Civil service organization as a political determinant of health: Analyzing relationships between merit-based hiring, corruption, and population health.

A growing literature finds that the way governments are organized can impact the societies they serve in important ways. The same is apparent with respect to civil service organizations. Numerous studies show that the recruitment of civil servants based on their credentials rather than on nepotism or patronage reduces corruption in government. Political corruption in turn appears to harm population health. Up to this time, however, civil service organization is not a recognized determinant of health and is little discussed outside of political science disciplines. To provoke a broader conversation on this subject, the following study proposes that meritocratic recruitment of civil servants improves population health. To test this proposition, a series of regression models examines comparative data for 118 countries. Consistent with study hypotheses, meritocratic recruitment of civil servants corresponds longitudinally with both lower rates of corruption and lower rates of infant mortality. Results are similar after robustness checks. Findings with regard to life expectancy are more mixed. However, additional tests suggest meritocratic recruitment contributes to life expectancy over a longer span of time. Findings also offer more support for a direct pathway from meritocratic recruitment to population health rather than via changes in corruption levels per se, although this may depend on a country's level of economic development. Overall, this study offers first evidence that civil service organization, particularly the recruitment of civil servants based on the merits of their applications rather than on whom they happen to know in government, is a positive determinant of health. More research in this area is needed.

Is Economic Growth Good for Population Health? A Critical Review.

A large multidisciplinary literature discusses the relationship between economic growth and population health. The idea that economic growth is good for societies has inspired extensive academic debate, but conclusions have been mixed. To help shed light on the subject, this paper focuses on opportunities for consensus in this large literature. Much scholarship finds that the health-growth relationship varies according to (1) which aspect of "health" is under consideration, (2) shape (e.g., positive linear or logarithmic), (3) issues of timing (e.g., growth over the short or long term), (4) a focus on health inequalities as opposed to population averages, and (5) multivariable relationships with additional factors. After reflecting upon these findings, I propose that economic growth promotes health in some respects, for some countries, and in conjunction with other life-supporting priorities, but does not by itself improve population health generally speaking. I then argue there is already wide, interdisciplinary consensus to support this stance. Moreover, policies focusing exclusively on economic growth threaten harm to both population health and growth, which is to say that political dynamics are also implicated. Yet multivariable approaches can help clarify the bigger picture of how growth relates to health. For moving this literature forward, the best opportunities may involve the simultaneous analysis of multiple factors. The recognition of consensus around these issues would be welcome, and timely. Supplementary Information: The online version contains supplementary material available at 10.1007/s42650-023-00072-y.

De nombreux travaux multidisciplinaires s'intéressent aux liens qui existent entre la croissance économique et la santé de la population. L'idée que la croissance économique est bénéfique pour les sociétés suscite de longs débats universitaires aux conclusions parfois mitigées. Afin de mieux comprendre ce sujet, cet article vise à dégager des possibilités de consensus au sein de cette littérature abondante. La plupart des études montrent que le rapport entre la santé et la croissance économique varie en fonction : 1) de l'aspect de la santé étudié; 2) de la forme (linéaire positive ou logarithmique par ex.); 3) de la temporalité (croissance à court ou à long terme par ex.); 4) de l'accent mis sur les inégalités en matière de santé plutôt que sur les moyennes de population; et 5) des relations à variables multiples avec facteurs additionnels. Après avoir considéré ces différentes conclusions, il est possible d'affirmer qu'à certains égards, la croissance économique a un effet bénéfique sur la santé, pour certains pays et en parallèle avec d'autres priorités vitales, mais qu'en elle-même, elle n'améliore globalement pas la santé de la population. L'article montre ensuite qu'il existe déjà un large consensus interdisciplinaire appuyant ce point de vue. En outre, les politiques axées exclusivement sur la croissance économique risquent de nuire non seulement à la santé de la population, mais également à la croissance économique elle-même, ce qui signifie que des dynamiques politiques sont également à l'œuvre. Toutefois, des approches à variables multiples peuvent contribuer à expliquer de façon plus large la façon dont la croissance économique exerce un rôle sur la santé. Pour faire évoluer cette littérature, il pourrait être judicieux de procéder à une analyse simultanée des différents facteurs. La reconnaissance d'un consensus sur ces questions seront également profitable et opportune.

