Zouine, Ma ouane; El Adnani, Mohamed Jallal; Salhi, Salah Eddine
A icle
Does highe educa ion ma e in mi iga ing ch onic disease Mo ali y?
E idence om MENA coun ies wi h conside a ion o Globaliza ion,
economic G ow h, and en i onmen al pollu ion
Resea ch in Globaliza ion
P o ided in Coope a ion wi h:
Else ie
Sugges ed Ci a ion: Zouine, Ma ouane; El Adnani, Mohamed Jallal; Salhi, Salah Eddine (2024) : Does
highe educa ion ma e in mi iga ing ch onic disease Mo ali y? E idence om MENA coun ies
wi h conside a ion o Globaliza ion, economic G ow h, and en i onmen al pollu ion, Resea ch in
Globaliza ion, ISSN 2590-051X, Else ie , Ams e dam, Vol. 9, pp. 1-10,
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Does highe educa ion ma e in mi iga ing ch onic disease Mo ali y?
e idence om MENA coun ies wi h conside a ion o Globaliza ion,
economic G ow h, and en i onmen al pollu ion
Ma ouane Zouine
*
, Mohamed Jallal el adnani , Salah eddine salhi
Facul y o Economics and Managemen . Sul an Moulay Slimane Uni e si y: Beni-Mellal, Mo occo
ARTICLE INFO
Keywo ds:
Highe educa ion
MENA coun ies
Globaliza ion
Ca bon dioxide emissions (co2 emissions)
Economic g ow h
ABSTRACT
This s udy in es iga es he ela ionship be ween highe educa ion and mo ali y a es om ch onic and a al
diseases in MENA coun ies om 2000 o 2020. U ilizing a obus panel econome ic amewo k wi h Gene -
alized Leas Squa e, Fully Modi ied O dina y Leas Squa es (FMOLS), and Dynamic O dina y Leas Squa es
(DOLS), we analyze empi ical da a while con olling o globaliza ion, CO2 emissions, and GDP pe capi a. Ou
indings e eal a signi ican nega i e co ela ion be ween educa ion and mo ali y a es, pa alleled by simila
ends o globaliza ion and GDP pe capi a. Con e sely, CO2 emissions a e ound o inc ease mo ali y a es,
highligh ing he de imen al impac o en i onmen al deg ada ion on public heal h. This unde sco es he pi o al
ole o educa ion, globaliza ion, and economic de elopmen in educing mo ali y a es associa ed wi h ch onic
and a al diseases. The s udy ad oca es o inc eased in es men s in educa ion and heal hca e in as uc u e o
add ess dispa i ies and enhance public heal h ou comes, alongside p omo ing esponsible globaliza ion p ac ices
o u he imp o e heal h me ics.
In oduc ion
Educa ion plays a c ucial ole in d i ing socie al p og ess, in lu-
encing no only economic g ow h, unemploymen a es, and en i on-
men al sus ainabili y bu also b oade aspec s o public heal h. Resea ch
by Su e al. (2021), Li e al. (2021), and Zouine e al. (2024) highligh s
how educa ion boos s p oduc i i y, os e s inno a ion, and ensu es
economic s abili y by equipping indi iduals wi h essen ial skills and
knowledge o success in a compe i i e global landscape. Beyond i s
economic impac s, educa ion signi ican ly in luences public heal h
ou comes. Indi iduals wi h highe le els o educa ion end o adop
heal hie li es yles, access p e en i e heal hca e se ices, and make
in o med heal h decisions, as no ed by Zouine & El Adnani (2023). This
educa ed popula ion con ibu es o heal hie communi ies, educes
heal hca e expendi u es, and enhances o e all well-being. Thus, edu-
ca ion plays a mul i ace ed ole, no only in ad ancing economies bu
also in p omo ing be e heal h ou comes and a highe quali y o li e o
socie y a la ge.
In he b oade con ex o global heal h policymaking, he pi o al ole
o educa ion in shaping heal h ou comes o en emains unde app eci-
a ed. Nume ous s udies ha e es ablished ha educa ion se es as a
po en heal h in e en ion, empowe ing indi iduals wi h knowledge
and esou ces o p oac i ely manage hei well-being. Indi iduals wi h
highe le els o educa ion end o exhibi g ea e awa eness o heal h
issues, leading o ea ly p e en i e measu es and imely access o
heal hca e se ices. This co ela ion is no me ely anecdo al; empi ical
e idence demons a es ha highe educa ional a ainmen co ela es
wi h imp o ed heal h ou comes and educed mo ali y a es, pa icu-
la ly in he con ex o ch onic and a al diseases.
In he Middle Eas and No h A ica (MENA) egion, ch onic diseases
such as ca dio ascula diseases (CVDs) cance s, diabe es, and ch onic
espi a o y p oblems a e on he ise, posing signi ican challenges o
public heal h. Acco ding o he Wo ld Bank (2019), hese diseases ha e
eme ged as leading causes o mo bidi y and mo ali y in he MENA e-
gion, wi h app oxima ely 70 % o dea hs a ibu ed o non-
communicable diseases (NCDs). Speci ically, in 2020, he egion wi -
nessed app oxima ely 461,000 new cance cases and o e 274,000
cance - ela ed dea hs. Addi ionally, CVDs, including hea disease and
s oke, accoun ed o o e 810,000 dea hs in 2019, while ch onic es-
pi a o y diseases, such as ch onic obs uc i e pulmona y disease
(COPD), esul ed in app oxima ely 3.2 million disabili y-adjus ed li e
yea s (DALYs) los he same yea .
