Temporal and spatial deduction pattern of health poverty eradication in countries along the Belt and Road :A systematic analysis of 141 countries from 2008-2019

Abstract

Background Among the numerous comprehensive development bottlenecks caused by multidimensional poverty, health poverty is the most fundamental and fatal one. Therefore, the eradication of health poverty is the basis for achieving the United Nations Sustainable Development Goals(SDGs) of eradicating poverty and the World Health Organization's proposal of universal health coverage. This study aims to analyze the spatial and temporal distribution patterns of health poverty and its influencing factors across countries in the Belt and Road(B&R), a region encompassing the poorest to the richest countries, and to provide a theoretical and practical basis for the subsequent development of differentiated health poverty eradication strategies. Methods Based on the theoretical framework of the three dimensions of health rights, health capabilities and health risks, this paper uses data from the World Bank's public databases and databases such as GBD2019 to select 10 corresponding indicators and uses the geometric mean method to calculate the health poverty index(HPI) of 141 countries along the B&R in the period of 2008–2019. We used 2.5% and 97.5% of each indicator as the maximum and minimum values for normalization to transform the values of on a scale of 0–1. For positive indicators(increase HPI), 0 is the best and 1 the worst, while the opposite is true for negative indicators(decrease HPI). This approach reduces sensitivity to extreme outliers in given location-years. Afterwards, this paper uses a Geographical and Temporal Weighted Regression (GTWR) model to analyze the impact of eight different factors on the HPI in each country to determine the differences in the influencing factors between countries with different HPI levels. Results From 2008 to 2019, the health poverty in B&R countries remains very high, with 29.1% of countries have an HPI greater than 0.6 in 2019. The HPI averages for high, upper-middle, lower-middle, and low-income countries in 2019 were 0.1747, 0.3676, 0.5298, and 0.6606, respectively. In terms of spatial distribution patterns, the HPI is lowest in Europe (0.0180–0.4027) and highest in Africa (0.3557–0.8820) in 2019, while intra-Asia heterogeneity is strongest (0.0778–0.7850). In terms of the trend in the temporal evolution of the HPI, most of the countries along the B&R have seen a decline in the HPI from 2008 to 2019, with only eight countries, including Greece, showing a slight increase in the HPI. But for 16 countries, including China and India, they have the largest decline in HPI (more than 0.1). The results of the GTWR model show that X2(Domestic general government health expenditure-% of GDP) is effective in mitigating the HPI in all countries and has the largest impact in low-income countries; for Asia and Africa, the coefficients of X6 (urban population-% of total population) show a shift from negative to positive from coastal areas or islands to the interior of the continent; X8 (GDP growth-annual %) is significantly correlated with the level of economic development of each country, with positive coefficients for economically developed Europe and the more rapidly developing East and Southeast Asian, and negative coefficients for the underdeveloped regions, especially in Central Africa and Central Asia. Overall, high HPI countries are more affected by different influencing factors and fluctuate more in time than low HPI countries. Conclusion Differences in HPI among the B&R countries are very large, reflecting the fact that health poverty has become a pressing global issue. The heterogeneity of health poverty between and within continents is caused by the unequal development of their social, cultural, political, and economic dimensions, and the accumulation of long-term inequalities has become an obstacle to the sustainable development of countries along the B&R. For low- and middle-income countries, the deprivation of the right to health through incapacitation remains the main cause of their high HPI. The B&R countries need to use the Health Silk Road as a link to establish vertical health assistance chains and horizontal regional mutual assistance and synergistic networks, to ultimately achieve the goal of eliminating health poverty.