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Chapter 2: Burden by Level of Development
CHAPTER 2: BURDEN BY LEVEL
OF DEVELOPMENT
Thus far we have examined variations between countries in the burden of digestive disorders
and the burden attributable to certain risk factors. We now present an analysis which explores
the extent to which the burden differs by the level of human development between countries.
Our health is determined by a wide range of factors including individual constitutional factors,
social and community networks, living and working conditions and the wider economic and
cultural environment.109 The non-medical factors that influence health outcomes are often
referred to as the social determinants of health, and are described by the World Health
Organization (WHO) as the conditions in which people are born, grow, live, work and age, that
are shaped by wider socioeconomic and political forces.110 The social determinants of health
are considered the most powerful determinants of health (over and above medical care) and
are deemed to be responsible for the majority of the global burden of disease.111 112 113
The Human Development Index (HDI) is an established summary measure of human
development, published by the United Nations Development Programme (UNDP). It was
created to emphasise that people and their capabilities should be the ultimate criteria for
assessing the development of a country.114 It is based on the concept that human
development is the process of expanding people's capabilities to lead the lives they value.115
116 It measures three capabilities deemed essential to enhance people's opportunities: (1) to
earn income for a decent standard of living (measured by gross national income per capita in
purchasing power parity terms), (2) to acquire knowledge (measured by mean years of
schooling and expected years of schooling), and (3) to live a long and healthy life (measured by
life expectancy at birth).115 117 It may therefore be considered as a simplified population-level
measure of the social, economic and environmental conditions which shape people's lives.
In this chapter, we focus on European UEG member countries to explore the relationship
between levels of human development and the burden of digestive diseases and cancers.
Based on global rankings, the UNDP classifies the 35 European UEG member countries as
having either high or very high levels of human development. Differences in levels of human
development between these countries may therefore reflect differences in enhanced
capabilities that bring greater agency to people's lives. For example, access to tertiary
education, access to new technologies and resilience to economic shocks.117 We investigate
linear relationships between the HDI, as well as the income and education components of the
HDI, and digestive disease burden measured using age-standardised DALY rates.
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