Heterogeneity in the Determinants of Health? An Empirical Analysis of the Smoking-Health Relationship in Socioeconomic Context

Stephen Birch (), Michael Jerrett and John Eyles
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Stephen Birch: Department of Clinical Epidemiology & Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University
Michael Jerrett: Department of Geography, Environmental Health Program, McMaster University
John Eyles: Department of Clinical Epidemiology & Biostatistics, Centre for Health Economics and Policy Analysis, Department of Geography, Environmental Health Program, McMaster University

No 1997-08, Centre for Health Economics and Policy Analysis Working Paper Series from Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada

Abstract: Systematic variations in health and illness among social groups have persisted and, in some cases increased, in many countries in spite of improvements in the availability of, and access to, health care services. Health policy makers have responded by showing increasing interest in non-clinical determinants of health as a way of explaining the observed systematic variations in health and illness. Yet health care and non-health care “factors” are often seen as competing for society’s scarce resources in the production of health. The purpose of this paper is to augment this traditional approach to understanding the determinants of health in populations by adopting a framework in which the impact of one determinant may be dependent upon the presence, absence or level of other determinants (that is, interactions), thus creating a set of complementary ‘inputs’ to health production. To test the proposed framework, logistic regression analyses were performed using data from the 1992-93 Santé Québec survey (N = 21454). The findings suggest that the socioeconomic variables are ‘effect modifiers,’ and the association between smoking and health cannot be assessed without reference to a specific value (category) of the socioeconomic variable. These findings, although preliminary, will be of importance for the development of strategic plans, policy development and programme management in the area of population health.

Keywords: population health; socioeconomic factors; smoking; Quebec; heterogeneity (search for similar items in EconPapers)
Pages: 31 pages
Date: 1997
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Citations: View citations in EconPapers (1)

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