This thesis aims to contribute to our understanding of the factors which affect both the level and distribution of health across developed and developing countries. It provides a critical review of existing health outcome measures, particularly mortality-based measures. There are two major limitations of such measures. Firstly, measures like life expectancy or infant mortality rates are more useful to measure average health status than health inequality. Secondly, they do not distinguish between avoidable and unavoidable risks and therefore implicitly assume that both have the same welfare implications. To address these issues, this thesis uses a new health outcome measure, namely the Realisation of Potential Life Years (RePLY) which distinguishes between avoidable and unavoidable mortality risks. RePLY can be used to measure both the average health level in a population as well as its distribution. RePLY-based health inequality measures thus highlight the extent of health inequality that is likely to be amenable to intervention.
This thesis focuses on three different RePLY-based health measures; average RePLY, which measures the overall health status of a population; the RePLY Gini, which measures the extent of health inequality within a population; and the gender RePLY, which measures health differences between males and females within a population. Using these three measures this thesis investigates the effect on health levels and inequality of a range of independent variables representing standard of living, socioeconomic status, human capital and direct health interventions. The regression models are based on data for around 100 countries at different levels of development for the year 2000. Sensitivity analyses were carried out to examine whether the impact of the explanatory variables differed across both high and low income countries
The key finding of this thesis is that if countries are to improve their overall health levels and reduce health inequalities, continued economic growth is essential. However economic growth alone is not sufficient; countries also need to focus on socioeconomic development, particularly better education and reducing discrimination against minority groups. Infrastructure development, particularly improved distribution of clean water and sanitation facilities, is also required for further health development.