* Co esponding au ho .
E-mail add ess: [email p o ec ed] (M. Zouine).
Con en s lis s a ailable a ScienceDi ec
Resea ch in Globaliza ion
jou nal homepage: www.sciencedi ec .com/jou nal/ esea ch-in-globaliza ion
h ps://doi.o g/10.1016/j. esglo.2024.100236
Recei ed 4 May 2024; Recei ed in e ised o m 19 June 2024; Accep ed 25 June 2024
Resea ch in Globaliza ion 9 (2024) 100236
2
Gi en he ala ming p e alence and impac o hese ch onic diseases,
in es ing in educa ion eme ges as a s a egic impe a i e o public
heal h in he MENA egion. Howe e , despi e he escala ing disease
bu den, he po en ial impac o highe educa ion in mi iga ing he isks
associa ed wi h hese diseases emains ela i ely unexplo ed in he
egional con ex . While educa ion is widely ecognized as a de e minan
o heal h ou comes globally, empi ical esea ch speci ic o he MENA
egion is limi ed. This unde sco es he need o comp ehensi e s udies
ha examine he ela ionship be ween highe educa ion and mo ali y
a es ela ed o ch onic and a al diseases in MENA coun ies.
In addi ion o in es iga ing he impac o highe educa ion on heal h
ou comes, ou s udy will del e in o he b oade con ex ual ac o s ha
in luence disease p e alence in MENA coun ies. Globaliza ion, cha -
ac e ized by inc eased in e connec edness and he exchange o knowl-
edge and goods, has been highligh ed in ecen esea ch by Quasinowski
and Liu (2020) and Jani e al. (2019) as a signi ican ac o shaping he
pa e ns o ch onic diseases. Unde s anding how globaliza ion a ec s
disease ansmission and p e alence in he MENA egion is c ucial o
de eloping e ec i e public heal h s a egies.
Fu he mo e, ou s udy will explo e he in ica e ela ionship be-
ween economic de elopmen , as measu ed by GDP pe capi a, and
ch onic diseases. Ex ensi e esea ch, such as ha by Bloom e al. (2020),
demons a es he complex in e play be ween economic g ow h and he
bu den o diseases like diabe es, CVD, and cance . This unde sco es he
impo ance o conside ing economic ac o s in designing and imple-
men ing heal h in e en ions ailo ed o local con ex s.
In addi ion o he de imen al heal h e ec s o CO2 emissions on
ch onic diseases, he p ese a ion o he en i onmen and he impo -
ance o educing CO2 emissions ha e been highligh ed in s udies by
Boubake e al. (2024), Hasan (2024), and Shah e al. (2024). These
s udies emphasize ha CO2 emissions con ibu e signi ican ly o en i-
onmen al pollu ion and clima e change, ampli ying heal h isks.
Add essing hese en i onmen al heal h challenges equi es comp e-
hensi e s a egies ha in eg a e public heal h policies wi h en i on-
men al sus ainabili y goals. Fu he mo e, he de imen al heal h e ec s
o CO2 emissions on ch onic diseases ha e been well-documen ed in
s udies by Pon ze (2021) and E dogan e al. (2020). These emissions
con ibu e o en i onmen al pollu ion and clima e change, exace ba ing
heal h isks associa ed wi h espi a o y diseases, ca dio ascula diso -
de s, and o he ch onic condi ions. Add essing hese en i onmen al
heal h challenges equi es comp ehensi e s a egies ha in eg a e
public heal h policies wi h en i onmen al sus ainabili y goals.
The ela ionship be ween highe educa ion and ch onic disease
mo ali y in he MENA egion emains unde explo ed, despi e i s sig-
ni icance o public heal h and policy. Unlike mo e de eloped egions
whe e ex ensi e esea ch has linked educa ion le els o imp o ed heal h
ou comes, s udies speci ic o MENA coun ies a e limi ed. This gap is
c i ical because he egion aces unique challenges such as apid u -
baniza ion, changing li es yles, and a ying heal hca e access, which
can signi ican ly impac disease p e alence and mo ali y a es. Un-
de s anding how highe educa ion in luences mo ali y in MENA coun-
ies is he e o e c ucial o designing a ge ed in e en ions and policies
ha can e ec i ely educe disease bu dens and imp o e popula ion
heal h.
