J. Estimating a health production function for the US: some new evidence. Appl Econ 2002; 34: 59-62. doi: 10.1080/00036840010025650
25. Audrey L. Do economic cycles have a permanent effect on population health? Revisiting the Brener hypothesis. Health Econ 2004; 13: 767-79. doi: 10.1002/hec.854
26. Shaw JW, Horrace WC, Vogel RJ. The Determinants of Life Expectancy: An Analysis of the OECD Health Data. South Econ J 2005; 71: 768-83. doi: 10.2307/20062079
27. Chang K, Ying Y H. An empirical study on health in TAIWAN and its long-term adjustment .The Japanese Economic Review 2008; 59: 84-98. doi: 10.1111/j.1468-5876.2007.00391.x
28. Kabir M. Determinants of life expectancy in developing countries. The Journal of Developing Areas 2008; 41: 185-204. doi: 10.1353/jda.2008.0013
29. Shing-Jong L. Economic fluctuations and health outcome: a panel analysis of Asia-Pacific countries. Appl Econ 2009; 41: 519-30. doi: 10.1080/00036840701720754
30. Halicioglu F. Modelling life expectancy in Turkey. MPRA Paper No. 30840. Available at:, 2010.
31. Baltagi BH, Moscone F, Tosetti E. Medical Technology and the Production of Health Care. Discussion Paper No. 5545. 2011. doi:
32. Bayati M, Akbarian R, Kavosi Z, SadraeiJavaheri A, AminiRarani M, Delavari S. Socioeconomic Determinants of Health in Western Pacific Region: A Panel Data Analysis. Social  welfare  quarterly 2013; 47 [in press]
33. Stahl MJ. Encyclopedia of Health Care Management. United States of America: SAGE publication; 2004.
34. Mikkonen J, Raphael D. Social Determinants of Health: the canadian facts. 2010, Library and Archives Canada Cataloguing in Publication.
35. Or Z. Determinants of Health outcomes in industrials countries: APooled, Cross-Country, Time-Series Analysis. OECD  Economic Studies2000; 30: 53-78.
36. Lin SJ. Economic fluctuations and health outcome: a panel analysis of Asia-Pacific countries. Appl Econ 2009; 41: 519-30. doi: 10.1080/00036840701720754
37. Mohan R, Mirmirani S. An Assessment of OECD Health Care System Using Panel Data Analysis. Bryant University, 2007.
38.Wilkinson R, Marot M .Social Determinants of Health: The Solid Facts. edition 2. World Health Organization; 2003.
39. Schoder O, Zweifel P. Flat-of-the-curve medicine: a new perspective on the production of health. Health Econ Rev 2011; 1: 1-10. doi: 10.1186/2191-1991-1-2
40.World Bank, World Development Indicators, available at:
41.World Health Organization, WHO Statistical Information System, available at:
42. United Nations, Human Development Reports 1995-2006, available at:
43.International LabourOrganization(ILO), Key Indicators of the Labour Market Programme, available at:
44. GDP per capita by purchasing power parities. Available at:
45. Gerdtham UG, Johannesson J. Business cycles and mortality: Results from Swedish micro data. Soc Sci Med 2005; 60: 205–18. doi: