Do Markets Worsen Economic Inequalities? Kuznets in the Bush

Integration into a market economy or economic development can erode the quality of life of indigenous people by, for example, increasing income inequalities. The Kuznets hypothesis predicts that the link between income inequality and income (a proxy for economic development) resembles an inverted U. We test the hypothesis using a survey of 511 households from 59 villages of Tsimane' Amerindians, a horticultural-foraging society in the tropical rain forest of Bolivia. We measure village inequalities of three economic outcomes: income, imputed annual value of rice production, and wealth. We used three indices of inequality: the coefficient of variation, the standard deviation of the logarithm, and the Gini coefficient. Explanatory variables include either income and income squared, wealth and wealth squared, or imputed annual rice production and production squared. We used village-to-town distance as a control. We find little evidence that integration to the market increases inequalities of economic outcomes, with two exceptions: Wealth bore the predicted inverted U-shaped relation with wealth inequalities, and imputed rice production bore a U-shaped relation to inequality, but only when (a) using adult equivalents to express household size and (b) the Gini coefficient and the coefficient of variation to measure inequality; in no case were results robust to different econometric specifications. We advance several explanations for why economic development might not accentuate economic inequalities among relatively autarkic rural economies.     

Individual health and the visibility of village economic inequality: Longitudinal evidence from native Amazonians in Bolivia

Mounting evidence suggests that income inequality is associated with worse individual health. But does the visibility of inequality matter? Using data from a horticultural-foraging society of native Amazonians in Bolivia (Tsimane’), we examined whether village inequality in resources and behaviors with greater cultural visibility is more likely to bear a negative association with health than village inequality in less conspicuous resources. We draw on a nine-year annual panel (2002–2010) from 13 Tsimane’ villages for our main analysis, and an additional survey to gauge the cultural visibility of resources. We measured inequality using the Gini coefficient. We tested the robustness of our results using a shorter two-year annual panel (2008–2009) in another 40 Tsimane’ villages and an additional measure of inequality (coefficient of variation, CV). Behaviors with low cultural visibility (e.g., household farm area planted with staples) were less likely to be associated with individual health, compared to more conspicuous behaviors (e.g., expenditures in durable goods, consumption of domesticated animals). We find some evidence that property rights and access to resources matter, with inequality of privately-owned resources showing a larger effect on health. More inequality was associated with improved perceived health – maybe due to improved health prospects from increasing wealth – and worse anthropometric indicators. For example, a unit increase in the Gini coefficient of expenditures in durable goods was associated with 0.24 fewer episodes of stress and a six percentage-point lower probability of reporting illness. A one-point increase in the CV of village inequality in meat consumption was associated with a 4 and 3 percentage-point lower probability of reporting illness and being in bed due to illness, and a 0.05 SD decrease in age-sex standardized arm-muscle area. In small-scale, rural societies at the periphery of market economies, nominal economic inequality in resources bore an association with individual health, but did not necessarily harm perceived health. Economic inequalities in small-scale societies apparently matter, but a thick cultural tapestry of reciprocity norms and kinship ties makes their effects less predictable than in industrial societies.     

Individual wealth rank, community wealth inequality, and self-reported adult poor health: a test of hypotheses with panel data (2002-2006) from native Amazonians, Bolivia

Growing evidence suggests that economic inequality in a community harms the health of a person. Using panel data from a small-scale, preindustrial rural society, we test whether individual wealth rank and village wealth inequality affects self-reported poor health in a foraging-farming native Amazonian society. A person's wealth rank was negatively but weakly associated with self-reported morbidity. Each step up/year in the village wealth hierarchy reduced total self-reported days ill by 0.4 percent. The Gini coefficient of village wealth inequality bore a positive association with self-reported poor health that was large in size, but not statistically significant. We found small village wealth inequality, and evidence that individual economic rank did not change. The modest effects may have to do with having used subjective rather than objective measures of health, having small village wealth inequality, and with the possibly true modest effect of a person's wealth rank on health in a small-scale, kin-based society. Finally, we also found that an increase in mean individual wealth by village was related to worse self-reported health. As the Tsimane' integrate into the market economy, their possibilities of wealth accumulation rise, which may affect their well-being. Our work contributes to recent efforts in biocultural anthropology to link the study of social inequalities, human biology, and human-environment interactions.     

