Modelling social determinants of self-evaluated health of poor older people in a middle-income developing nation
Paul A. Bourne
DOI: 10.4236/jbise.2010.37094   PDF    HTML     7,053 Downloads   11,249 Views   Citations


Over the last 2 decades (1988-2007), poverty in Jamaica has fallen by 67.5%, and this is within the context of a 194.7% increase in inflation for 2007 over 2006. It does not abate there, as Jamaicans are reporting more health conditions in a 4-week period (15.5% in 2007) and at the same time this corresponds to a decline in the percentage of people seeking medical care. Older people’s health status is of increasing concern, given the high rates of prostate cancer, genitourinary disorders, hypertension, diabetes mellitus and the presence of risk factors such as smoking. Yet, there is a dearth of studies on the health status of older people in the two poor quintiles. This study examined 1) the health status of those elderly Jamaicans who were in the two poor quintiles and 2) factors that are associated with their health status. A sample of 1,149 elderly respondents, with an average age of 72.6 years (SD = 8.7 years) were extracted from a total survey of 25,018 Jamaicans. The initial survey sample was selected from a stratified probability sampling frame of Jamaicans. An administered questionnaire was used to collect the data. Descriptive statistics were used to examine background information on the sample, and stepwise logistic regression was used to ascertain the factors which are associated with health status. The health status of older poor people was influenced by 6 factors, and those factors accounted for 26.6% of the variability in health status: Health insurance coverage (OR = 13.90; 95% CI: 7.98-24.19), age of respondents (OR = 7.98; 95% CI: 1.02-1.06), and secondary level education (OR=1.82; 95% CI: 1.35-2.45). Males are less likely to report good health status than females (OR = 0.56; 95% CI: 0.42-0.75). Older people in Jamaica do not purchase health insurance coverage as a preventative measure but as a curative measure. Health insurance coverage in this study does not indicate good health but is a proxy of poor health status. The demand of the health services in Jamaica in the future must be geared towards a particular age cohort and certain health conditions, and not only to the general population, as the social determinants which give rise to inequities are not the same, even among the same age cohort.

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Bourne, P. (2010) Modelling social determinants of self-evaluated health of poor older people in a middle-income developing nation. Journal of Biomedical Science and Engineering, 3, 700-710. doi: 10.4236/jbise.2010.37094.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] WHO, (1998) The world health report 1998. Life in the 21st century. A vision for all. WHO, Geneva.
[2] Marmot, M. (2002) The influence of income on health: Views of an epidemiologist. Does money really matter? Or is it a marker for something else? Health Affairs, 21(2), 31-46.
[3] Graham, H. (2004) Social determinants and their unequal dis-tribution: Clarifying policy understanding. The Milbank Quar-terly, 82(1), 101-124.
[4] Marmot, M. and Wilkinson, R.G., Eds. (2003) Social determi-nants of health. 2nd Edition, Oxford University Press.
[5] Kawachi, I. (2000) Income inequality and health. In Social Epidemiology, Ed., Berkman, L.K. and Kawachi, I., Oxford Univeristy Press, New York.
[6] Kawachi, I., Kennedy, B.P., Lochner, K. and Prothrow- Stitch, D. (1997) Social capital, income inequality, and mortality. American Journal of Public Health, 87(9), 1491-1498.
[7] Rojas, M. (2005) Heterogeneity in the relationship be- tween income and happiness: A conceptual-referent-theory explanation. Journal of Economic Psychology, 28(1), 1-14.
[8] United Nations Development Programmed, (2006) Human development report 2006. United Nations Deve- lopment Pro-gramme, New York:
[9] Sen, A. (1998) Mortality as an indicator of economic success and failure. Economic Journal, 108(446), 1-25.
[10] Roos, L., Magoon, J., Gupta, S., Chateau, D. and Veugelers, P.J. (2004) Socioeconomic determinants of mortality in two Cana-dian provinces: Multilevel modeling and neighborhood context. Social Sciences and Medicine, 59(11), 1435-1447.