Exploring an anomaly: the synthesis of 7,7'-diazaindirubin through a 7-azaindoxyl intermediate.

Two independent methods generating 7-azaindoxyl as an intermediate verify that 7,7'-diazaindirubin is formed exclusively over 7,7'-diazaindigo. This contrasts with long-standing knowledge related to the reactivity of indoxyl, which proceeds via a radical-initiated homodimerization process, leading to indigo. A series of experiments confirms 7-azaindoxyl as an intermediate with results suggesting a condensation pathway followed by oxidation.

Not all built the same? A comparative study of electoral systems and population health.

Much literature depicts a worldwide democratic advantage in population health. However, less research compares health outcomes in the different kinds of democracy or autocracy. In an examination of 179 countries as they existed between 1975 and 2012, advantages in life expectancy and infant health appear most reliably for democracies that include the principle of proportional representation in their electoral rules. Compared to closed autocracies, they had up to 12 or more years of life expectancy on average, 75% less infant mortality, and double the savings in overall mortality for most other age groups. Majoritarian democracies, in contrast, did not experience longitudinal improvements in health relative to closed autocracies. Instead their population health appeared to be on par with or even superseded by competitive autocracies in most models. Findings suggest that the principle of proportional representation may be good for health at the national level. Implications and limitations are discussed.

Black-White health inequalities in Canada at the intersection of gender and immigration.

OBJECTIVES: Intersectionality theory proposes that each combination of social categories derived from gender, race and nationality, such as immigrant White man or native-born Black woman, is associated with unique social experiences. We tested the potential of intersectionality theory for explicating racial inequalities in Canada by investigating whether Black-White health inequalities are conditioned by gender and immigrant status in a synergistic way. METHODS: Our dataset comprised 10 cycles (2001-2013) of the Canadian Community Health Survey. We used binary logistic regression to model Black- White inequalities in hypertension, diabetes, self-rated health, self-rated mental health and asthma separately for native-born women, native-born men, immigrant women and immigrant men. RESULTS: After controlling for potentially confounding factors we found that immigrant Black women had significantly higher odds of hypertension, diabetes and fair/poor self-rated health than immigrant White women. Native-born Black women and immigrant Black men had higher odds of hypertension and diabetes than native-born White women and immigrant White men respectively, and native-born White women were more likely than native-born Black women to report asthma. There were no statistically significant health differences between native-born Black and White men. Socio-economic status, smoking, physical activity and body mass index were implicated in some but not all of these racial health inequalities. None of the three-way interactions between racial identity, gender and immigration status was statistically significant. CONCLUSION: We found relatively high risks of ill health for Black Canadians in three of the four samples. Overall, however, we found little support for the intersectional hypothesis that Black-White health inequalities in Canada are conditioned by gender and immigrant status in a synergistic way.

Politics and population health: Testing the impact of electoral democracy.

This study addresses questions of whether and why electoral democracies have better health than other nations. After devising a replicable approach to missing data, we compare political, economic, and health-related data for 168 nations collected annually from 1960 through 2010. Regression models estimate that electoral democracies have 11 years of longer life expectancy on average and 62.5% lower rates of infant mortality. The association with life expectancy reduces markedly after controlling for GDP, while a combination of factors may explain the democratic advantage in infant health. Results suggest that income inequality associates independently with both health outcomes but does not mediate their associations with democracy.

South Asian-White health inequalities in Canada: intersections with gender and immigrant status.