Income inequality and depression: a systematic review and meta‐analysis of the association and a scoping review of mechanisms

Most countries have witnessed a dramatic increase of income inequality in the past three decades. This paper addresses the question of whether income inequality is associated with the population prevalence of depression and, if so, the potential mechanisms and pathways which may explain this association. Our systematic review included 26 studies, mostly from high‐income countries. Nearly two‐thirds of all studies and five out of six longitudinal studies reported a statistically significant positive relationship between income inequality and risk of depression; only one study reported a statistically significant negative relationship. Twelve studies were included in a meta‐analysis with dichotomized inequality groupings. The pooled risk ratio was 1.19 (95% CI: 1.07‐1.31), demonstrating greater risk of depression in populations with higher income inequality relative to populations with lower inequality. Multiple studies reported subgroup effects, including greater impacts of income inequality among women and low‐income populations. We propose an ecological framework, with mechanisms operating at the national level (the neo‐material hypothesis), neighbourhood level (the social capital and the social comparison hypotheses) and individual level (psychological stress and social defeat hypotheses) to explain this association. We conclude that policy makers should actively promote actions to reduce income inequality, such as progressive taxation policies and a basic universal income. Mental health professionals should champion such policies, as well as promote the delivery of interventions which target the pathways and proximal determinants, such as building life skills in adolescents and provision of psychological therapies and packages of care with demonstrated effectiveness for settings of poverty and high income inequality.     

The origins of monetary income inequality: Patience,human capital,and division of labor

We present an explanation about the origins of monetary income inequality when an economically self-sufficient society opens to a market economy. The chain of associations runs from patience, to the accumulation of different forms of human capital, to self-selection into different occupations, and to the division of labor, which contributes to monetary income inequality. In a self-sufficient society, patience is exogenously determined and people rely on folk knowledge as the only form of human capital. With the establishment of schools, patient and impatient people sort themselves out by the type of human capital they begin to accumulate. Impatient people do not acquire folk knowledge because return to schooling takes many years to bear fruit. Schooling opens opportunities in occupations outside the village, whereas folk knowledge enhances employment opportunities that draw on farming or foraging. Self-selection into different occupations with different earnings potential spawns monetary income inequality. To test the explanation, we draw on data from a foraging–farming society in the Bolivian Amazon, the Tsimane'. We collected data during four consecutive quarters in 1999–2000 and a follow-up interview (2004). Data came from 151 adults (age, 16 years or more) from all households (n=48) in two villages with different levels of market exposure. During 1999–2000, impatience was associated with (a) greater folk knowledge and fewer years of schooling, (b) lower likelihood of working in wage labor, and (c) greater likelihood of working in rural subsistence occupations. People who had been patient in 1999–2000 had greater wage earnings and more modern physical assets in 2004.     

Modeling the Origin and Possible Control of the Wealth Inequality Surge

The rapid increase of wealth inequality in the past few decades is a most disturbing social and economic issue of our time. In order to control, and even reverse that surge, its origin and underlying mechanisms should be revealed. One of the challenges in studying these mechanisms is to incorporate realistic individual dynamics in the population level in a self-consistent manner. Our theoretical approach meets the challenge by using interacting multi-agent master-equations to model the dynamics of wealth inequality. The model is solved using stochastic multi-agent iterated maps. Taking into account growth rate, return on capital, private savings and economic mobility, we were able to capture the historical dynamics of wealth inequality in the United States during the course of the 20th century. We show that the fraction of capital income in the national income and the fraction of private savings are the critical factors that govern the wealth inequality dynamics. In addition, we found that economic mobility plays a crucial role in wealth accumulation. Notably, we found that the major decrease in private savings since the 1980s could be associated primarily with the recent surge in wealth inequality and if nothing changes in this respect we predict further increase in wealth inequality in the future. However, the 2007–08 financial crisis brought an opportunity to restrain the wealth inequality surge by increasing private savings. If this trend continues, it may lead to prevention, and even reversing, of the ongoing inequality surge.     

Physical stature of adult Tsimane’ Amerindians, Bolivian Amazon in the 20th century

We examine the association between exposure to the market and Western society on the height of adult Tsimane', a foraging-farming society in the Bolivian Amazon. As with other contemporary native peoples, we find little evidence of a significant secular change in height during 1920-1980. Female height bore a positive association with own schooling and fluency in spoken Spanish and with maternal modern human capital (schooling, writing ability, and fluency in spoken Spanish), but male heights bore no association with parental height or with modern human capital. The absence of a secular change likely reflects the persistence of traditional forms of social organization and production that protect health.     

