Background: Myanmar’s National Health Plan 2017-2021 set out concrete steps to strengthen the health system on the way to achieving the goal of universal health coverage by 2030. Ensuring these steps include the 7.7 million older adults in Myanmar’s population by 2030 will require novel strategies that improve health and reduce financial burden of health expenditures. An examination of the relationship between social networks and selected health outcomes was undertaken to determine whether these networks can safeguard older adults’ continued contributions to family, society and their own health. Methods: Secondary analysis of a nationally representative study of adults aged 60 years and older. Ordered logistic regression analyses with weighted data were used to examine the relationship between a social network variable and a number of health outcomes. Findings: Stronger social networks were associated with better health outcomes like better memory (OR 1.2), lower reported walking difficulties (OR 0.58), better self-reported health (R 1.15). People with higher social ties were also more like to receive regular assistance and provide care for other household members. Interpretation: Social networks play a role in mediating health outcomes and interactions with the health care systems. Social network interventions should be explored as part of policy mechanisms to ensure universal health coverage for older adults in Myanmar.
References
[1]
WHO (2019) Global Spending on Health: A World in Transition. World Health Organization, Geneva.
https://apps.who.int/iris/bitstream/handle/10665/330357/WHO-HIS-HGF-HF-WorkingPaper-19.4-eng.pdf?ua=1
[2]
WHO. Global Health Expenditure Database.
http://apps.who.int/nha/database/country_profile/Index/en
[3]
Van Rooijen, M., Myint, C.Y., Pavlova, M. and Groot, W. (2018) Health Insurance in Myanmar: The Views and Perception of Healthcare Consumers and Health System Informants on the Establishment of a Nationwide Health Insurance System. Risks, 6, Article No. 81. https://doi.org/10.3390/risks6030081
[4]
Myint, C.Y., Pavlova, M. and Groot, W. (2019) Health Insurance in Myanmar: Knowledge, Perceptions, and Preferences of Social Security Scheme Members and General Adult Population. The International Journal of Health Planning and Management, 34, 346-369. https://doi.org/10.1002/hpm.2643
[5]
Myint, C.Y., Pavlova, M. and Groot, W. (2019) Patterns of Health Care Use and Out-of-Pocket Payments among General Population and Social Security Beneficiaries in Myanmar. BMC Health Services Research, 19, Article No. 258.
https://doi.org/10.1186/s12913-019-4071-8
[6]
Van Damme, W., Van Leemput, L., Por, I., Hardeman, W. and Meessen, B. (2004) Out-of-Pocket Health Expenditure and Debt in Poor Households: Evidence from Cambodia. Tropical Medicine & International Health, 9, 273-280.
https://doi.org/10.1046/j.1365-3156.2003.01194.x
[7]
Joe, W. (2015) Distressed Financing of Household Out-of-Pocket Health Care Payments in India: Incidence and Correlates. Health Policy and Planning, 30, 728-741.
https://doi.org/10.1093/heapol/czu050
[8]
Institute for Health Metrics and Evaluation (2019) Global Burden of Disease Study 2019. University of Washington, Seattle. http://ghdx.healthdata.org/gbd-results-tool
[9]
Krisha, A. (2019) Tackling Non-Communicable Diseases to Achieve Universal Health Coverage in Myanmar. HelpAge International Myanmar 2019.
http://themimu.info/sites/themimu.info/files/assessment_file_attachments/NCDs_policy_brief_FINAL.pdf
[10]
Maung, K.T., Kowal, P., Ng, N. and Krisha, A. (2019) The Road to Universal Health Coverage in Myanmar Runs through Non-Communicable Disease Risk Factors: Supporting Evidence from WHO in 2009 and 2014 and the Global Burden of Disease Study 2016. Health, 11, 1206-1223.
https://www.scirp.org/pdf/Health_2019092716142688.pdf
https://doi.org/10.4236/health.2019.119094
[11]
Swe, E.E., Htet, K.K.K., Thekkur, P., Aung, L.L., Aye, L.L. and Myint, T. (2020) Increasing Trends in Admissions Due to Non-Communicable Diseases over 2012 to 2017: Findings from Three Large Cities in Myanmar. Tropical Medicine and Health, 48, Article No. 24. https://doi.org/10.1186/s41182-020-00209-8
[12]
Khaing, I.K., Malik, A., Oo, M. and Hamajima, N. (2015) Health Care Expenditure of Household in Magway, Myanmar. Nagoya Journal of Medical Science, 77, 203-212. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361522/
[13]
United Nations Population Division (2019) World Population Prospects: The 2019 Revision. UN, New York.
