Abstract
Empirical evidence demonstrates associations between socioeconomic or environmental area deprivation and public health. To measure such structural effects, deprivation indices have been developed in the UK initially. Meanwhile their application is increasingly discussed in Germany, however with little attempts to adapt the concept to national conditions. In this paper, we develop a model of area deprivation differentiating between material, social and ecological deprivation effects. We apply structural equation modelling to endogenously estimate the latent deprivation dimensions as well as their relative impact on the health outcome, accounting for potential measurement errors and controlling for health care infrastructure. We use data at the level of German municipal associations (n=4,491) for the years 2013 and 2016, if available. We find that differences in material (βmaterial=−0.168, p<0.001) and social deprivation (βsocial=−0.249, p<0.001) as well as ecological damage (βecological=−0.077, p<0.001) explain part of the health differences in Germany. The social dimension is paramount in a health context. Moreover, deprivation dimensions cancel out each other and combining them in one overall index blurs the diverse picture of area deprivation in Germany. The small area analysis illustrates, that different strategies in environmental-, education- or health policy are necessary to reduce deprivation in different regions.
Acknowledgements
The authors are grateful for valuable comments of two anonymous referees. Alexander Karmann wants to thank for helpful discussion of an earlier paper version at the Standing Fields Committee of Health Economics, Verein fuer Socialpolitik, University of Linz, October 6, 2017. Danny Wende did benefit from involvement in discussions on risk adjustment at the Bundesversicherungsamt (BVA) and - together with Ines Weinhold - in contributing to the report on capacity planning for the Federal Joint Committee (G-BA).
Conflict of Interest: The authors declare that they have no conflict of interest.
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© 2019 Oldenbourg Wissenschaftsverlag GmbH, Published by De Gruyter Oldenbourg, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Does It Pay to Be Active on Many Foreign Markets? Profitability in German Multi-Market Exporters and Importers from Manufacturing Industries
- Willingness to Pay for Energy Efficient Refrigerating Appliances in Accra, Ghana: A Choice Experiment Approach
- Trade Openness and Carbon Emissions: Evidence from Central and Eastern European Countries
- Area Deprivation and its Impact on Population Health: Conceptual Aspects, Measurement and Evidence from Germany
Articles in the same Issue
- Frontmatter
- Does It Pay to Be Active on Many Foreign Markets? Profitability in German Multi-Market Exporters and Importers from Manufacturing Industries
- Willingness to Pay for Energy Efficient Refrigerating Appliances in Accra, Ghana: A Choice Experiment Approach
- Trade Openness and Carbon Emissions: Evidence from Central and Eastern European Countries
- Area Deprivation and its Impact on Population Health: Conceptual Aspects, Measurement and Evidence from Germany