Income Inequality,Socioeconomic Deprivation and Depressive Symptoms among Older Adults in Mexico

Objective

Depression is the second most common mental disorder in older adults (OA) worldwide. The ways in which depression is influenced by the social determinants of health – specifically, by socioeconomic deprivation, income inequality and social capital - have been analyzed with only partially conclusive results thus far. The objective of our study was to estimate the association of income inequality and socioeconomic deprivation at the locality, municipal and state levels with the prevalence of depressive symptoms among OA in Mexico.

Methods

Cross-sectional study based on a nationally representative sample of 8,874 OA aged 60 and over. We applied the brief seven-item version of the Center for Epidemiologic Studies Depression Scale (CES-D) to determine the presence of depressive symptoms. Additionally, to select the principal context variables, we used the Deprivation Index of the National Population Council of Mexico at the locality, municipal and state levels, and the Gini Index at the municipal and state levels. Finally, we estimated the association of income inequality and socioeconomic deprivation with the presence of depressive symptoms using a multilevel logistic regression model.

Results

Socioeconomic deprivation at the locality (OR = 1.28; p<0.10) and municipal levels (OR = 1.16; p<0.01) correlated significantly with the presence of depressive symptoms, while income inequality did not.

Conclusions

The results of our study confirm that the social determinants of health are relevant to the mental health of OA. Further research is required, however, to identify which are the specific socioeconomic deprivation components at the locality and municipal levels that correlate with depression in this population group.     

Adoption of Modern Agricultural Technologies by Lowland Indigenous Groups in Bolivia: The Role of Households, Villages, Ethnicity, and Markets

A survey of 102 Mojeno and 62 Yuracare Amerindian households in the department of Beni in the Bolivian rain forest was done to measure the effects of household and village attributes, ethnicity, and markets on the adoption of chemical herbicides and insecticides for farming. We hypothesized: i) that village attributes would matter more among households with weak links to the market, ii) that education and income would matter more in households integrated to the market, and iii) that ethnic membership would not matter because, as a null hypothesis, we assume all cultures are equally adept at processing information about technological innovations. The results of a probit model with Huber robust standard errors did not confirm any of the hypotheses. Village variables were statistically significant at all levels of integration to the market. Contrary to human capital theory, income and education played a more prominent role in relatively autarkic villages. Ethnicity was statistically significant in the pooled sample and at different levels of integration. Results suggest that conventional determinants of adoption of new farm technologies may need reappraisal in more autarkic settings.     

Inequality in income and mortality in the United States: analysis of mortality and potential pathways.

OBJECTIVE--To examine the relation between health outcomes and the equality with which income is distributed in the United States. DESIGN--The degree of income inequality, defined as the percentage of total household income received by the less well off 50% of households, and changes in income inequality were calculated for the 50 states in 1980 and 1990. These measures were then examined in relation to all cause mortality adjusted for age for each state, age specific deaths, changes in mortalities, and other health outcomes and potential pathways for 1980, 1990, and 1989-91. MAIN OUTCOME MEASURE--Age adjusted mortality from all causes. RESULTS--There was a significant correlation (r = -0.62 [corrected], P < 0.001) between the percentage of total household income received by the less well off 50% in each state and all cause mortality, unaffected by adjustment for state median incomes. Income inequality was also significantly associated with age specific mortalities and rates of low birth weight, homicide, violent crime, work disability, expenditures on medical care and police protection, smoking, and sedentary activity. Rates of unemployment, imprisonment, recipients of income assistance and food stamps, lack of medical insurance, and educational outcomes were also worse as income inequality increased. Income inequality was also associated with mortality trends, and there was a suggestion of an impact of inequality trends on mortality trends. CONCLUSION--Variations between states in the inequality of the distribution of income are significantly associated with variations between states in a large number of health outcomes and social indicators and with mortality trends. These differences parallel relative investments in human and social capital. Economic policies that influence income and wealth inequality may have an important impact on the health of countries.     

Association of Neighbourhood and Individual Social Capital,Neighbourhood Economic Deprivation and Self-Rated Health in South Africa – a Multi-Level Analysis

Introduction

Social capital is said to influence health, mostly in research undertaken in high income countries'' settings. Because social capital may differ from one setting to another, it is suggested that its measurement be context specific. We examine the association of individual and neighbourhood level social capital, and neighbourhood deprivation to self-rated health using a multi-level analysis.

