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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 227-231

Impact of under-five mortality on economic growth and health-care expenditures in India


SRM School of Public Health, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Chengalpattu District, Tamil Nadu, India

Date of Submission23-Apr-2021
Date of Acceptance24-Apr-2021
Date of Web Publication03-Sep-2021

Correspondence Address:
Mr. Saravanan Chinnaiyan
SRM School of Public Health, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur 603203, Chengalpattu District, Tamil Nadu.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_6_21

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  Abstract 

Introduction: Under-five mortalities are the significant vital indicators of the population health condition and the social development of the country. Child survival is measured by the under-five mortality rate (U5MR). It also reflects the social, economic, and environmental circumstances, as well as their health care. Our main objective is to determine the impact of the U5MR on economic growth changes and health-care expenditure and examine the sex difference trend of under-five mortalities. Materials and Methods: We have retrieved data from World Bank Indicators from 2005 to 2017, with under-five mortality as the independent variable and health expenditure as a dependent variable. We used correlation analysis to assess the impact of under-five mortalities on economic growth and health-care expenditure in Rstudio (open-source software). Results: The U5MR was higher in females than in males. The correlation of mortality rate, under-five (per 1000 live births) with current health expenditure per capita, domestic general government health expenditure per capita, and domestic private health expenditure per capita was found to be statistically significant (P < 0.05). Conclusion: Accordingly, political stability, effective social sector policies, and government interventions are essential for reducing under-five mortality. The human health force’s participation in macro and micro policy-making is also necessary, and other determinants of health-care expenses should be critically examined.

Keywords: Child health, health budget, health expenditure, SDG goals, under-five mortality


How to cite this article:
Chinnaiyan S, Babu B, Ghimire A. Impact of under-five mortality on economic growth and health-care expenditures in India. MGM J Med Sci 2021;8:227-31

How to cite this URL:
Chinnaiyan S, Babu B, Ghimire A. Impact of under-five mortality on economic growth and health-care expenditures in India. MGM J Med Sci [serial online] 2021 [cited 2021 Sep 21];8:227-31. Available from: http://www.mgmjms.com/text.asp?2021/8/3/227/325549




  Introduction Top


Under-five mortality is the rate of infant mortality, representing the risk of dying, expressed per 1000 live births, between birth and exactly five years of age, according to existing mortality rates. As a barometer of child welfare in general and child wellbeing in particular, it has many benefits.

Under-five mortality is known to be the result of a wide variety of factors. They are the nutritional status and the health of a child and a mother, knowledge of mothers, the availability of maternal care, child health and reproductive services (including prenatal care), the level of immunization and oral rehydration therapy, income and food availability in the family, educational level of the family, access to safe drinking water, sanitation facilities, and the overall protection of the environment of the child.

The under-five mortality rate (U5MR) is less vulnerable to average fallacy than, for example, gross national income per capita. Even though the human scale allows them to have 1000 times as much wealth, the natural scale does not allow the wealthy children to be 1000 times as likely to survive.[1] In other words, influencing the U5MR of a nation is far more difficult for a wealthy minority. Therefore, it offers a more reliable, if far from the perfect, image of most children’s health status.

Nearly 40% of all under-five deaths occur from several complications during the neonatal period, the first month of life. Of these neonatal deaths, about 26% are caused by severe infections, accounting for 10% of all under-five deaths. Pneumonia and sepsis (a severe blood-borne bacterial infection) are responsible for many of these infections. Each year, two million children under five die from pneumonia (about one in five deaths worldwide). Besides, up to one million additional infants die from severe infections during the neonatal period, including pneumonia. Diarrheal diseases account for 17% of under-five casualties, prompting gains since the 1980s. Together, malaria, measles, and AIDS are responsible for 15% of child deaths.[2]

Several international conferences and summits, the World Summit for Children (WSC 1990), the International Conference on Population and Growth (ICPG 1994), the Fourth World Conference on Women (WCW 1995), World Summit for Social Development (WSSD 1995), and the United Nations Millennium Summit have introduced quantitative objectives for reducing mortality rates of children under the age of five. The goal of reducing under-five mortalities by two-thirds between 2000 and 2015 was set by the United Nations Millennium Declaration, adopted in 2000.[2] One of the metrics used in the Human Resource Index is the U5MR. It is also one of the quantitative parameters for identifying countries.

The world spent 7.3 trillion USD on health in 2015, almost 10% of the world’s gross domestic product (GDP). At nearly 12% on average, health expenditure per share of GDP was the highest in high-income countries. Health-spending accounts for 7% of GDP in low-income countries and 6% in middle-income countries.[3] The critical measure of investment levels in health is the degree of health-spending in a country. It is recognized as an essential contribution to improving health outcomes. Previous studies have shown that expenditure on health has a positive impact, such as infant growth and reduce in infant mortality.


  Materials and methods Top


Our present study analyzed annual time data of India from 2005 to 2017. The data on determinants of health expenditure used in the empirical analysis were sourced from the World Bank[4] mortality rate, under-five (per 1000 live births). We had taken current health expenditure (CHE) (% of GDP); CHE per capita, public–private partnership (PPP) current international $; CHE per capita current, US$; domestic general government health expenditure (DGGHE) percentage of CHE; DGGHE per capita, current US$; DGGHE per capita, PPP current international $;domestic private health expenditure (DPHE) percentage of CHE; external health expenditure (EHE) per capita (PPP), current international $ as a dependent variables and mortality rate under-five, male per 1000 live births and mortality rate, under-five, female per 1000 live births as an independent variable. Correlation analyses have been done through the Rstudio statistical software package.


