Macroeconomic Policies and Increasing Social-Health Inequality in Iran

Document Type : Original Article

Authors

1 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background
Health is a complex phenomenon that can be studied from different approaches. Despite a growing research in the areas of Social Determinants of Health (SDH) and health equity, effects of macroeconomic policies on the social aspect of health are unknown in developing countries. This study aimed to determine the effect of macroeconomic policies on increasing of the social-health inequality in Iran.
 
Methods
This study was a mixed method research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect the data along with a multiple attribute decision-making method for the quantitative phase of the research in which the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was employed for prioritization. The NVivo and MATLAB softwares were used for data analysis.
 
Results
Seven main themes for the effect of macroeconomic policies on increasing the social-health inequality were identified. The result of TOPSIS approved that the inflation and economic instability exert the greatest impact on social-health inequality, with an index of 0.710 and the government policy in paying the subsidies with a 0.291 index has the lowest impact on social-health inequality in the country.
 
Discussion
It is required to invest on the social determinants of health as a priority to reduce health inequality. Also, evaluating the extent to which the future macroeconomic policies impact the health of population is necessary.

Keywords

Main Subjects

References

  1. World Health Organization (WHO). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health: Commission on Social Determinants of Health Final Report: Geneva: World Health Organization, Commission on Social Determinants of Health; 2008.
  2. Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008; 372: 1661-9. doi: 10.1016/s0140-6736(08)61690-6
  3. Ahnquist J, Wamala SP, Lindstrom M. Social determinants of health--a question of social or economic capital? Interaction effects of socioeconomic factors on health outcomes. Soc Sci Med 2012; 74: 930-9. doi: 10.1016/j.socscimed.2011.11.026
  4. Embrett MG, Randall GE. Social determinants of health and health equity policy research: Exploring the use, misuse, and nonuse of policy analysis theory. Soc Sci Med 2014; 108C: 147-55.  doi: 10.1016/j.socscimed.2014.03.004
  5. Kiesler J, Vaughn LM, Kaur G. “Voicing” the social determinants of health on the backside of a horse racetrack. J Health Care Poor Underserved 2013; 24: 1074-88. doi: 10.1353/hpu.2013.0153
  6. May J, Carey TA, Curry R. Social determinants of health: whose responsibility? Aust J Rural Health 2013; 21: 139-40. doi: 10.1111/ajr.12050
  7. Moatti JP. [Social determinants of health inequalities: a public health research priority]. Rev Epidemiol Sante Publique 2013; 61: S123-5.
  8. Abel T, Hofmann K, Schori D. Social and regional variations in health status and health behaviours among Swiss young adults. Swiss Med Wkly 2013; 143: w13901. Doi: 10.4414/smw.2013.13901
  9. Alter HJ. Social Determinants of Health: From Bench to Bedside. JAMA Intern Med  2014; 174: 543-5. doi: 10.1001/jamainternmed.2013.13302
  10. Dean HD, Williams KM, Fenton KA. From theory to action: applying social determinants of health to public health practice. Public Health Rep 2013; 128: 1-4.
  11. Marmot M, Pellegrini Filho A, Vega J, Solar O, Fortune K. Action on social determinants of health in the Americas. Rev Panam Salud Publica 2013; 34: 382-4.
  12. Braveman P, Gottlieb L. The social determinants of health: it\'s time to consider the causes of the causes. Public Health Rep 2014; 129: 19-31.
  13. Krumeich A, Meershoek A. Health in global context; beyond the social determinants of health? Glob Health Action 2014; 7: 23506. doi: 10.3402/gha.v7.23506
  14. Perrin VA. Social determinants of health. Health Aff (Millwood) 2013; 32: 2060. doi: 10.1377/hlthaff.2013.1102
  15. Marmot M, Bell R, Goldblatt P. Action on the social determinants of health. Rev Epidemiol Sante Publique 2013; 61: S127-32. doi: 10.1016/j.respe.2013.05.014
  16. Badry D, Felske AW. An examination of the social determinants of health as factors related to health, healing and prevention of foetal alcohol spectrum disorder in a northern context--the Brightening Our Home Fires Project, Northwest Territories, Canada. Int J Circumpolar Health 2013; 72: 21140. doi: 10.3402/ijch.v72i0.21140