Methods

Data are taken from the 2008 South Africa National Income Dynamic Survey. Health was self-reported on a scale from 1 (excellent) to 5 (poor). Two measures of social capital were used: individual, measured by two variables denoting trust and civic participation; and neighbourhood social capital, denoting support, association, behaviour and safety in a community.

Results

Compared to males, females were less likely to report good health (Odds Ratio 0.82: Confidence Interval 0.73, 0.91). There were variations in association of individual social capital and self-rated health among the provinces. In Western Cape (1.37: 0.98, 1.91) and North West (1.39: 1.13, 1.71), trust was positively associated with reporting good health, while the reverse was true in Limpopo (0.56: 0.38, 0.84) and Free State (0.70: 0.48, 1.02). In Western Cape (0.60: 0.44, 0.82) and Mpumalanga (0.72: 0.55, 0.94), neighbourhood social capital was negatively associated with reporting good health. In North West (1.59: 1.27, 1.99) and Gauteng (1.90: 1.21, 2.97), increased neighbourhood social capital was positively associated with reporting good health.

Conclusion

Our study demonstrated the importance of considering contextual factors when analysing the relationship between social capital and health. Analysis by province showed variations in the way in which social capital affected health in different contexts. Further studies should be undertaken to understand the mechanisms through which social capital impacts on health in South Africa.     

Impact of Income Inequality and Other Social Determinants on Suicide Rate in Brazil

Studies about suicide worldwide have mainly focused on individual-level psychiatric risk factors. In Brazil, suicide is an important public health problem. Brazil has evidenced important socioeconomic changes over the last decades, leading to decreasing income inequality. However, the impact of income inequality on suicide rate has never been studied in the country.

Purpose

To analyze whether income inequality and other social determinants are associated with suicide rate in Brazil.

Method

This study used panel data from all 5,507 Brazilian municipalities from 2000 to 2011. Suicide rates were calculated by sex and standardized by age for each municipality and year. The independent variables of the regression model included the Gini Index, per capita income, percentage of individuals with up to eight years of education, urbanization, average number of residents per household, percentage of divorced people, of Catholics, Pentecostals, and Evangelicals. A multivariable negative binomial regression for panel data with fixed-effects specification was performed.

Results

The Gini index was positively associated with suicide rates; the rate ratio (RR) was 1.055 (95% CI: 1.011–1.101). Of the other social determinants, income had a significant negative association with suicide rates (RR: 0.968, 95% CI: 0.948–0.988), whereas a low-level education had a positive association (RR: 1.015, 95% CI: 1.010–1.021).

Conclusions

Income inequality represents a community-level risk factor for suicide rates in Brazil. The decrease in income inequality, increase in income per capita, and decrease in the percentage of individuals who did not complete basic studies may have counteracted the increase in suicides in the last decade. Other changes, such as the decrease in the mean residents per household, may have contributed to their increase. Therefore, the implementation of social policies that may improve the population’s socioeconomic conditions and reduce income inequality in Brazil, and in other low and middle-income countries, can help to reduce suicide rates.     

Gender Differences in Material,Psychological, and Social Domains of the Income Gradient in Mortality: Implications for Policy

We set out to examine the material, psychological, and sociological pathways mediating the income gradient in health and mortality. We used the 2008 General Social Survey-National Death Index dataset (N = 26,870), which contains three decades of social survey data in the US linked to thirty years of mortality follow-up. We grouped a large number of variables into 3 domains: material, psychological, and sociological using factor analysis. We then employed discrete-time hazard models to examine the extent to which these three domains mediated the income-mortality association among men and women. Overall, the gradient was weaker for females than for males. While psychological and material factors explained mortality hazards among females, hazards among males were explained only by social capital. Poor health significantly predicted both income and mortality, particularly among females, suggesting a strong role for reverse causation. We also find that many traditional associations between income and mortality are absent in this dataset, such as perceived social status.     

Focus: Health Equity: Predictors of Depressive Symptoms Based on the Human Capital Model Approach: Findings From the Indonesia Family Life Survey

Depression is the leading factor of disability and the overall global burden of diseases. The human capital model provides an appropriate conceptual model for managing human health. This study aimed to determine the association between human capital (including social, emotional, physical, financial, and intellectual capital) and depressive symptoms among productive age groups in Indonesia. A cross-sectional study was conducted by analyzing data of 9,858 respondents aged 15-59 years that were obtained from the Indonesia Family Life Survey 5 (IFLS 5). Multivariate logistic regression was used to assess the association between human capital components and depressive symptoms. Among respondents, 23.65% had higher depressive symptoms. Social trust and social networks (part of social capital) were significantly related to depressive symptoms. Self-reported satisfaction (part of emotional capital) were also related to depressive symptoms, as well as self-rated health, sleep quality, a number of chronic disease, body mass index (BMI), and physical functioning (part of physical capital). Log income (part of financial capital) and education level (part of intellectual capital) were related to depressive symptoms after controlling for other variables. Of all the components of human capital, physical capital has the most attributes associated with the risk of depressive symptoms. Therefore, depression prevention programs can be prioritized on attributes related to physical capital.     