[11] Murray, S. (2006) Poverty and health. Canadian Medical As-sociation Journal, 174(7), 923-923.
[12] Benzeval, M., Judge, K. and Shouls, S. (2001) Understanding the relationship between income and health: How much can be gleamed from cross-sectional data? Social Policy and Admin-istration Quoted in Benzeval, M. and Judge, K., Income and health: The time dimension. Social Science and Medicine, 52(4), 1371-1390.
[13] Powell, L.A., Bourne, P. and Waller, L. (2007) Probing Jamai-ca’s political culture, Vol. 1: Main trends in the July-August 2006 leadership and governance survey. Centre of Leadership and Governance, Kingston, Department of Government, Uni-versity of the West Indies, Mona.
[14] WHO, (1998) The world health report, 1998. Life in the 21st century. A vision for all. WHO, Geneva.
[15] Rowland DT, (2003). Demographic methods and concepts. Oxford University Press, Oxford.
[16] WHO, (1998) Health promotion glossary. WHO, Geneva.
[17] Gavrilov, L.A. and Heuveline, P. (2003) Aging of population. Quoted in the Encyclopedia of Population Demeny, P. and McNicol, G., Eds., Macmillan, New York.
[18] Ali, A., Christian, D. and Chung, E. (2007) Funny turns in an elderly man. West Indian Medical Journal, 56(4), 376-379.
[19] WHO, (2000) WHO issues new healthy life expectancy rank-ings: Japan number one in new ‘healthy life’ system. WHO, Washington D.C. & Geneva.
[20] Hambleton, I.R., Clarke, K., Broome, H.L., Fraser, H.S., Brathwaite, F. and Hennis, A.J. (2005) Historical and current predictors of self-reported health status among elderly persons in Barbados. Revista Panamericana de Salud Pública, 17(5-6), 342-352.
[21] Smith, J.P. and Kington, R. (1997) Demographic and economic correlates of health in old age. Demography, 34(1), 159-170.
[22] Grossman, M. (1972) The demand for health - A theo- retical and empirical investigation. National Bureau of Economic Research, New York.
[23] Bourne, P. (2007) Determinants of well-being of the Jamaican Elderly. Unpublished thesis, The University of the West Indies, Mona.
[24] Bourne, P. (2007) Using the biopsychosocial model to evaluate the wellbeing of the Jamaican elderly. West Indian Medical Journal, 56(suppl 3), 39-40.
[25] Bourne, P.A. (2008) Health determinants: Using secondary data to model predictors of well-being of Jamaicans. West Indian Medical Journal, 57(5), 476-481.
[26] Pacione, M. (2003) Urban environmental quality and human wellbeing – A social geographical perspective. Landscape and Urban Planning, 65(1-2), 19-30.
[27] Abel-Smith, B. (1994) An introduction to health: Policy, plan-ning and financing. Pearson Education, Harlow.
[28] Planning Institute of Jamaica, (PIOJ), Statistical Institute of Jamaica (STATIN), (1989-2008) Jamaica survey of living con-ditions, 1988-2007. PIOJ, STATIN, Kingston.
[29] United Nations, ECLAC, (2003) Older Person in Latin America and the Caribbean: Situation and policies. Regional Inter-governmental Conference on Ageing: Towards a Regional Strategy for the Implementation in Latin America and the Ca-ribbean of the Madrid International Plan of Action on Ageing, UN Economic Commission for Latin America and the Caribbean, Santiago, Chile.
[30] The Health Promotion and Protection Division, Jamaican Min-istry of Health (MOH), (2005) Epidemiology profile of selected health status and services in Jamaica, 1990-2002, MOH, Kingston.
[31] Wu, D., Cypser, R., Yashin, A.I. and Jonson, T.E. (2008) The U-shaped response of initial mortality in caenor- habditis ele-gans to mild heat shock: Does it explain recent trends it human mortality. The Journal of gerontology: Biological Sciences, 63(7), 660-668.