  17. Baer TE, Gottlieb L, Sandel M. Addressing social determinants of health in the adolescent medical home. Curr Opin Pediatr 2013; 25: 447-53. doi: 10.1097/mop.0b013e32836280ae
  18. Heidarnia MA, Monfared ED, Akbari ME, Yavari P, Amanpour F, Mohseni M. Social determinants of health and 5-year survival of colorectal cancer. Asian Pac J Cancer Prev 2013; 14: 5111-6. doi: 10.7314/apjcp.2013.14.9.5111
  19. Prasad A, Groot AM, Monteiro T, Murphy K, O\'Campo P, Broide EE, et al. Linking evidence to action on social determinants of health using Urban HEART in the Americas. Rev Panam Salud Publica 2013; 34: 407-15.
  20. Sanneving L, Trygg N, Saxena D, Mavalankar D, Thomsen S. Inequity in India: the case of maternal and reproductive health. Glob Health Action 2013; 6: 19145. doi: 10.3402/gha.v6i0.19145
  21. Schutte S, Chastang JF, Parent-Thirion A, Vermeylen G, Niedhammer I. Social Inequalities in Psychological Well-Being: A European Comparison. Community Ment Health J 2014; forthcoming. doi: 10.1007/s10597-014-9725-8
  22. Shojaei P, Karimloo M, Mohammadi F, Malek Afzali H, Forouzan AS. Position of social determinants of health in urban man-made lakes plans. Glob J Health Sci 2013; 5: 100-11. doi: 10.5539/gjhs.v5n6100
  23. Srinivasan S, Williams SD. Transitioning from health disparities to a health equity research agenda: the time is now. Public Health Rep 2014; 129: 71-6.
  24. Ward PR, Mamerow L, Meyer SB. Identifying vulnerable populations using a social determinants of health framework: analysis of national survey data across six Asia-Pacific countries. PLoS One 2013; 8: e83000. doi: 10.1371/journal.pone.0083000
  25. Clarke CE, Niederdeppe J, Lundell HC. Narratives and images used by public communication campaigns addressing social determinants of health and health disparities. Int J Environ Res Public Health 2012; 9: 4254-77. doi: 10.3390/ijerph9124254
  26. Davies JK, Sherriff NS. Assessing public health policy approaches to level-up the gradient in health inequalities: the Gradient Evaluation Framework. Public Health 2014; 128: 246-53. doi: 10.1016/j.puhe.2013.11.011
  27. Zaboli R, Tourani S, Seyedin SH, Oliaie Manesh A. Prioritizing the Determinants of Social-health Inequality in Iran: A Multiple Attribute Decision Making Application. Iran Red Crescent Med J 2014; 16: e12607. doi: 10.5812/ircmj.12607
  28. Freudenberg N, Tsui E. Evidence, power, and policy change in community-based participatory research. Am J Public Health 2014; 104: 11-4. doi: 10.2105/ajph.2013.301471
  29. Gollust SE, Cappella JN. Understanding Public Resistance to Messages About Health Disparities. J Health Commun 2014; 19: 493-510. doi: 10.1080/10810730.2013.821561
  30. Gore DM, Kothari AR. Getting to the root of the problem: health promotion strategies to address the social determinants of health. Can J Public Health 2013; 104: e52-4.
  31. Hardy LJ, Bohan KD, Trotter RT, 2nd. Synthesizing evidence-based strategies and community-engaged research: a model to address social determinants of health. Public Health Rep 2013; 128: 68-76.
  32. Solar OAI, World health organization. A conceptual framework for action on the social determinants of health. Social Determinants of Health. Discussion Paper 2 (Policy and Practice). 2010. Available from: http://www.who.int/social_determinants/corner/SDHDP2. pdf
  33. Chen CT. Extensions of the TOPSIS for group decision-making under fuzzy environment. Fuzzy Sets and Systems 2000; 114: 1-9. doi: 10.1016/s0165-0114(97)00377-1
  34. Lai YJ, Liu TY, Hwang CL. Topsis for MODM. Eur J Oper Res 1994; 76: 486-500. doi: 10.1016/0377-2217(94)90282-8
  35. Shih HS, Shyur HJ, Lee ES. An extension of TOPSIS for group decision making. Mathematical and Computer Modelling 2007; 45: 801-13. doi: 10.1016/j.mcm.2006.03.023
  36. Gottlieb L, Sandel M, Adler NE. Collecting and applying data on social determinants of health in health care settings. JAMA Intern Med 2013; 173: 1017-20. doi: 10.1001/jamainternmed.2013.560
  37. Ingram M, Schachter KA, Sabo SJ, Reinschmidt KM, Gomez S, De Zapien JG, et al. A community health worker intervention to address the social determinants of health through policy change. J Prim Prev 2014; 35: 119-23. doi: 10.1007/s10935-013-0335-y
  38. Jackson CS, Gracia JN. Addressing health and health-care disparities: the role of a diverse workforce and the social determinants of health. Public Health Rep 2014; 129: 57-61.