Well-being and social capital on planet Earth: cross-national evidence from 142 countries

High levels of social trust and social support are associated with life satisfaction around the world. However, it is not known whether this association extends to other indicators of social capital and of subjective well-being globally. We examine associations between three measures of social capital and three indicators of subjective well-being in 142 low-, middle- and high-income countries. Furthermore, we explore whether positive and negative feelings mirror each other or if they are separate constructs that behave differently in relation to social capital. Data comes from the Gallup World Poll, an international cross-sectional comparable survey conducted yearly from 2005 to 2009 for those 15 years of age and over. The poll represents 95% of the world's population. Social capital was measured with self-reports of access to support from relatives and friends, of volunteering to an organization in the past month, and of trusting others. Subjective well-being was measured with self-reports of life satisfaction, positive affect, and negative affect. We first estimate random coefficient (multi-level) models and then use multivariate (individual-level) Ordinary Least Square (OLS) regression to model subjective well-being as a function of social support, volunteering and social trust, controlling for age, gender, education, marital status, household income and religiosity. We found that having somebody to count on in case of need and reporting high levels of social trust are associated with better life evaluations and more positive feelings and an absence of negative feelings in most countries around the world. Associations, however, are stronger for high- and middle-income countries. Volunteering is also associated with better life evaluations and a higher frequency of positive emotions. There is not an association, however, between volunteering and experiencing negative feelings, except for low-income countries. Finally, we present evidence that the two affective components of subjective well-being behave differently in relation to different indicators of social capital and social support across countries.     

Relations of income inequality and family income to chronic medical conditions and mental health disorders: national survey

ObjectivesTo analyse the relation between geographical inequalities in income and the prevalence of common chronic medical conditions and mental health disorders, and to compare it with the relation between family income and these health problems.Design Nationally representative household telephone survey conducted in 1997-8.Setting 60 metropolitan areas or economic areas of the United States.Participants 9585 adults who participated in the community tracking study.Results A strong continuous association was seen between health and education or family income. No relation was found between income inequality and the prevalence of chronic medical problems or depressive disorders and anxiety disorders, either across the whole population or among poorer people. Only self reported overall health, the measure used in previous studies, was significantly correlated with inequality at the population level, but this correlation disappeared after adjustment for individual characteristics.Conclusions This study provides no evidence for the hypothesis that income inequality is a major risk factor for common disorders of physical or mental health.

What is already known on this topic

Several studies have found a relation between income inequality and self reported health or mortality

What this study adds

There is a strong social gradient in health, as measured by the prevalence of chronic medical conditions and specific mental health disorders, by income or educationNo such association is seen between income inequality and health     

Collective Action and Social Capital of Wildlife Management Associations

Abstract: In areas with dense landownership patterns, management of white-tailed deer (Odocoileus virginianus) depends upon collective decision making of landowners and hunters. To resolve conflicts associated with this commons dilemma, wildlife management associations (WMAs) have become a popular mechanism for coordinating wildlife management decisions in private land states, especially in Texas, USA. Social capital, represented by metrics such as trust, reciprocity, and community involvement, has been identified as an important determinant of the success of collaborative institutional arrangements. To determine the influence of social capital on the effectiveness of WMAs, we address 2 research questions: 1) do WMAs exhibit elements of social capital, and 2) what landowner characteristics affect elements of social capital within WMAs? We used a mail survey questionnaire to determine the effect of various factors on the activities and management practices in 4 WMAs in 2 regions in Texas: the Lower Post Oak Savannah (LPOS) and the Central Post Oak Savannah (CPOS). The LPOS landowners were members of larger associations, had generally acquired their land more recently, held more frequent meetings, and tended to have longer association membership than CPOS landowners, yet they exhibited lower social capital. The CPOS landowners owned significantly larger properties, and were predominantly absentee wealthy males that considered relaxation and hunting more important land uses than property ownership for a place to live. The smaller group size of the CPOS associations may be the most important factor in building and maintaining social capital. Intra-association trust, a primary measure of social capital, was positively influenced by the longevity of property ownership, the number of association meetings, the percentage of males in the association, and other factors. Conversely, negative influences on trust included absentee ownership and the proportion of woodland habitat present in each WMA. We suggest that deer are a common-pool resource whose populations are dependent upon collective action by stakeholders. Social capital building within landowner associations could facilitate the sustainable harvest of quality deer and possibly lead to cooperative management of other common-pool natural resources.     