OBJECTIVES: We apply intersectionality theory to health inequalities in Canada by investigating whether South Asian-White health inequalities are conditioned by gender and immigrant status in a synergistic way. DESIGN: Our dataset comprised 10 cycles (2001-2013) of the Canadian Community Health Survey. Using binary logistic regression modeling, we examined South Asian-White inequalities in self-rated health, diabetes, hypertension and asthma before and after controlling for potentially explanatory factors. Models were calculated separately in subsamples of native-born women, native-born men, immigrant women and immigrant men. RESULTS: South Asian immigrants had higher odds of fair/poor self-rated health, diabetes and hypertension than White immigrants. Native-born South Asian men had higher odds of fair/poor self-rated health than native-born White men and native-born South Asian women had lower odds of hypertension than native-born White women. Education, household income, smoking, physical activity and body mass index did little to explain these associations. The three-way interaction between racial identity, gender and immigrant status approached statistical significance for hypertension but not for self-rated health and asthma. CONCLUSION: Our findings provide modest support for the intersectionally inspired principle that combinations of identities derived from race, gender and nationality constitute sui generis categories in the manifestation of health outcomes.

Does the mortality risk of social isolation depend upon socioeconomic factors?

This study considers whether socioeconomic status influences the impact of social isolation on mortality risk. Using data from the Alameda County Study, Cox proportional hazard models indicate that having a high income worsens the mortality risk of social isolation. Education may offset risk, however, and the specific pattern that emerges depends on which measures for socioeconomic status and social isolation are included. Additionally, lonely people who earn high incomes suffer especially high risk of accidents and suicides as well as cancer. Further research is needed that contextualizes the health risks of social isolation within the broader social environment.

Black-White Health Inequalities in Canada.

Little is known about Black-White health inequalities in Canada or the applicability of competing explanations for them. To address this gap, we used nine cycles of the Canadian Community Health Survey to analyze multiple health outcomes in a sample of 3,127 Black women, 309,720 White women, 2,529 Black men and 250,511 White men. Adjusting for age, marital status, urban/rural residence and immigrant status, Black women and men were more likely than their White counterparts to report diabetes and hypertension, Black women were less likely than White women to report cancer and fair/poor mental health and Black men were less likely than White men to report heart disease. These health inequalities persisted after controlling for education, household income, smoking, physical activity and body-mass index. We conclude that high rates of diabetes and hypertension among Black Canadians may stem from experiences of racism in everyday life, low rates of heart disease and cancer among Black Canadians may reflect survival bias and low rates of fair/poor mental health among Black Canadian women represent a mental health paradox similar to the one that exists for African Americans in the United States.

Capital relations and health: mediating and moderating effects of cultural, economic, and social capitals on mortality in Alameda County, California.

Inspired by Bourdieu's theories on various forms of capital, conversions among them, and the fields (social spaces) delineated by possession of them, the authors investigate distinct and interconnected effects of cultural, economic, and social capitals on risk of mortality. Using 35 years of longitudinal data from the Alameda County Study (n = 6,157), they created discrete-time hazard models to predict all-cause mortality from educational attainment (institutionalized cultural capital), household income (economic capital), and different forms of personal ties (social capital). The results show that education, income, having three or more close friends, regularity of church attendance, and participation in social/recreational groups were all negatively and significantly associated with risk of mortality. Income mediated a significant portion of the education effect. None of the personal ties variables mediated the effects of education or income. Relative composition of the sum total of education and income did not have an effect. Lastly, examination of statistical interactions between capitals determined that protective effects of church attendance and participation in community betterment groups applied only to non-wealthy people. These findings speak to the structure of the U.S. social space within which health-delimiting relationally defined social classes may be made manifest.

Loneliness and risk of mortality: a longitudinal investigation in Alameda County, California.

We investigated the prospective impact of self-reported loneliness on all-cause mortality, mortality from ischemic disease and mortality from other cardiovascular diseases. We tested these effects through GEE binomial regression models applied to longitudinal data from the Alameda County Study of persons aged 21 and over arranged into person-years. Controlling for age and gender, the chances of all-cause mortality were significantly higher among respondents reporting that they often feel lonely compared to those who report that they never feel lonely. Frequent loneliness was not significantly associated with mortality from ischemic heart disease but more than doubled the odds of mortality from other ailments of the circulatory system in models controlling for age and gender. Subsequent models showed that physical activity and depression may be important mediators of loneliness-mortality associations. Finally, we find support for the contention that chronic loneliness significantly increases risk of mortality but also find reason to believe that relatively recent changes in feelings of loneliness increase risk of mortality as well.