Cent Eur J Public Health 2019, 27(2):145-152 | DOI: 10.21101/cejph.a5226

Objective and subjective determinants of self-rated health in Central and Eastern Europe: a multilevel approach

Liubov V. Borisova
Department of Sociology, Uppsala Univerisity, Uppsala, Sweden

Objectives: Determinants of health in Central and Eastern Europe (CEE) have been discussed primarily in relation to the transition of the 1990's and early 2000's, citing lifestyles as the main culprit. This paper tries to draw a bigger picture of the health determinants in CEE in the first decade of the 21st century. To do so, the two main analytical approaches to health are united in one setting. One of them is based on the definition of health as a personal commodity relying mostly on micro-level subjective data. The other views health as a public commodity analysing objective societal characteristics and health care interventions with often a macro-level perspective. The current study incorporates these different approaches (subjective and objective) in a multi-level setting in CEE.

Methods: The analysis concentrates on health care, social, political, and economic factors as determinants of self-rated health. Multilevel analysis is carried out on a dataset of Life in Transition Survey (LiTS), conducted in 2006 and 2010, pooled cross-sectional data on 46,546 individuals in 27 CEE states. They are accompanied by macro-level data.

Results: The findings demonstrate that a complex mix of determinants influences subjective health in CEE. There are clear differences in the way objective and subjective indicators influence self-rated health. While societal economic prosperity does not influence health, there are strong country-specific differences in the effect of individual prosperity on health.

Conclusions: The study adds to the recent literature on health in CEE by introducing an encompassing systematic approach to analysing health, as no leading cause for self-rated health variation was found. This paper also contributes to research on the determinants of health by fusing objective and subjective determinants in a hierarchical setting. Both subjective and objective determinants matter for health.

Klíčová slova: Central and Eastern Europe, subjective health, determinants of health, Life in Transition survey, multilevel analysis

Vloženo: 11. říjen 2017; Revidováno: 28. květen 2019; Přijato: 28. květen 2019; Zveřejněno: 26. červen 2019  Zobrazit citaci

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Borisova LV. Objective and subjective determinants of self-rated health in Central and Eastern Europe: a multilevel approach. Cent Eur J Public Health. 2019;27(2):145-152. doi: 10.21101/cejph.a5226. PubMed PMID: 31241291.
Stáhnout citaci