  Results Top


As the year increased, the U5MR decreased among both males and females. The U5MR among females was found to be higher as compared to males across the years [Figure 1].
Figure 1: Graph representing females have high under-five mortality than males

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The correlation of mortality rate, under-five (per 1000 live births) with CHE per capita, PPP current international $, DGGHE per capita, PPP current international $, and DPHE per capita, PPP current international $ was found to be statistically significant (P < 0.05) [Table 1]. There was a negative and high correlation between the mortality rate and under-five per 1000 live births with each of these three variables. Meanwhile, the correlation of mortality rate, under-five per 1000 live births with CHE % of GDP, and EHE per capita, PPP current international $ was not found statistically significant (P > 0.05). The correlation between these variables can be visualized in [Figure 2][Figure 3][Figure 4][Figure 5][Figure 6].
Table 1: Correlation of under-five mortality with different variables

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Figure 2: Scatter plot showing the correlation between mortality rate, under-five (per 1000 live births), and current health expenditure (% of gross domestic product)

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Figure 3: Scatter plot showing the correlation between mortality rate, under-five (per 1000 live births), and current health expenditure per capita, PPP (current international $). PPP = public–private partnership

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Figure 4: Scatter plot showing the correlation between mortality rate, under-five (per 1000 live births), and domestic general government health expenditure per capita, PPP (current international $). PPP = public–private partnership

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Figure 5: Scatter plot showing the correlation between mortality rate, under-five (per 1000 live births), and domestic private health expenditure per capita, PPP (current international $). PPP = public–private partnership. PPP = public–private partnership

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Figure 6: Scatter plot showing the correlation between mortality rate, under-five (per 1000 live births), and external health expenditure per capita, PPP (current international $). PPP = public–private partnership

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  Discussion Top


Across the world, implementing various interventions for child survival and improved socioeconomic conditions in many countries has contributed to a low significant reduction of U5MR. A study by Black, et al.[5] shreds of evidence of the fall of U5MR. A study by Acheampong, et al.[6] revealed that increased spending on health care was more important than access to better water. Our present study showed a positive correlation with per capita GDP, whereas a study by Baird, et al.[7] observed a strong negative association of per capita GDP with infant mortality. Several studies on European countries found that a higher per capita GDP reduces child mortality. Studies by Maruthappu, et al.[8] have also shown that child care and government financial resources impact public health-spending. The medical care offered to the children can also worsen, especially in countries where the proportion of direct private health-spending is high concerning the total spending. A study by Emamgholipour and Asemane[9] in Iran revealed that a 1% increase in public health expenditure per capita resulted in a 0.03% decrease in the U5MR. Based on our current study results, an increase in per capita public health expenditure decreases U5MRs. But the study by Filmer and Pritchett[10] showed that the effect of health expenditure on the U5MR was minimal and concluded that health expenditure did not significantly decrease the child mortality rate.


  Conclusion Top


This study’s findings showed that the increase in GDP per capita and public health expenditure per capita positively affects the child mortality rate in the current period. The under-five mortality rate shows that the more a country spends on health, the more it seeks to improve health of the child and reduce child mortality. In the postdevolution situation and with the advent of sustainable development goals, we encourage policymakers to consider the economic outlook for health policy formulation and review as a matter of urgency.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethical consideration

The article entitled “Impact of under-five mortality on economic growth and health-care expenditures in India” study was based on a large dataset that is publicly available on World Bank (https://data.worldbank.org) hence permission from the institutional ethics committee is not required.



 
  References Top

1.
Kiross GT, Chojenta C, Barker D, Loxton D. The effects of health expenditure on infant mortality in Sub-Saharan Africa: Evidence from panel data analysis. Health Econ Rev 2020;10:5.  Back to cited text no. 1
    
2.
Tavares AI. Infant mortality in Europe, socio-economic determinants based on aggregate data. Appl Econ Lett 2017;24:1588-96.  Back to cited text no. 2
    
3.
Houweling TA, Caspar AE, Looman WN, Mackenbach JP. Determinants of under-5 mortality among the poor and the rich: A cross-national analysis of 43 developing countries. Int J Epidemiol 2005;34:1257-65.  Back to cited text no. 3
    
4.
World Bank. Mortality rate, under-5 (per 1,000 live births). Estimates developed by the UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN DESA Population Division) at childmortality.org. Available from: https://data.worldbank.org/indicator/SH.DYN.MORT. [Last accessed on March 3, 2021].  Back to cited text no. 4
    
5.
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality in 2008: A systematic analysis. Lancet 2010;375:1969-87.  Back to cited text no. 5
    
6.
Acheampong M, Ejiofor C, Salinas-Miranda A, Wall B, Yu Q. Priority setting towards achieving under-five mortality target in Africa in context of sustainable development goals: An ordinary least squares (OLS) analysis. Glob Health Res Policy 2019;4:3.  Back to cited text no. 6
    
7.
Baird S, Friedman J, Schady N. Aggregate income shocks and infant mortality in the developing world. Rev Econ Stat 2011;93: 847-56.  Back to cited text no. 7
    
8.
Maruthappu M, Watson RA, Watkins J, Zeltner T, Raine R, Atun R. Effects of economic downturns on child mortality: A global economic analysis, 1981-2010. BMJ Glob Health 2017;2:e000157.  Back to cited text no. 8
    
9.
Emamgholipour S, Asemane Z. Effect of governance indicators on under-five mortality in OECD nations: Generalized method of moments. Electron Physician 2016;8:1747-51.  Back to cited text no. 9
    
10.
Filmer D, Pritchett L. The impact of public spending on health: Does money matter? Soc Sci Med 1999;49:1309-23.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1]



 

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Introduction
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