Three essays on Convergence and Health Economics

Abstract

Health is one of the mainstays for the economic development and the welfare state of any society. Therefore, it comes as no surprise that the main international organizations, such as United Nations, World Bank or International Monetary Fund, have highlighted its importance by granting numerous projects worldwide and by creating international institutions dedicated exclusively to the field of health. This is the case of the WorldHealth Organization (WHO), which was constituted in 1948. We can additionally emphasize the importance of health by taking into account the United Nations Millennium Declaration, the most ambitious project of this organization so far, signed in September 2000 by 189 member countries, in which they undertook to pursue eightMillennium Development Goals (MDGs) of the United Nations. These MDGs were replaced in 2016 by the Sustainable Development Goals (SDGs).Although all the objectives set out in the MDGs have a direct or indirect relationship with health, there are three of them dedicated exclusively to it: MDG4- Reduce child mortality, MDG5- Improve maternal health and MDG6- Combat Human Immunodeficiency Virus (HIV) / Acquire Immunodeficiency Syndrome (AIDS), malaria and other diseases. Currently, these objectives have been included in objective 3 of the SDGs, denominated "Health and well-being", whose targets for 2030 include: To end the preventable deaths of newborns and children under 5 years of age, making all countries try to reduce neonatal mortality to at least as low as 12 per 1,000 live birthsand the mortality of children under 5 years old at least as low as 25 per 1,000 live births. End to the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases. As well as fighting hepatitis, waterborne diseases and other communicable diseases.The interest that the field of health arouse in the economy has attracted a large number of researchers. Following the same interest, it seems relevant to analyze how and to what degree have the objectives established by the United Nations in the MDGs been achieved. Specifically, we analyze the evolution of the HIV / AIDS epidemic andthe degree of reduction of the infant mortality rate (IMR), from the time series approach.The reason for the study of these two objectives is to determine the evolution of these variables over time and to verify if the obtained achievements have been equally reached by all the countries, or if, on the contrary, the progress has been unequal both between countries and within them. So that if these objectives have not been met, we can study the causes and possible explanations of this result, in order to shed some light on the decision making that helps these objectives can be achieved by 2030.In order to be able to compare the analysis results of the different series, we have used the same methodology throughout the three chapters that make up the thesis: convergence analysis. The justification in the choice of the convergence analysis to carry out our research focuses on the fact that any policy aimed at either reducing infantmortality or ending the HIV / AIDS epidemic implies these variable should move go closer to their respective reference rates. Therefore, if all countries have reached the rates established in the MDGs /SDGs, this result could be interpreted as existence demonstration of convergence between countries. On the contrary, if only a part of the countries had been able to reach the reference rates in terms of infant mortality and prevalence of HIV / AIDS, then we could interpret the result as proof of the existence of a divergent behavior between countries. This fact would open the gate to the presence of different convergence clubs.In this context, we consider recent advances in the field of convergence analysis, which are extremely useful to study whether the objectives proposed have been achieved and to identify those countries that have not managed to complete them. In this way, we are in a position to determine the forces that influence the creation of theseconvergence clubs by investigating the potentially explanatory variables previously collected in the literature.This represents a radical change with respect to the type of data used mostly in the field of health economics, in which the use of time series data is strangely scarce.Against this, this thesis provides a different approach in the evaluation of health, from the perspective of time series and analysis of convergence, using macroeconomic data at national and international level, and through the application of novel econometric techniques not used until now in this type of studies.Against this framework, this thesis tries to answer the following questions: Chapter 1: The recent evolution of the HIV / AIDS rates in Sub-Saharan Africa: Do differences still persist?- Have the MDGs / SDGs been met in terms of prevalence of HIV / AIDS in sub-Saharan Africa?- Are the differences in the evolution of HIV / AIDS maintained between sub-Saharan countries?- If the differences with regard to the expansion of HIV / AIDS in the countries of the African continent remain, what are the forces that lead to this result?- Are the explanatory variables collected in the literature as determinants of HIV / AIDS relevant in our analysis? Chapter 2: Do international child mortality rates converge?- Are the MDGs / SDGs met homogeneously in terms of reducing child mortality?- Which countries have problems to achieve the MDGs / SDGs with respect to the objective established for the IMR?- What are the socioeconomic determinants that limit a country in the attempt to reduce its IMR? Chapter 3: Convergence in infant mortality rates: The Spanish case - Does convergence in the IMR exist between Spanish regions?- Has the great economic recession influenced the regional differences of IMR in Spain?- What have been the determining factors in the evolution of the IMR in Spain?With the purpose of answer these questions, the Thesis compiles three scientific articles structured into chapters, which can be considered independently, although they are related to each other, prioritizing in this way the publication format.Each of the chapters consists of two clearly differentiated parts. The first one is the convergence analysis, which includes the possibility of finding convergence clubs in the case of rejecting full convergence. The second one corresponds to the study of the explanatory factors that have led to the formation of these clubs in the case of having them.The first chapter analyses the prevalence and incidence rates of HIV / AIDS in the countries of sub-Saharan Africa. Although the HIV epidemic is a global issue, the sub- Saharan region is the most affected region, with 25.6 million people living with HIV in 2016 and concentrating almost two-thirds of new infections. Countries in this region also face resource scarcity and depend on foreign aid to fight against HIV/AIDS. Accordingly, we find sufficient reason to geographically concentrate our research in the African continent.In this chapter, after a preliminary study of the recent evolution of HIV prevalence and incidence rates, we proceed to test the null hypothesis of convergence for the entire sample, with the aim of verifying the existence of a unique pattern of behavior in the evolution of the analyzed rates. If we can reject the convergence hypothesis, andtherefore the MDGs / SDGs have not been reached in the sub-Saharan region, we try to determine the presence of groups of countries with similar profiles trends in prevalence or incidence rates, or “convergence clubs”. Once the presence of these clubs is determined, we analyze their characteristics and explain the factors that make these different behaviors coexist.The second chapter studies the reduction of international infant mortality rates (IMRs), which coincides with the fourth objective of the MDGs / SDGs. The IMR is considered one of the best global indicators to assess the welfare and health of a society, and this is the reason why this work has focused its attention on this MDG / SDGobjective. Despite the great achievements made in reducing the IMR around the world, we cannot forget that around 15,000 children died every day in 2016 before reaching their fifth birthday, and more than five million children continue to die each year nowadays.The procedure followed in this chapter is similar to the previous one. First, we evaluated the existence of a single pattern of behavior for the two samples used (Infant mortality rate of children under one year of age and infant mortality rate for children under five years of age). If we reject this hypothesis, we should analyze the existencedifferent groups of convergence between countries. In the second phase of the study, we proceed to determine the forces that lead to the creation of these clubs.To conclude, the third chapter of this Thesis explores the long-term evolution of infant mortality rates in the case of Spain. The justification in the choice of this essay comes from the need to compare the results obtained in the previous chapter, at the international level, in a context where different national health systems do not interferein the results.The application of the convergence analysis methodology, which acts as the backbone of this Thesis, allows us to exploit in greater depth the possible existence of stochastic convergence between the IMR of the Spanish regions. This offers us the opportunity to study the determinants that lead to obtaining the results in the previous analysis, as has been done in the preceding chapters.<br /