Reference

  1. Bobak M, Pikhart H, Rose R, Hertzman C, Marmot M. Socioeconomic factors, material inequalities, and perceived control in self-rated health: cross-sectional data from seven post-communist countries. Soc Sci Med. 2000;51(9):1343-50. Přejít k původnímu zdroji... Přejít na PubMed...
  2. Brainerd E, Cutler DM. Autopsy on an empire: understanding mortality in Russia and the former Soviet Union. J Econ Perspect. 2005;19(1):107-30. Přejít k původnímu zdroji...
  3. Bobak M, Malyutina S, Horvat P, Pajak A, Tamosiunas A, Kubinova R, et al. Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe. Eur J Epidemiol. 2016 Jan;31(1):21-30. Přejít k původnímu zdroji... Přejít na PubMed...
  4. Berger MC, Messer J. Public financing of health expenditures, insurance, and health outcomes. Appl Econ. 2002;34(17):2105-13. Přejít k původnímu zdroji...
  5. WHO, Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health [Internet]. Geneva: WHO; 2008 [cited 2019 May 28]. Available from: http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf.
  6. Inglehart R, Foa R, Peterson C, Welzel C. Development, freedom, and rising happiness: a global perspective (1981-2007). Perspect Psychol Sci. 2008;3(4):264-85. Přejít k původnímu zdroji... Přejít na PubMed...
  7. Szreter S. The Population health approach in historical perspective. Am J Public Health. 2003 Mar;93(3):421-31. Přejít k původnímu zdroji... Přejít na PubMed...
  8. Eikemo TA, Bambra C, Judge K, Ringdal K. Welfare state regimes and differences in self-perceived health in Europe: a multilevel analysis. Soc Sci Med. 2008;66(11):2281-95. Přejít k původnímu zdroji... Přejít na PubMed...
  9. Diez-Roux AV. Multilevel analysis in public health research. Annu Rev Public Health. 2000;21:171-92. Přejít k původnímu zdroji... Přejít na PubMed...
  10. Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Copenhagen: WHO Regional Office for Europe; 1991.
  11. Cummins RA. Objective and subjective quality of life: an interactive model. Soc Indic Res. 2000;52(1):55-72. Přejít k původnímu zdroji...
  12. Ostrove JM, Adler NE, Kuppermann M, Washington AE. Objective and subjective assessments of socioeconomic status and their relationship to self-rated health in an ethnically diverse sample of pregnant women. Health Psychol. 2000;19(6):613-8. Přejít k původnímu zdroji...
  13. Subramanian SV, Belli P, Kawachi I. The macroeconomic determinants of health. Annu Rev Public Health. 2002;23:287-302. Přejít k původnímu zdroji... Přejít na PubMed...
  14. Dolan CV. Factor analysis of variables with 2, 3, 5 and 7 response categories: A comparison of categorical variable estimators using simulated data. Br J Math Stat Psychol. 1994;47(2):309-26. Přejít k původnímu zdroji...
  15. Starfield B. Basic concepts in population health and health care. J Epidemiol Community Health. 2001;55(7):452-4. Přejít k původnímu zdroji... Přejít na PubMed...
  16. Braveman P, Barclay C. Health disparities beginning in childhood: a life-course perspective. Pediatrics. 2009 Nov;124 Suppl 3:S163-75. Přejít k původnímu zdroji... Přejít na PubMed...
  17. Hill TD, Needham BL. Gender-specific trends in educational attainment and self-rated health, 1972-2002. Am J Public Health. 2006;96(7):1288-92. Přejít k původnímu zdroji... Přejít na PubMed...
  18. Sala-i-Martin X. On the health-poverty trap. In: López-Casasnovas G, Rivera B, Currais L, editors. Health and economic growth: findings and policy implications. Cambridge (MA): MIT Press; 2005. p. 95-114. Přejít k původnímu zdroji...
  19. Deaton A. Global patterns of income and health: facts, interpretations, and policies [Internet]. Cambridge (MA): National Bureau of Economic Research; 2006 [cited 2019 May 28]. Available from: http://www.nber.org/papers/w12735. Přejít k původnímu zdroji...
  20. Ledeneva A. Corruption in postcommunist societies in Europe: a re-examination. Perspect Eur Polit Soc. 2009;10(1):69-86. Přejít k původnímu zdroji...
  21. Kawachi I, Subramanian SV, Kim D. Social capital and health. New York: Springer; 2008. Přejít k původnímu zdroji...
  22. Adams J, White M. Evidence concerning social capital and health inequalities is still lacking. J Public Health Med. 2003;25(2):184-5. Přejít k původnímu zdroji... Přejít na PubMed...
  23. Putnam RD. Bowling alone: America's declining social capital. J Democr. 1995;6(1):65-78. Přejít k původnímu zdroji...
  24. Wilkinson RG. Unhealthy societies: the afflictions of inequality. London: Routledge; 1996.
  25. Kim D, Subramanian SV, Kawachi I. Social capital and physical health: a systematic review of the literature. In: Kawachi I, Subramanian SV, Kim D, editors. Social capital and health. New York: Springer; 2008. p. 139-90. Přejít k původnímu zdroji...
  26. Poortinga W. Social capital: An individual or collective resource for health? Soc Sci Med. 2006;62(2):292-302. Přejít k původnímu zdroji... Přejít na PubMed...
  27. Lantz PM, Pritchard A. Socioeconomic indicators that matter for population health. Prev Chronic Dis [Internet]. 2010 Jul [cited 2019 May 28];7(4):A74. Available from: https://www.cdc.gov/pcd/issues/2010/jul/pdf/09_0246.pdf Přejít na PubMed...
  28. Jen MH, Jones K, Johnston R. Global variations in health: Evaluating Wilkinson's income inequality hypothesis using the World Values Survey. Soc Sci Med. 2009;68(4):643-53. Přejít k původnímu zdroji... Přejít na PubMed...
  29. Filipkowski KB, Smyth JM, Rutchick AM, Santuzzi AM, Adya M, Petrie KJ, et al. Do healthy people worry? Modern health worries, subjective health complaints, perceived health, and health care utilization. Int J Behav Med. 2010 Sep;17(3):182-8. Přejít k původnímu zdroji... Přejít na PubMed...
  30. Borisova LV. Health care systems as determinants of health outcomes in transition countries: Developing classification. Soc Theory Health. 2011;9(4):326-54. Přejít k původnímu zdroji...
  31. Miething A. The Relevance of objective and subjective social position for self-rated health: a combined approach for the Swedish context. Soc Indic Res. 2013;111(1):161-73. Přejít k původnímu zdroji...
  32. Raudenbush SW, Bryk AS. Hierarchical linear models: applications and data analysis methods. Thousand Oaks: Sage Publications; 2002.