Abstract
BackgroundAccording to the recommendations of the World Health Organization Commission On Social Determinants of Health (CSDH) for intersectoral action on health, the well-being of and equity in health within a population are achieved via a complex fusion of policies and actions. In this study, following the CSDH’s approach and considering set-theoretic relations, we aimed to unravel this complexity and answer the kinds of questions that are outside the scope of conventional variable-oriented approach.MethodsA fuzzy-set qualitative comparative analysis of 131 countries was conducted to examine the configurational effects of five macro-level structural conditions on life expectancy at birth. The potential causal conditions were level of country wealth, income inequality, quality of governance, education, and health system. The data collected from different international data sources were recorded during 2004–2015.ResultsThe intermediate solution of the truth table analysis indicated a configuration of conditions including high level of governance, education, wealth, and affluent health system to be consistently sufficient for high life expectancy. On the other hand, four configurations, each containing two or three conditions, were consistent with being usually sufficient to cause low life expectancy.ConclusionsWe were able to configurationally explore the cases and specify the combinations of potentially causal conditions which were usually sufficient to explain high or low life expectancy in different countries. As a result, particular cases were identified for further research. In addition, research may provide support for the CSDH’s recommendations emphasizing the importance of intersectoral action for health.
Highlights
According to the recommendations of the World Health Organization Commission On Social Determinants of Health (CSDH) for intersectoral action on health, the well-being of and equity in health within a population are achieved via a complex fusion of policies and actions
Following the CSDH’s recommendations and considering set-theoretic relations, we were concerned with two main questions: (1)What combination of structural conditions is usually sufficient for high life expectancy?
What combination of structural conditions is usually sufficient for high life expectancy? With the five conditions, the truth table would have 32 (i.e. 25) logically possible combinations of causal conditions
Summary
According to the recommendations of the World Health Organization Commission On Social Determinants of Health (CSDH) for intersectoral action on health, the well-being of and equity in health within a population are achieved via a complex fusion of policies and actions. It is generally accepted that inequalities root in the conditions under which people are born, grow up, live, work, and grow older Such conditions of daily life, referred to as social determinants of health (SDH), are linked to several systems and forces, including political systems, social policies, economic policies, and social. The interactions between various socioeconomic and political factors, such as gender, race/ethnicity, income, education, occupation, and other factors, form a set of socioeconomic positions which affect the intermediary determinants of health. These determinants, which reflect a person’s position in the social order, are influenced by one’s social status and experiences of exposure and vulnerability to health-compromising conditions. The CSDH has subcategorized health determinants as the sociopolitical context, structural determinants and socioeconomic position, and intermediary determinants [29]
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