Cultural Determinants of Global Health

Abstract

This PhD thesis examines the role of cultural values as a predictor of population health and wellbeing in a global context. Within the Social Determinants of Health (SDH) framework, several factors including social class, income and education have been studied extensively as drivers of cross-national differences in health, but much less literature exists on the role of culture and cultural values. In order to address this gap in the literature I employ a qualitative analytical approach applied to multiple waves of the World Values Survey (1979-2014). In an initial analysis, I assess whether the three most common cultural values models, those of Hofstede, Schwartz and Inglehart, are good predictors of population health outcomes. Indulgence, traditional/rational, intellectual and affective autonomy, long-term orientation and embeddedness dimensions yield largest effect sizes in predicting health outcomes. I also find a significant and large interaction effects between country’s wealth and selected cultural dimensions Secondly, I develop a novel, data-driven, computationally intensive approach to Exploratory Factor Analysis to explore whether clusters, or dimensions, of values exist, and which are the most relevant for explaining population health. Of the dimensions identified, I find that religiosity, membership in civic organisations and democratic views are the most useful for explaining global differences in health and wellbeing. Thirdly, I explore the question of autonomy. I show that two dimensions of autonomy may be identified, which I term Individual and Female Autonomy. Of the two, Individual Autonomy is a good predictor of rates of national maternal mortality and combined maternal and child mortality. Finally, I critically review and assess country-level indicators of women’s social position (also referred to in the literature as gender equality or equity, or women’s empowerment). I provide an extensive critique of the so-called ‘parity’ approach prevalent in the global health and development literature, and suggest an alternative ‘institutional’ approach as more comprehensive and socially just.