[14]
MoHS (2017) Myanmar National Health Plan 2017-2021. Ministry of Health and Sports, Nay Pyi Taw.
http://mohs.gov.mm/Main/content/publication/national-health-plan-2017-2021-eng
[15]
Umberson, D. and Karas Monte, J. (2010) Social Relationships and Health: A Flashpoint for Health Policy. Journal of Health and Social Behavior, 51, S54-S66.
https://doi.org/10.1177/0022146510383501
[16]
Schroders, J., Dewi, F.S.T., Nilsson, M. and Nichter, M. (2020) Effects of Social Network Diversity in the Disablement Process: A Comparison of Causal Inference Methods and an Outcome-Wide Approach to the Indonesian Family Life Surveys, 2007-2015. International Journal for Equity in Health, 19, Article No. 128.
https://doi.org/10.1186/s12939-020-01238-9
[17]
Perkins, J.M., Subramanian, S.V. and Christakis, N.A. (2015) Social Networks and Health: A Systematic Review of Sociocentric Network Studies in Low- and Middle-Income Countries. Social Science & Medicine, 125, 60-78.
https://doi.org/10.1016/j.socscimed.2014.08.019
[18]
Stokes, J.E. (2020) Social Integration, Daily Discrimination, and Biological Markers of Health in Mid- and Later Life: Does Self-Esteem Play an Intermediary Role? Innovation in Aging, 4, igaa026. https://doi.org/10.1093/geroni/igaa026
[19]
Wright, K. (2016) Social Networks, Interpersonal Social Support, and Health Outcomes: A Health Communication Perspective. Frontiers in Communication, 1, Article No. 10. https://doi.org/10.3389/fcomm.2016.00010
[20]
World Economic Forum (WEF) (2017) Human-Centric Health: Behaviour Change and the Prevention of Non-Communicable Diseases. World Economic Forum, Geneva. http://www3.weforum.org/docs/IP/2016/HE/HCH_Report2017.pdf
[21]
Schwamm, L.H. (2018) The Communicable Nature of Non-Communicable Diseases. Lancet Neurol, 17, 665. https://doi.org/10.1016/S1474-4422(18)30216-3
[22]
MoHS (2017) National Strategic Plan for Prevention and Control of NCDs (2017-2021). Ministry of Health and Sports, Nay Pyi Taw.
http://mohs.gov.mm/su/MyCBSF
[23]
WHO (2013) Noncommunicable Diseases and Social Determinants of Health. World Health Organization, Geneva.
https://apps.who.int/iris/bitstream/handle/10665/126794/ncd.pdf?sequence=8&isAllowed=y
[24]
WHO (2020) Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020. World Health Organization, Geneva.
[25]
Knodel, J. (2013) The Situation of Older Persons in Myanmar. Results from the 2012 Survey of Older Persons. HelpAge International Myanmar, Yangon.
https://deepblue.lib.umich.edu/bitstream/handle/2027.42/100343/Myanmar%20report.pdf?sequence=1&isAllowed=y
[26]
Kowal, P. and Ng, N. (2010) Social Networks, Health and Well-Being: Evidence from SAGE. WHO, Geneva.
https://www.researchgate.net/publication/274701434_Social_networks_health_and_well-being_Evidence_from_SAGE
[27]
Kowal, P. (2016) Social Networks and Health Care Utilization. In: He, W., Goodkind, D. and Kowal, P., Eds., An Aging World: 2015, International Population Reports, U.S. Government Publishing Office, Washington DC, 78.
[28]
Falk, H., Skoog, I., Johansson, L., Guerchet, M., Mayston, R., Horder, H., Prince, M. and Prina, A.M. (2017) Self-Rated Health and Its Association with Mortality in Older Adults in China, India and Latin America—A 10/66 Dementia Research Group Study. Age and Ageing, 46, 932-939. https://doi.org/10.1093/ageing/afx126
[29]
Fernández-Olano, C., López-Torres Hidalgo, J.D., Cerdá-Díaz, R., Requena-Gallego, M., Sánchez-Castano, M., Urbistondo-Cascales, L. and Otero-Puime, A. (2006) Factors Associated with Health Care Utilization by the Elderly in a Public Health Care System. Health Policy, 75, 131-139. https://doi.org/10.1016/j.healthpol.2005.02.005
[30]
Fong, J.H. and Kok, Z.C. (2020) Does Subjective Health Matter? Predicting Overall and Specific ADL Disability Incidence. Archives of Gerontology and Geriatrics, 90, Article ID: 104169. https://doi.org/10.1016/j.archger.2020.104169
[31]
DeSalvo, K.B., Jones, T.M., Peabody, J., et al. (2009) Health Care Expenditure Prediction with a Single Item, Self-Rated Health Measure. Medical Care, 47, 440-447.
https://doi.org/10.1097/MLR.0b013e318190b716
[32]
Halford, C., Wallman, T., Welin, L., et al. (2012) Effects of Self-Rated Health on Sick Leave, Disability Pension, Hospital Admissions and Mortality. A Population-Based Longitudinal Study of Nearly 15,000 Observations among Swedish Women and Men. BMC Public Health, 12, Article No. 1103.
