The relationship between relative deprivation and self-rated health among Palestinian women in refugee camps in Lebanon

AbstractBackgroundRelative deprivation (RD) has been advanced as a theory to explain the relationship between income inequality and health in high-income countries. In this study, we tested the theory in a low-income protracted refugee setting in a middle-income country.MethodsUsing data from the 2010 Socioeconomic Survey of Palestine Refugees in Lebanon, we examined the relationship between RD and health among a representative sample of Palestinian refugee women (N=1047). Data were gathered utilizing a household questionnaire with information on socio-demographics and an individual-level questionnaire with information on the health of each respondent. We examined self-rated health (SRH) as the main health measure but also checked the sensitivity of our results using self-reported chronic conditions. We used two measures for absolute SES: total household monthly expenditures on non-food goods and services and total household monthly expenditures on non-health goods and services. With refugee camp as a reference group, we measured a household’s RD as a household’s rank of absolute SES within the reference group, multiplied by the distance between its absolute SES and the average absolute SES of all households ranked above it. We investigated the robustness of the RD–SRH relationship using these two alternative measures of absolute SES.ResultsOur findings show that, controlling for absolute SES and other possible confounders, women report significantly poorer health when they live in households with a higher score on our RD measure (because of either lower relative rank or lower relative SES compared to households better off in the reference group which we take to be the refugee camp). While RD is always significant as a determinant of SRH under a variety of specifications, absolute SES is not consistently significant. These findings persist when we use self-reported chronic conditions as our measure of health instead of SRH, suggesting that the relationship between health and RD may be operating through a psychosocial mechanism.DiscussionOur findings underscore the importance of examining RD under conditions of poverty and in diverse socio-cultural contexts. They also highlight that public health approaches should be concerned with reducing social inequalities in low-income settings in addition to alleviating poverty

Health equity in Lebanon: a microeconomic analysis

<p>Abstract</p> <p>Background</p> <p>The health sector in Lebanon suffers from high levels of spending and is acknowledged to be a source of fiscal waste. Lebanon initiated a series of health sector reforms which aim at containing the fiscal waste caused by high and inefficient public health expenditures. Yet these reforms do not address the issues of health equity in use and coverage of healthcare services, which appear to be acute. This paper takes a closer look at the micro-level inequities in the use of healthcare, in access, in ability to pay, and in some health outcomes.</p> <p>Methods</p> <p>We use data from the 2004/2005 Multi Purpose Survey of Households in Lebanon to conduct health equity analysis, including equity in need, access and outcomes. We briefly describe the data and explain some of its limitations. We examine, in turn, and using standardization techniques, the equity in health care utilization, the impact of catastrophic health payments on household wellbeing, the effect of health payment on household impoverishment, the equity implications of existing health financing methods, and health characteristics by geographical region.</p> <p>Results</p> <p>We find that the incidence of disability decreases steadily across expenditure quintiles, whereas the incidence of chronic disease shows the opposite pattern, which may be an indication of better diagnostics for higher quintiles. The presence of any health-related expenditure is regressive while the magnitude of out-of-pocket expenditures on health is progressive. Spending on health is found to be "normal" and income-elastic. Catastrophic health payments are likelier among disadvantaged groups (in terms of income, geography and gender). However, the cash amounts of catastrophic payments are progressive. Poverty is associated with lower insurance coverage for both private and public insurance. While the insured seem to spend an average of almost LL93,000 ($62) on health a year in excess of the uninsured, they devote a smaller <it>proportion </it>of their expenditures to health.</p> <p>Conclusions</p> <p>The lowest quintiles of expenditures per adult have less of an ability to pay out-of-pocket for healthcare, and yet incur healthcare expenditures more often than the wealthy. They have lower rates of insurance coverage, causing them to spend a larger proportion of their expenditures on health, and further confirming our results on the vulnerability of the bottom quintiles.</p

Generating evidence to support policies for raising taxes on tobacco products in Lebanon : a research study funded by IDRC-RITC Canada; final report

