Quality & Quantity

, Volume 49, Issue 3, pp 1121–1134 | Cite as

The relationship between economic and health indicators in Rural Pakistan



Drawing on a unique survey data for rural Pakistan, we investigate the relationship between economic and health indicators. The data elicits information on health in terms of number of doctor visits per household and uses income as indicator of their material welfare. We estimate the Poisson regression model for count data (i.e. number of doctor visits per household) which allows us to evaluate the impact of the material standards in different parts of the distribution. The overall effect is higher income reduces the number of doctor visits, because of higher standards of living and a better access to the private as well as efficient health care services.


Health assessment Health inequality Health care services Socio-economic indicators Rural Pakistan 



I would like to thank Luis Angeles, Sai Ding, Richard Harris, Alexander Kadow, Philippe LeMay-Boucher and seminar participants at the University of Glasgow for helpful comments. I am very grateful to the sample households for their patience and cooperation in data collection. The financial support of the Higher Education Commission (HEC) of Pakistan is acknowledged. All remaining errors are my own.


  1. Blalock, H.M.: Contextual-effects models: theoretical and methodological issues. Department of Sociology, University of Washington, Seattle, Washington 98195 (1984)Google Scholar
  2. Bommier, A., Stecklov, G.: Defining health inequality: why Rawls succeeds where social welfare theory fails. J. Health Econ. 21, 497–513 (2002)CrossRefGoogle Scholar
  3. CIA: The World Factbook (2008)Google Scholar
  4. Cohen, S., David, T., Andrew, S.: Psychological stress and susceptibility to the common cold. N. Engl. J. Med. 325(9), 606–612 (1991)CrossRefGoogle Scholar
  5. Cohen, S., Scott, L., Stephen, M., Bruce, R., Eugene, H., Jay, K.: Chronic social stress, social status and susceptibility to upper respiratory infections in nonhuman primates. Psychosom. Med. 59(3), 213–221 (1997)CrossRefGoogle Scholar
  6. Daly, M., Duncan, G., Kaplan, G., Lynch, J.: Macro-to-micro links in the relation between income inequality and mortality. Milbank Q. 76(3), 315–339 (1998)CrossRefGoogle Scholar
  7. Deaton, A.: Health inequality and economic development. J. Econ. Lit. 41, 113–158 (2003)CrossRefGoogle Scholar
  8. Doornbos, G., Kromhout, D.: Education level and mortality in a 32-year follow-up study of 18-year-old men in the netherlands. Int. J. Epidemiol. 19, 374–379 (1990)CrossRefGoogle Scholar
  9. Doorslaer, E.V., Koolman, X.: Income-related inequalities in health in Europe: evidence from the European Community Household Panel., Ecuity II Project, Working Paper 1, Erasmus University, Rotterdam (2000)Google Scholar
  10. Doorslaer, E.V., Wagstaff, A., Bleichrodt, H.: Income-related inequalities in health: some international comparisons. J. Health Econ. 16, 93–112 (1997)CrossRefGoogle Scholar
  11. Ferrer-i-Carbonell, A.: Income and well-being: an empirical analysis of the comparison income effect. J. Public Econ. 89, 997–1019 (2005)CrossRefGoogle Scholar
  12. Fiscella, K., Franks, P.: Poverty or income inequality as predictor of mortality: longitudinal cohort study. Br. Med. J. 314(7096), 1724–1727 (1997)CrossRefGoogle Scholar
  13. Fox, A., Goldblatt, P., Jones, D.: Social class mortality differentials: artifact, selection or life circumstances? J. Epidemiol. Community Health 39, 1–8 (1985)CrossRefGoogle Scholar
