title: The impact of crude oil-led economic growth on health and its determinants
Creators: name: Okon, Marian Emmanuel
Publisher: name: University of Glasgow
Year: 2020
Subjects: subject: economic growth, population health, health determinants, crude oil economy, crude oil resources.

description: Background and aims: There is a close connection between the demographic and epidemiological transitions which many countries undergo. Shifts in population structure and population health go hand in hand. In theory, increased economic capacity in a country generates resources for development of infrastructure and basic amenities and, in turn, health improvement. Countries that have oil resources to exploit, might expect the economic benefits to drive health improvement. However, limited evidence suggests that crude oil and other natural resources may not guarantee population health benefits. The thesis sought evidence for a pathway from oil resources to population health improvement in two linked quantitative studies. The first study was an international comparison. The second focused on Nigeria as a case study country with crude oil abundance, yet relatively poor economic performance. Methods: A theoretical model was developed to describe how oil resources could drive social, economic, and infrastructure transition, and ultimately health improvement. In the first phase study, evidence for this relationship between crude oil resources and population health was assessed globally via panel models and the relationship between oil-led economic growth and population health was assessed via cross-sectional models. Data were drawn from the World Health Organisation and United States energy information administration (n = 156 countries) and were analysed using structural equation modelling. The panel models spanned from 2000 to 2015, at 5-year intervals while the cross-sectional models explored the 2000-2015 growth in oil economy on health and its determinants in 2015. In the second phase, relationships between oil-led economic growth at state-level and household-level with health and its determinants were explored in Nigeria (n=38,522 households). Multilevel modelling was used to allow for the nested structure of the data. Results: The panel analysis in the phase one study showed that the relationship between all the markers for crude oil resources and health/determinants were not statistically significant, except for crude oil export and access to basic sanitary facility (Coefficient = -0.01, p&lt;0.05), over the study period. For oil-based income (oil-rent contribution to GDP), there was no significant association with access to basic drinking water sources (Coefficient = -0.01; p&gt;0.05) or access to basic sanitary facilities (Coefficient = 0.01; p&gt;0.05), over the study period. There was also no significant association between oil-based income and health over the study period: for infant mortality (Coefficient = 0.05; p&gt;0.05) and for life expectancy (Coefficient = -0.01; p&gt;0.05). Income group was not significant in these relationships. However, the cross-sectional analysis in the phase one study showed that the oil-rent contribution to GDP measure of oil-led economic growth was directly associated with health determinants. For example, there was a significant positive association with access to drinking water sources in low-income (Coefficient = 0.48; p&lt;0.05) and high-income countries (Coefficient = 0.53; p&lt;0.05). There was also a significant positive association with access to sanitary facilities in low-income countries (Coefficient = 0.38; p&lt;0.05) but this was not found in high-income countries. Results were inconsistent between markers of health and relationships were sensitive to the measure of oil-led economic growth. This study also found that crude oil export measure of oil-led economic growth was directly associated with some markers of population health: with infant mortality (Coefficient = -0.10; p&lt;0.05) in high-income countries and with life expectancy (Coefficient = -0.20; p&lt;0.05) for low-income-countries. There was no significant association between oil-led economic growth and household deaths in Nigeria (Coefficient = -0.0001; p&gt;0.05). However, oil-led economic growth did seem to be related to the type of household sanitary facilities available, indicating a possible role in improving infrastructure related to health. For example, greater oil-led economic growth was associated with the likelihood of households having flush toilet relative to no facility (Coefficient = 0.005; p&lt;0.05). Yet, there was no significant association with other markers such as water supply for example. Overall, the results showed very weak support for a well-trodden pathway from oil to improved population health, via improved infrastructure. If anything, they supported the pathway in already higher income countries only. Conclusion: Within the necessary caveats of a very methodologically challenging study, the conclusion of these analyses must be that having oil wealth does not readily translate to population health improvement. Measurement of all steps on the pathway was difficult, but the results hint that the mediating effects of institutions are important influences. Channelling crude oil wealth into health improvement requires strong institutions as seen with high-income countries. Where these are absent, governments (particularly in low-income countries) seem to have failed to convert their oil revenues to population health benefits. The implications are that appropriate models of managing oil revenue should be established. Without strong governance, the social, economic and environmental harms from crude oil activities may actually outweigh the benefits. Since governance and priority setting determines the amount of oil revenue allocated for health improvement in a country, the potential remains for oil to be a positive resource for population health.