Healthy Country, Healthy People

New SHARE-based study explores how country-specific health factors influence one’s subjective health.

Chronic diseases represent a social, economic and health burden for industrialised countries. Especially in the case of noncommunicable diseases, individual behavioural practices serve as a predominant risk factor - everyday activities, such as the consumption of alcohol and nicotine products, or living with non-normal weight, are potentially detrimental to objective and subjective health. Although the closely intertwined relation between behaviour and health remains in the focus of research, environmental determinants have been gaining relevance among the scientific community. A rarely examined aspect in this framework is the influence of health risk factors on the country level. Researchers Muñoz, Neuman and Neuman, therefore, take on the question if and how an individual’s self-assessed health status relates to the overall country-specific health risks.

Measuring subjective health on individual and country level

In order to examine the relation between self-assessed health status and country health risk factors, the authors base their analysis on data from the fourth wave of the Survey on Health, Aging and Retirement in Europe (SHARE). The dataset compiles input from 16 European countries gathered in 2010 and 2011, resulting in a sample of 47,114 individual records.
As indicators for subjective health and for the link between personal health perception and country-level health risks, Muñoz et al. focus on three behavioural factors: smoking, alcohol consumption and obesity. Although excess weight is a condition rather than an action, it results from the continuous exercising of unhealthy behavioural practices, such as over-eating or lack of physical activity, and can therefore serve as a proxy for a health risk factor in the analysis. For the country-level health risk measures, the authors complement the dataset with OECD indicators for percentage of daily smokers, annual per-capita consumption of alcohol (litres), and percentage of obese individuals.

Subjective health is negatively impacted by smoking and abnormal weight

Muñoz et al. find that all three individual risk factors are significantly associated with the personal self-assessed health status. In line with previous research, the authors discover a negative link between smoking (both current and past) with one’s self-assessed health status. However, the association varies between countries, indicating that the national culture (including television and movie content) has a significant role in shaping societal perception and, potentially, behaviour regarding smoking.
With regard to alcohol consumption, Muñoz et al. find that moderate and heavy drinkers tend to assess their health status positively. Although surprising, the outcome might be explained by some beneficial effects of alcoholic beverages on the well-being of adults. In accordance with the results on smoking, the authors detected country-specific variations of the association, signifying the influence of cultural factors. However, it was found that the country level of alcohol consumption is negatively related to one’s self-assessed health status – an indication that the more the consequences of excessive drinking are prevalent and visible, the higher the awareness of its risks in the population could be.
When it comes to weight, the authors identified that under- and overweight were negatively associated with one’s subjective health, with the association being the strongest for severe obesity. In contrast to smoking and alcohol consumption, however, the association does not vary by country – it only softens when the country percentage of obesity increases.
Based on statistical testing, Muñoz et al. conclude that subjective health is negatively associated with smoking and non-normal weight (both under- and excessive weight), but surprisingly positively associated with moderate and heavy alcohol consumption. In regards to country-level interactions, however, excess weight is the only factor associated with the individual’s perceived health – although individuals with excess weight are perceiving their health as poorer compared to people with normal weight, the negative self-assessment weakens when the person resides in a country with a higher obesity rate.

Preventive measures on country level can improve population health

With noncommunicable diseases accounting for the majority of deaths in industrialized countries, implementing population-wide preventive measures is a necessity. The outcomes by Muñoz et al. provide clear evidence that the contextual social environment of a country has an impact on the perception of one’s own health, especially in the case of obesity. Hence, preventive policies on a national level have the potential to raise awareness about high-risk behavioural patterns.

Study by Teresa G. Muñoz, Shoshana Neuman and Tzahi Neuman (2018): Behavioural Health Risk Factors: the Interaction of Personal and Country Effects. International Journal of Behavioral Medicine 25(2): 183-197.


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