title: Welfare generosity and population health among Canadian provinces: a time-series cross-sectional analysis, 1989-2009.
abstract: BACKGROUND
  Recent work in comparative social epidemiology uses an expenditures approach to examine the link between welfare states and population health. More work is needed that examines the impact of disaggregated expenditures within nations. This study takes advantage of provincial differences within Canada to examine the effects of subnational expenditures and a provincial welfare generosity index on population health.
  
  
  METHODS
  Time-series cross-sectional data are retrieved from the Canadian Socio-Economic Information Management System II Tables for 1989-2009 (10 provinces and 21 years=210 cases). Expenditures are measured using 20 disaggregated indicators, total expenditures and a provincial welfare generosity index, a ombined measure of significant predictors. Health is measured as total, male and female age-standardised mortality rates per 1000 deaths. Estimation techniques include the Prais-Winsten regressions with panel-corrected SEs, a first-order autocorrelation correction model, and fixed-unit effects, adjusted for alternative factors.
  
  
  RESULTS
  Analyses reveal that four expenditures effectively reduce mortality rates: medical care, preventive care, other social services and postsecondary education. The provincial welfare generosity index has even larger effects. For an SD increase in the provincial welfare generosity index, total mortality rates are expected to decline by 0.44 SDs. Standardised effects are larger for women (β=-0.57, z(19)=-5.70, p<0.01) than for men (β=-0.38, z(19)=-5.59, p<0.01).
  
  
  CONCLUSIONS
  Findings show that the expenditures approach can be effectively applied within the context of Canadian provinces, and that targeted spending on health, social services and education has salutary effects.
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Edwin
authors.initials: E
authors.lastname: Ng
authors.affiliation: Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Department of Public Health Sciences, Korea University, Seoul, South Korea.
authors.forename: Carles
authors.initials: C
authors.lastname: Muntaner
mesh_terms: D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality / Q000639:trends; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data; D011634:Public Health / Q000191:economics*; D017678:Sex Distribution; D064890:Social Determinants of Health; D012946:Social Welfare / Q000191:economics*
keywords: PUBLIC HEALTH; PUBLIC HEALTH POLICY; SOCIAL EPIDEMIOLOGY