International evidence confirms that increased taxation on tobacco products and purchase price are effective tobacco control strategies. Using the model simulation in this study, findings show that consumption among youth of local cigarettes would drop by 101% (compared to 93% for the entire population), of imported cigarettes by 9% (compared to 7% overall), and shisha tobacco by 37% (26% overall). Increasing tobacco taxes would generate 127 million USD in additional public revenues. Proposed tobacco tax reforms would operate on two dimensions: increasing the final price of tobacco products, and increasing the share of taxes in the final retail price

The determinants of sustained adherence to COVID-19 preventive measures among older Syrian refugees in Lebanon

Acknowledgments The authors thank the participants at the Economic Research Forum annual conference in March 2022 for comments. Funding: SA and HG received the ELRHA Research for Health in Humanitarian Crises award (Number 51538) for "Tracking adherence of older refugees to COVID-19 preventive measures in response to changing vulnerabilities: A multi-level, panel study to inform humanitarian response in Lebanon". This work was supported by ELRHA’s Research for Health in Humanitarian Crisis (R2HC) Programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. R2HC is funded by the UK Foreign, Commonwealth and Development Office (FCDO), Wellcome, and the UK National Institute for Health Research (NIHR). The views expressed herein should not be taken, in any way, to reflect the official opinion of the NRC or ELRHA. The funding agency was not involved in the data collection, analysis or interpretation. ELRHA: https://www.elrha.org/programme/research-for-health-in-humanitarian-crises/ The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.Peer reviewedPublisher PD

Equity Impacts of Price Policies to Promote Healthy Behaviours

Governments can use fiscal policies to regulate the prices and consumption of potentially unhealthy products. However, policies aimed at reducing consumption by increasing prices, for example by taxation, might impose an unfair financial burden on low-income households. We used data from household expenditure surveys to estimate patterns of expenditure on potentially unhealthy products by socioeconomic status, with a primary focus on low-income and middle-income countries. Price policies affect the consumption and expenditure of a larger number of high-income households than low-income households, and any resulting price increases tend to be financed disproportionately by high-income households. As a share of all household consumption, however, price increases are often a larger financial burden for low-income households than for high-income households, most consistently in the case of tobacco, depending on how much consumption decreases in response to increased prices. Large health benefits often accrue to individual low-income consumers because of their strong response to price changes. The potentially larger financial burden on low-income households created by taxation could be mitigated by a pro-poor use of the generated tax revenues

Support for UNRWA's survival

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres, some of which are affected by the ongoing humanitarian disasters in Syria and the Gaza Strip. It has dramatically reduced the prevalence of infectious diseases, mortality, and illiteracy. Its social services include rebuilding infrastructure and homes that have been destroyed by conflict and providing cash assistance and micro-finance loans for Palestinians whose rights are curtailed and who are denied the right of return to their homeland

Natural-Resource Wealth: Elbow Grease or Fuel for Poverty?

We consider the effect of natural resources on growth using a two-sector model (resource and nonresource). Government taxes the nonresource sector and chooses institutional quality, which determines productivity in the nonresource sector and the government's ability to appropriate resource rents. We find that resource booms harm institutions. Their effect on growth depends on relative sector sizes: when rents are more substantial, governments are likelier to corrupt institutions to secure larger shares of rents. Cross-country panel data substantiate the results: countries in the bottom tercile of value added in manufacturing and services divided by GDP are cursed by resources; others are blessed.

Relative deprivation and mortality in South Africa

This paper tests the relative income hypothesis by considering the relationship between mortality, income and relative deprivation in South Africa using individual-level data on income and five measures of relative deprivation each with a different reference group. We find that income tends to be protective of, and relative deprivation detrimental to health, but the latter often gives a better account of mortality than does income alone. For some population groups the fit is improved in specifications which include both income and relative deprivation. Overall, there seems to be solid evidence in support of the relative income hypothesis, particularly for the more economically disadvantaged population groups. Relative deprivation is especially significant when age is the reference group, suggesting that the comparison of socio-economic standing that has an impact on health tends to happen within cohorts. The results are robust to splitting the sample into urban/rural subsamples and to looking at the incidence of illness as the health outcome rather than mortality. While little is known about the mechanisms underlying the effect of relative deprivation on health and mortality, the consistent evidence in favor of age as a reference group, particularly in a context like South Africa's suggests that intra-cohort comparisons should be an avenue for more in depth investigation.South Africa Relative deprivation Income inequality Mortality Age cohorts Race