Impact of Social and Political Determinants on Health Care Resources, Patient Outcomes

In a first of its kind study, researchers examined the impact and extent that health system and country-level contextual factors had on Human Resources for Health (HRH).

The researchers defined country-level contextual factors as the broader social and political institutional structures that directly or indirectly affect the health care system, population health, and health worker supply and demand.

The findings of the study, published inBioMedCentral, focused on physicians and nurses/midwives, since these 2 groups were the most consistently identifiable around the world. The data measured the Nurse/Midwife per Population Ration (NMPR), and the Physician per Population Ration (PPR).

“This exploratory observational study is grounded in complexity theory as a guiding framework,” said Simon Jones, PhD, MSc. “Variables were selected through a process that attempted to choose macro-level indicators identified by the interdisciplinary literature as known or likely to affect the number of health care workers in a country.”

The researchers combined these variables in an attempt to account for the gender- and class-sensitive identities of physicians and nurses. The data used for the analysis was comprised of 1 year of publicly available data, using the most recently available year for each country.

“The significance of the economic and inequality variables in the model suggests that systematic national policies aimed at reducing social, gender, and economic equality could positively affect health workforce production,” said lead researcher Allison Squires, PhD, RN, FAAN. “For example, we discovered a strong, positive correlation between the average years spent in school and a population/health workforce ratio. More schooling equals a better NMPR and PPR.”

Researchers pointed out the positive factors from the increase in education, which correlates with a decrease in gender inequality in these professions.

For nurses/midwives, gender inequality is a larger and potentially more systemic problem, which could be a result of mostly females dominating this occupation.

“Our results indicate that nurse/midwife production may be more sensitive to broader gender inequality issues than physicians,” Squires said. “In some ways, this may seem like a ‘common sense finding’, but the prevailing research had not previously quantified it.”

Additional findings indicated that the association between NMPR and migration rates may also be gender sensitive, because men are more likely to migrate than women. Furthermore, women from low and middle income countries are more likely to follow their migrating husbands, rather than do it themselves.

“This analysis is the first of its kind in a multitude of ways,” said Hiram Beltrán-Sánchez, MS, MA, PhD. “Only a few studies have looked at the context of HRH production at a macro-level, but none in this way. It also is one of few to look at gender inequality issues among health professions beyond pay disparities, and among the first of its kind to highlight how political regimes and governance issues influence health workforce production.”

Limitations to the study included known data quality that may have potentially had inconsistencies in reporting across countries, as well as data coordination failures known to affect cross-national datasets.

The authors noted that future studies should test other variables in the identified categories to determine whether it enhances the model’s precision. The authors added that they hope their current findings will help advance research on these particular issues.