  39. Kickbusch I, Williams C, Lawless A. Making the most of open windows: establishing health in all policies in South Australia. Int J Health Serv 2014; 44: 185-94. doi: 10.2190/hs.44.1.k
  40. Morasae EK, Forouzan AS, Majdzadeh R, Asadi-Lari M, Noorbala AA, Hosseinpoor AR. Understanding determinants of socioeconomic inequality in mental health in Iran’s capital, Tehran: a concentration index decomposition approach. Int J Equity Health 2012; 11: 18. doi: 10.1186/1475-9276-11-18
  41. Imani-Nasab MH, Seyedin H, Majdzadeh R, Yazdizadeh B, Salehi M. Development of Evidence-Based Health Policy Documents in Developing Countries: A Case of Iran. Glob J Health Sci 2014; 6: 27. doi: 10.5539/gjhs.v6n3p27
  42. Jackson SF, Birn AE, Fawcett SB, Poland B, Schultz JA. Synergy for health equity: integrating health promotion and social determinants of health approaches in and beyond the Americas. Rev Panam Salud Publica 2013; 34: 473-80.
  43. Leong D, Roberts E. Social determinants of health and the affordable care act. R I Med J (2013) 2013; 96: 20-2.
  44. Suther E, Sandel M. Health impact assessments. R I Med J (2013) 2013; 96: 27-30.
  45. Wang MP, Viswanath K, Lam TH, Wang X, Chan SS. Social determinants of health information seeking among Chinese adults in Hong Kong. PLoS One 2013; 8: e73049. doi: 10.1371/journal.pone.0073049
  46. Welch VA, Petticrew M, O\'Neill J, Waters E, Armstrong R, Bhutta ZA, et al. Health equity: evidence synthesis and knowledge translation methods. Syst Rev 2013; 2: 43. doi: 10.1186/2046-4053-2-43
  47. Lofters A, Slater M, Kirst M, Shankardass K, Quinonez C. How do people attribute income-related inequalities in health? A cross-sectional study in Ontario, Canada. PLoS One 2014; 9: e85286. doi: 10.1371/journal.pone.0085286
  48. Muntaner C, Chung H. Commentary: macrosocial determinants, epidemiology, and health policy: should politics and economics be banned from social determinants of health research? J Public Health Policy 2008; 29: 299-306. doi: 10.1057/jphp.2008.23
  49. O\'Dea JA, Chiang H, Peralta LR. Socioeconomic patterns of overweight, obesity but not thinness persist from childhood to adolescence in a 6 -year longitudinal cohort of Australian schoolchildren from 2007 to 2012. BMC Public Health 2014; 14: 222. doi: 10.1186/1471-2458-14-222
  50. Parthasarathy P, Dailey DE, Young ME, Lam C, Pies C. Building Economic Security Today: making the health-wealth connection in Contra Costa county\'s maternal and child health programs. Matern Child Health J 2014; 18: 396-404. doi: 10.1007/s10995-013-1309-7
  51. Ritchie D, Nolan PA. Health in all policies: a start in rhode island. R I Med J (2013) 2013; 96: 31-6.
  52. Tallarek nee Grimm MJ, Helgesen MK, Fosse E. Reducing social inequities in health in Norway: concerted action at state and local levels? Health Policy 2013; 113: 228-35. doi: 10.1016/j.healthpol.2013.09.019
  53. Thakur J, Prinja S, Garg CC, Mendis S, Menabde N. Social and Economic Implications of Noncommunicable diseases in India. Indian J Community Med 2011; 36: S13-22. doi: 10.4103/0970-0218.94704
  54. Urbanos R. [Health in all policies. Is the economic depression a time of opportunities? SESPAS Report 2010]. Gac Sanit 2010; 24: 7-11.
  55. South J, Phillips G. Evaluating community engagement as part of the public health system. J Epidemiol Community Health 2014; 68: 692-6. doi: 10.1136/jech-2013-203742
  56. Tozer AP, Belanger P, Moore K, Caudle J. Socioeconomic status of emergency department users in ontario, 2003 to 2009. CJEM 2013; 15: 1-7.
  57. Vogel L. Ottawa needs to address social determinants of health, Canadians tell CMA. CMAJ 2013; 185: E599. doi: 10.1503/cmaj.109-4566
  58. Yavangi M, Sohrabi MR, Riazi S. Out of pocket payment for obstetrical complications: a cost analysis study in iran. Int J Prev Med 2013; 4: 1296-303.
  59. Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P. WHO European review of social determinants of health and the health divide. Lancet 2012; 380: 1011-29. doi: 10.1016/s0140-6736(12)61228-8
  60. Priya R, Chikersal A. Developing a public health cadre in 21 st century India: addressing gaps in technical, administrative and social dimensions of public health services. Indian J Public Health 2013; 57: 219-24.

 

 

Files

History

  • Receive Date: 26 April 2014
  • Revise Date: 18 June 2014
  • Accept Date: 19 July 2014
  • First Publish Date: 01 August 2014

Share

How to cite

Statistics