[32] Raynaud-Simon, A., Kuhn, M. and Moulis, J. (2008) Tolerance and efficacy of a new enteral formula specifically designed for elderly persons: An experimental study in the aged rat. The Journal of Gerontology: Biological Sciences, 63(7), 669-677.
[33] Ruggiero, C., Metter, E.J., Melenovsky, V., Cherubini, A., Naj-jar, S.S., Ble, A., Senin, U., Longo, D.L. and Ferrucci, L. (2008) High basal metabolic rate is a risk factor for mortality: The Baltimore longitudinal study of aging. The Journal of geron-tology: Biological Sciences, 63(7), 668- 706.
[34] WHO, (2001) Life course perspectives on coronary heart dis-ease, stroke and diabetes: Key issues and implications for policy and research. Summary Report of a Meeting of Experts, WHO, Geneva.
[35] Bogue, D.J. (1999) The ecological impact of population aging. Essays in Human Ecology, 4, Social Development Center, Chicago.
[36] WHO, (2002) Active ageing: A policy framework. WHO, Ge-neva.
[37] Engel, G. (1960) A unified concept of health and disease. Perspectives in Biology and Medicine, 3(4), 459-485.
[38] Engel, G. (1977) The care of the patient: art or science? Johns Hopkins Medical Journal, 140(5), 222-232.
[39] Engel, G. (1977) The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136.
[40] Engel, G. (1978) The biopsychosocial model and the education of health professionals. Annals of the New York Academy of Sciences, 310(1), 169-181.
[41] Engel, G. (1980) The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137(5), 535-544.
[42] Eldemire, D. (1995) A situational analysis of the Jamaican elderly, 1992. The Planning Institute of Jamaica, Kingston.
[43] v Eldemire, D. (1997) The Jamaican elderly: A socioeconomic perspective & policy implications. Social and Economic Studies, 46(1), 175-193.
[44] Eldemire-Shearer, D. (2003) Organization of long-term care services for seniors. Workshop Proceedings, Ageing Well: A Life Course Perspective, the University of the West Indies, Mona and WHO/PAHO Collaborating Centre on Ageing and Health.
[45] Eldemire, D. (1996) Older women: A situational analysis, Ja-maica 1996. United Nations Division for the Advancement of Women, New York.
[46] Eldemire, D. (1994) The elderly and the family: The Jamaican experience. Bulletin of Eastern Caribbean Affairs, 19, 31-46.
[47] Eldemire, D. (1987) The elderly – A Jamaican perspective. In: Grell, Gerald, A.C., Ed., The Elderly in the Caribbean: Pro-ceedings of Continuing Medical Education Symposium, Uni-versity Printery, Kingston, Jamaica.
[48] Eldemire, D. (2008) Ageing - The response: Yesterday, today and tomorrow. Inaugural Professorial Lecture, UWI, Mona, Jamaica.
[49] Kalache, A. (2003) Active ageing: WHO perspective. Workshop Proceedings, Ageing Well: A Life Course Perspective, The Uni-versity of the West Indies, Mona and WHO/PAHO Collaborating Centre on Ageing and Health.
[50] Henry-Lee, A. (2001) The dynamics of poverty in Jamaica, 1989-1999. Social and Economic Studies, 51(1), 199-228.
[51] WHO, (2008) The Social Determinants of Health. http://
[52] Kelly, M.P., Morgan, A., Bonnefoy, J., Butt, J. and Bergman, V. (2007) The social determinants of health: Developing an evi-dence base for political action. Final Report to World Health Organization Commission on the Social Determinants of Health from Measurement and Evidence Knowledge Network.
[53] Solar, O. and Irwin, A. (2005) Towards a conceptual framework for analysis and action on the social determinants of health. Commission on Social Determinants of Health, Geneva.

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