Cultural Determinants of Global Health

Change log
Doniec, Katarzyna 

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.

Iacovou, Maria
culture, cultural values, social values, health, global health, religiosity, democracy, autonomy, women, World Values Survey, mortality, life expectancy, Hofstede, Schwartz, Inglehart, well-being, cross-country, gender equality, gender equity
Doctor of Philosophy (PhD)
Awarding Institution
University of Cambridge