Ecological footprint and real income: Panel data evidence from the 27 highest emitting countries

This study examines the effects of real income, financial development and trade openness on the ecological footprint (EF) of consumption using a panel data of leading world EF contributors during the period 1991–2012. A number of panel unit root tests confirm that the data are first-difference stationary. Results from Pedroni co-integration tests show that the variables are co-integrated. The panel dynamic ordinary least squares (DOLS) method is then employed to estimate the long run association between the variables. The results indicate a positive and significant association between ecological footprint (EF) and real income, and a negative and insignificant impact of trade openness on EF. Financial development is also observed to reduce EF. Afterwards, the group-mean fully modified ordinary least squares method is applied to check the robustness of the DOLS estimates. The findings are partially robust as only real income confirms the positive significant impact on EF. In addition, the vector error correction model supports a unidirectional causal impact running from real income to EF. Finally, findings from variance decomposition analysis and impulse response functions reveal that real income will have an increasing effect on EF for the selected countries into the future.     

The Association between Oxytocin and Social Capital

Background

Oxytocin is known to be related to social behaviors, including trust. However, few studies have investigated the association between oxytocin levels and social capital. Thus, we tested the hypothesis that endogenous oxytocin levels are positively associated with social capital. We also considered whether the association differed across gender because previous studies have shown differential effects of OT on social behaviors depending on gender.

Methods

We recruited a convenience sample of 50 women and 31 men in Japan via community sampling from whom we obtained urine sample with which to measure oxytocin levels. Individual-level cognitive social capital (social trust and mutual aid) and structural social capital (community participation) were assessed using a questionnaire. We used multivariate regression, adjusted for covariates (age, number of children, self-rated health, and education), and stratified by gender to consider associations between oxytocin and social capital.

Results

Among women, oxytocin was inversely associated with social trust and mutual aid (p<0.05). However, women participating in only 1 organization in the community showed higher oxytocin than women who participated in either no organizations (p<0.05) or 2 or more organization (i.e. inverse-U shape association). Among men, no association was observed between oxytocin and either form of cognitive and structural social capital.

Conclusion

Women who perceived low cognitive social capital showed higher oxytocin levels, while structural social capital showed inverse-U shape association with oxytocin. No association between oxytocin and social capital was found among men. Further study is needed to elucidate why oxytocin was inversely associated with cognitive social capital only among women.     

Assessment of the Association of Health with the Liberalisation of Trade in Services under the World Trade Organisation

Background

The liberalisation of trade in services which began in 1995 under the General Agreement on Trade in Services (GATS) of the World Trade Organisation (WTO) has generated arguments for and against its potential health effects. Our goal was to explore the relationship between the liberalisation of services under the GATS and three health indicators - life expectancy (LE), under-5 mortality (U5M) and maternal mortality (MM) - since the WTO was established.

Methods and Findings

This was a cross-sectional ecological study that explored the association in 2010 and 1995 between liberalisation and health (LE, U5M and MM), and between liberalisation and progress in health in the period 1995–2010, considering variables related to economic and social policies such as per capita income (GDP pc), public expenditure on health (PEH), and income inequality (Gini index). The units of observation and analysis were WTO member countries with data available for 2010 (n = 116), 1995 (n = 114) and 1995–2010 (n = 114). We conducted bivariate and multivariate linear regression analyses adjusted for GDP pc, Gini and PEH. Increased global liberalisation in services under the WTO was associated with better health in 2010 (U5M: −0.358 p<0.001; MM: −0.338 p = 0.001; LE: 0.247 p = 0.008) and in 1995, after adjusting for economic and social policy variables. For the period 1995–2010, progress in health was associated with income equality, PEH and per capita income. No association was found with global liberalisation in services.

Conclusions

The favourable association in 2010 between health and liberalisation in services under the WTO seems to reflect a pre-WTO association observed in the 1995 data. However, this liberalisation did not appear as a factor associated with progress in health during 1995–2010. Income equality, health expenditure and per capita income were more powerful determinants of the health of populations.