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Testing Provincial Welfare Generosity and Leftist Politics As Macro-Social Determinants of Population Health

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Testing Provincial Welfare Generosity and Leftist Politics As Macro-Social Determinants of Population Health TITLE PAGE The Politics of Population Health in Canada: Testing Provincial Welfare Generosity and Leftist Politics as Macro-social Determinants of Population Health by Edwin Yee-Hong Ng A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Graduate Department of Public Health Sciences Dalla Lana School of Public Health University of Toronto © Copyright by Edwin Yee-Hong Ng 2013 The Politics of Population Health in Canada: Testing Provincial Welfare Generosity and Leftist Politics as Macro-social Determinants of Population Health Edwin Yee-Hong Ng Doctor of Philosophy Graduate Department of Public Health Sciences Dalla Lana School of Public Health University of Toronto 2013 ABSTRACT This dissertation pools time-series and cross-section data among Canadian provinces to examine: (1) whether provincial welfare generosity (health, social services, and education expenditures), power resources and political parties (unions and left, centre, and right political parties), and political democracy (voter turnout and women in government) affects population health; (2) whether the effect of leftist politics channels through or combines with provincial welfare generosity to affect population health; and (3) whether provinces cluster into distinct political regimes which are predictive of population health. Data is retrieved from the Canadian Socio-Economic Information Management System (CANSIM) II Tables from 1976 to 2008 and Canadian Parliamentary Guides from various years. Population health is measured using total, male, and female age- standardized mortality rates. Estimation techniques include Prais-Winsten regressions with panel-corrected standard errors (PCSE), a first-order autocorrelation correction model (AR1), and fixed unit effects. Hierarchical cluster analysis is used to identify how ii provinces cluster into distinct regimes. Primary findings are three-fold. First, provincial welfare generosity has a significant impact in lowering mortality rates, net of other factors, such as demographic and economic variables. Second, the political power of left and centre political parties and women in government have significant negative effects on mortality rates. Whereas left political parties and women in government combine with provincial welfare generosity to improve population health, the effect of centre political parties is channeled through provincial expenditures. Third, provinces cluster into three distinct regimes based on left political party power and women in government: 1) leftist (Saskatchewan, British Columbia, and Manitoba); 2) centre-left (Ontario and Quebec); and 3) conservative (Alberta, Nova Scotia, New Brunswick, Prince Edward Island, and Newfoundland). Compared to the leftist regime, centre-left and conservative provinces have significantly higher mortality rates; however, provincial welfare generosity accounts for most of the observed inter-provincial differences in population health. iii ACKNOWLEDGEMENTS This dissertation represents the support, guidance, and instruction of many important people. I would like to express my sincere appreciation to past instructors, supervisors, and mentors: Drs. Michael Bagby, Gerald Booth, Janice DuMont, Jim Dunn, Wilfred Gallant, Kevin Gorey, Michael Holosko, Peggy McDonough, Blake Poland, and Ann Robertson. Invaluable assistance was provided by former and current staff and faculty within the Dalla Lana School of Public Health: Karin Domnick, Bessie Gorospe, Joan Kwan, Sandra Lang, Ted Myers, Andrea Sass-Kortsak, Ellen Sokoloff, Diane Tang, Mariana Vardaei, and Rachel Zulla. Special thanks to the helpful staff at the School of Graduate Studies: Lisa Fannin, Jong Mi Sze, and Pat Singh, as well as to fellow Social Science and Health classmates: Dana Howse, Krista Maxwell, and Sandra Moll. I am appreciative for the doctoral supervision provided by Drs. Joan Benach and Haejoo Chung, and for the collegial support from Drs. Carme Borrell and Patricia O’Campo. Special thanks to members of my final oral examination committee: Drs. Paul Hamel (Chair), Andrea Madarasová Gecková (External Examiner), Jim Dunn (Voting Member), and Arjumand Siddiqi (Voting Member). I am deeply grateful for the support and encouragement of family members: Lai- Yin and Fai-Sheung Ng (parents), Mabel and Ken Tung (parent-in-laws), Anthony Tung (brother-in-law), Howie Tran (future brother-in-law), and Julia Chan (super aunt). Last but not least, I am most grateful to my thesis supervisor, sister, and wife. Special thanks to Dr. Carles Muntaner for serving as my thesis supervisor, giving me the chance to contribute to his research program, and having full confidence in my academic abilities. Second, extraordinary thanks to Karina Ng for being my ever-supportive sister, iv encouraging me in all my endeavors, and raising my spirits whenever I needed a confidence boost. Third, I owe a very important debt to my wife, Jenn Tung, who has supported me and my studies in countless ways and who always believed that I could earn my doctorate. Without the support and encouragement of Carles, Karina, and Jenn, this dissertation would not have been possible. For this, this work is dedicated to you all; I am and will forever be in your debt. v TABLE OF CONTENTS TITLE PAGE .................................................................................................................... i ABSTRACT .................................................................................................................... ii ACKNOWLEDGEMENTS .............................................................................................. iv TABLE OF CONTENTS ................................................................................................. vi LIST OF TABLES ........................................................................................................ viii LIST OF FIGURES......................................................................................................... xi LIST OF APPENDICES ................................................................................................... i CHAPTER ONE. INTRODUCTION ................................................................................. 1 Theoretical Location ..................................................................................................... 9 Methodological Approach .......................................................................................... 12 What this Dissertation Adds ....................................................................................... 14 Outline of Chapters .................................................................................................... 15 CHAPTER TWO. LITERATURE REVIEW .................................................................... 17 Social Epidemiological Approaches ........................................................................... 17 Political Sociological Theories .................................................................................... 25 Empirics: Political Determinants of Population Health ............................................... 39 CHAPTER THREE. CONCEPTUAL MODEL ............................................................... 75 Politics of Population Health in Canada ..................................................................... 75 Conceptual Model: Welfare Generosity, Leftist Politics, and Population Health ........ 79 CHAPTER FOUR. METHODS ...................................................................................... 90 Data Sources ............................................................................................................. 90 Measures of Dependent, Independent, and Control Variables .................................. 91 Estimation and Post-Estimation Techniques ............................................................ 115 CHAPTER FIVE. PROVINCIAL WELFARE GENEROSITY AND POPULATION HEALTH ...................................................................................................................... 125 Introduction .............................................................................................................. 125 Data and Methods .................................................................................................... 129 Results ..................................................................................................................... 133 Discussion................................................................................................................ 141 CHAPTER SIX. LEFTIST POLITICS, PROVINCIAL WELFARE GENEROSITY, AND POPULATION HEALTH ............................................................................................. 169 Introduction .............................................................................................................. 169 vi Data and Methods .................................................................................................... 177 Results ..................................................................................................................... 181 Discussion................................................................................................................ 187 CHAPTER SEVEN. HIERARCHICAL CLUSTER OF LEFTIST POLITICS AND POPULATION HEALTH: A TAXONOMY OF PROVINCIAL REGIMES .................... 211 Introduction .............................................................................................................. 211 Data and
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