Does urbanization improve health outcomes: a cross country level analysis

Abstract

Though rapid escalating urbanization has a positive effect on economic growth and employment, its impacts on health outcomes need to be analyzed. Using panel quantile regression models: the present study examined the impact of urbanization on health outcomes by considering 204 countries from 1960 to 2021. We measured urbanization by considering three proxy variables; total urban population, percentage of the urban population, and percentage of the population living in million-plus agglomerations. Overall estimated results suggested a negative effect on the fertility rate and a positive impact on life expectancy at birth due to urbanization. A mixed impact of urbanization was perceived on the infant mortality rate. Urbanization quality and management variables such as percentage of the urban population having access to clean fuel and technologies for cooking, electricity, basic drinking water, sanitation services, and hand washing facilities showed an asymmetric impact on health outcomes. The study additionally deployed feasible generalized least square (FGLS) and bias corrected least square dummy variable (LSDV) regressions to confirm the robustness of outcomes. The Granger causality test indicated that the relationship between urbanization and health outcomes is bidirectional. The panel cointegration test suggested that there is a long-run relationship between them. Order logit regression results suggested that the impact of urbanization on health outcomes may vary with the different stages of development a country is experiencing. The results indicate that well managed urbanization is beneficial for achieving higher health outcomes. Most importantly, developing countries are yet to promote and manage urbanization from this perspective, thus urgent attention is needed. Finally, we suggest appropriate policies for sustainable urbanization to achieve higher health outcomes in the world.