  14. Gerdtham, U.-G., Johanneson, M.: Income-related inequality in life-years and quality-adjusted life-years. J. Health Econ. 19(6), 1007–1026 (2000)CrossRefGoogle Scholar
  15. Gerdtham, U.-G., Johannesson, M.: Absolute income, relative income, income inequality and mortality. J. Human Resour. (JHR) XXXIX(1), 228–247 (2004)CrossRefGoogle Scholar
  16. Humphries, K., van Doorslaer, E.: Income-related inequalities in health in Canada. Soc. Sci. Med. 50, 663–671 (2000)CrossRefGoogle Scholar
  17. Kawachi, I., Subramanian, S.V., Almeida-Filho, N.: A glossary for health inequalities. J. Epidemiol. Community Health 56, 647–652 (2002)CrossRefGoogle Scholar
  18. Kennedy, B., Kawachi, I., Glass, R., Prothrow-Stith, D.: Income distribution, socioeconomic status and self-rated health in the United States: muti-level analysis. Br. Med. J. 317(7163), 917–921 (1998)CrossRefGoogle Scholar
  19. Li, H., Zhu, Y.: Income, income inequality and health: evidence from China. J. Comp. Econ. 34, 668–693 (2006)CrossRefGoogle Scholar
  20. Lindley, J., Lorgelly, P.: The relative income hypothesis: does it exist over time?, Sheffield Economic Research Paper Series (2005)Google Scholar
  21. Lobmayer, P., Wilkinson, R.: Income, inequality and mortality in 14 developed countries. Sociol. Health Illn. 22(4), 401–414 (2000)CrossRefGoogle Scholar
  22. Marmot, M., George, S., Fiona, N., Amanda, F.: Health inequalities among British civil servants: the Whitehall II study. Lancet 337(8754), 1387–1393 (1991)CrossRefGoogle Scholar
  23. Meara, E.: Inequality and infant health, Harvard Medical School. Manuscript. Boston, Massachusetts (1999)Google Scholar
  24. Mellor, J., Milyo, J.: Reexamining the evidence of an ecological association between income inequality and health. J. Health Polit. Policy Law 26(3), 487–522 (2001)CrossRefGoogle Scholar
  25. Mellor, J., Milyo, J.: Income inequality and health status in the United states: evidence from the current population survey. J. Human Resour. 37, 510–539 (2002)CrossRefGoogle Scholar
  26. Power, C., Manor, A.F., Fogelman, K.: Health in childhood and social inequalities in health in young adults. J. R. Stat. Soc. 153, 17–28 (1990)CrossRefGoogle Scholar
  27. Smith, J.P.: Healthy bodies and thick wallets: the dual relation between health and economic status. J. Econ. Perspect. 13, 145–166 (1999)CrossRefGoogle Scholar
  28. Soobader, M., LeClere, F.: Aggregation and the measurement of income inequality: effects of morbidity. Soc. Sci. Med. 48(6), 733–744 (1999)CrossRefGoogle Scholar
  29. Wagstaff, A., Doorslaer, E.V.: Income inequality and health: what does the literature tell us? Public Health 21, 543–567 (2000)CrossRefGoogle Scholar
  30. Wagstaff, A., van Doorslaer, E., Paci, P.: Equity in the finance and delivery of health care: some tentative cross-country comparisons. Oxf. Rev. Econ. Policy 5(1), 89–112 (1989)CrossRefGoogle Scholar
  31. Wilkinson, R.: Unhealthy Societies: The Afflictions of Inequality. Routledge, London (1996)CrossRefGoogle Scholar
  32. Wilkinson, R.: Health inequalities: relative or absolute material standards? Br. Med. J. 314(7080), 591–595 (1997)CrossRefGoogle Scholar
  33. Wilkinson, R.: Low relative income affects mortality. Br. Med. J. 316(7144), 1611 (1998)Google Scholar
  34. Wilkinson, R.G.: Class and Health: Research and Longitudinal Data. Tavistock, London (1986)Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.University of GlasgowGlasgowUK
  2. 2.Department of EconomicsShaheed Benazir Bhutto Women UniversityPeshawarPakistan

Personalised recommendations