https://doi.org/10.1186/1471-2458-12-1103
[33]
Schnittker, J., and Bacak, V. (2014) The Increasing Predictive Validity of Self-Rated Health. PLoS ONE, 9, e84933. https://doi.org/10.1371/journal.pone.0084933
[34]
Christakis, N.A. and Fowler, J.H. (2007) The Spread of Obesity in a Large Social Network over 32 Years. The New England Journal of Medicine, 357, 370-379.
https://doi.org/10.1056/NEJMsa066082
[35]
Shaya, F.T., Chirikov, V.V., Mullins, C.D., et al. (2013) Social Networks Help Control Hypertension. The Journal of Clinical Hypertension, 15, 34-40.
https://doi.org/10.1111/jch.12036
[36]
Reeves, D., Blickem, C., Vassilev, I., Brooks, H., Kennedy, A., Richardson, G., et al. (2014) The Contribution of Social Networks to the Health and Self-Management of Patients with Long-Term Conditions: A Longitudinal Study. PLoS ONE, 9, e98340.
https://doi.org/10.1371/journal.pone.0098340
[37]
Bloom, D.E., Chatterji, S., Kowal, P., et al. (2015) Macroeconomic Implications of Population Ageing and Selected Policy Responses. The Lancet, 385, 649-657.
https://doi.org/10.1016/S0140-6736(14)61464-1
[38]
Myint, C., Pavlova, M. and Groot, W. (2019) Catastrophic Health Care Expenditure in Myanmar: Policy Implications in Leading Progress towards Universal Health Coverage. International Journal for Equity in Health, 18, Article No. 118.
https://doi.org/10.1186/s12939-019-1018-y
[39]
Wagstaff, A. and Neelsen, S. (2020) A Comprehensive Assessment of Universal Health Coverage in 111 Countries: A Retrospective Observational Study. The Lancet Global Health, 8, E39-E49. https://doi.org/10.1016/S2214-109X(19)30463-2
[40]
Bambra, C., Fox, D. and Scott-Samuel, A. (2005) Towards a Politics of Health. Health Promotion International, 20, 187-193. https://doi.org/10.1093/heapro/dah608
[41]
Gilson, L., Orgill, M. and Shroff, Z.C. (2018) A Health Policy Analysis Reader: The Politics of Policy Change in Low- and Middle-Income Countries. World Health Organization, Geneva. https://www.who.int/alliance-hpsr/resources/publications/Alliance-HPA-Reader-web.pdf
[42]
Buse, K., Tanaka, S. and Hawkes, S. (2017) Healthy People and Healthy Profits? Elaborating a Conceptual Framework for Governing the Commercial Determinants of Non-Communicable Diseases and Identifying Options for Reducing Risk Exposure. Globalization and Health, 13, Article No. 34.
https://doi.org/10.1186/s12992-017-0255-3
[43]
Savedoff, W.D., de Ferranti, D., Smith, A.L. and Fan, V. (2012) Political and Economic Aspects of the Transition to Universal Health Coverage. The Lancet, 380, 924-932. https://doi.org/10.1016/S0140-6736(12)61083-6
[44]
Andermann, A. (2016) Taking Action on the Social Determinants of Health in Clinical Practice: A Framework for Health Professionals. Canadian Medical Association Journal, 188, E474-E483. https://doi.org/10.1503/cmaj.160177
[45]
Marmot, M. (2017) Commentary: Social Determinants and the Health Gap: Creating a Social Movement. International Journal of Epidemiology, 46, 1335-1339.
https://doi.org/10.1093/ije/dyx182
[46]
Marmot, M. (2020) Society and the Slow Burn of Inequality. The Lancet, 395, 1413-1414. https://doi.org/10.1016/S0140-6736(20)30940-5
[47]
Isaranuwatchai, W., Teerawattananon, Y., Archer, R.A., et al. (2020) Prevention of non-Communicable Disease: Best Buys, Wasted Buys, and Contestable Buys. British Medical Journal, 368, m141.
[48]
Nugent, R., Bertram, M.Y., Jan, S., et al. (2018) Investing in Non-Communicable Disease Prevention and Management to Advance the Sustainable Development Goals. The Lancet, 391, 2029-2035. https://doi.org/10.1016/S0140-6736(18)30667-6
[49]
Dhand, A., White, C.C., Johnson, C., Xia, Z. and De Jager, P.L. (2018) A Scalable Online Tool For Quantitative Social Network Assessment Reveals Potentially Modifiable Social Environmental Risks. Nature Communications, 9, Article No. 3930.
https://doi.org/10.1038/s41467-018-06408-6
[50]
(2020) HelpAge International Myanmar. https://europa.eu/capacity4dev/capacity-building-in-public-health-for-development/documents/sphc-myanmar-preparedness-and-responsiveness-ncd-service-delivery-pen-clinics