To comp ehensi ely add ess hese esea ch gaps, ou s udy will
u ilize igo ous econome ic analysis g ounded in heo e ical ame-
wo ks such as Phelan and B uce Link’s Fundamen al Cause Theo y and
Ga y Becke ’s human capi al heo y (HCP). This heo e ical ounda ion
will guide ou in es iga ion in o he complex in e play be ween edu-
ca ion, en i onmen al ac o s, and mo ali y a es associa ed wi h
ch onic and a al diseases in he MENA egion. Employing ad anced
panel da a analysis echniques, including c oss-dependency es s, uni
oo es s, Kao coin eg a ion es s, gene alized leas squa es (GLS), Fully
Modi ied OLS (FMOLS), and dynamic OLS (DOLS) es ima o s, we aim o
p o ide a nuanced unde s anding o hese ela ionships.
Ou main con ibu ion lies in empi ically examining how highe
educa ion in luences mo ali y a es ela ed o ch onic and a al diseases
wi hin he MENA con ex by highligh educa ion as a undamen al
componen o e ec i e public heal h s a egies. By le e aging obus
econome ic me hods, ou s udy aims o unco e he speci ic mecha-
nisms h ough which educa ion impac s heal h ou comes, he eby illing
a c i ical gap in cu en li e a u e. Mo eo e , we seek o ex end he
heo e ical implica ions o Fundamen al Cause Theo y and Human
Capi al Theo y by demons a ing hei applicabili y in unde s anding
heal h dispa i ies and in o ming policy in e en ions.
Th oughou his pape , we will conduc an exhaus i e e iew o he
li e a u e, syn hesizing bo h heo e ical amewo ks and empi ical
s udies o examine ecen con ibu ions on he impac o educa ion, CO2
emissions, globaliza ion, and economic g ow h on mo ali y a es
associa ed wi h ch onic and a al diseases. In subsequen sec ions, we
will explica e he me hodology employed in his s udy, delinea ing he
geog aphical con ex o ou in es iga ion ( he MENA egion) and he
concep ual amewo k guiding ou esea ch model.
Following his, we will igo ously analyze and in e p e he indings
de i ed om ou empi ical analysis. Las ly, he pape will conclude wi h
a comp ehensi e syn hesis o he esul s, accompanied by ecommen-
da ions in o med by ou esea ch ou comes. This sys ema ic app oach
ensu es a igo ous explo a ion o he esea ch inqui y, o e ing aluable
insigh s pe inen o schola ly discou se and policy o mula ion.
1. Li e a u e e iew
1.1. Theo e ical backg ound
The Fundamen al Cause Theo y posi s ha educa ion ac s as a
undamen al cause o heal h dispa i ies by in luencing access o mul iple
esou ces c i ical o heal h. Educa ion a ec s heal h ou comes h ough
a ious in e connec ed mechanisms oo ed in socioeconomic s a us
(SES), heal h beha io s, and access o heal hca e. Highe le els o ed-
uca ion a e associa ed wi h highe SES, which p o ides indi iduals wi h
g ea e inancial esou ces, be e job oppo uni ies, and imp o ed ac-
cess o heal hca e se ices (Phelan e al., 2010).
Socioeconomic ad an ages linked o educa ion acili a e heal hie
li ing en i onmen s, including access o nu i ious ood, sa e housing,
and en i onmen s conduci e o physical ac i i y. These ac o s
con ibu e signi ican ly o educing he isk ac o s o ch onic diseases
such as ca dio ascula disease, cance , diabe es, and ch onic espi a o y
diseases. Addi ionally, educa ion enhances heal h li e acy, empowe ing
indi iduals o unde s and and na iga e heal h in o ma ion, make
in o med decisions abou p e en i e measu es, and engage in heal hie
li es yles (Zajaco a & Law ence, 2018).
Fu he mo e, educa ion in luences heal h beha io s h ough i s
impac on cogni i e abili ies and social no ms. Educa ed indi iduals a e
mo e likely o adop heal h-p omo ing beha io s such as egula phys-
ical exe cise, balanced die s, and a oiding ha m ul subs ances like o-
bacco and excessi e alcohol consump ion (F eese & Lu ey, 2011). They
also end o ha e be e adhe ence o medical ea men s and p e en i e
heal hca e p ac ices, leading o ea ly de ec ion o diseases and imp o ed
heal h ou comes o e he li espan.
Fundamen al Cause Theo y emphasizes he pe sis en na u e o ed-
uca ion’s impac on heal h dispa i ies. I sugges s ha e en as speci ic
pa hways linking educa ion o heal h ou comes may e ol e, he
undamen al ad an age o educa ion in p o iding indi iduals wi h he
skills and esou ces o manage heal h isks emains obus . This heo y
unde sco es he b oade socie al implica ions o educa ion policies and
in e en ions aimed a educing heal h inequali ies ac oss di e en so-
cioeconomic s a a (Link & Phelan, 1995).
In con as , Human Capi al Theo y iews educa ion as an in es -
men in enhancing human capi al, which encompasses bo h p oduc i e
skills and heal h capabili ies. Acco ding o HCT, educa ion enhances
heal h ou comes by equipping indi iduals wi h knowledge and skills
necessa y o main aining and imp o ing heal h (Becke , 2009).
M. Zouine e al.
Resea ch in Globaliza ion 9 (2024) 100236
3
Educa ed indi iduals a e mo e likely o engage in p oac i e heal h be-
ha io s and p e en i e measu es, con ibu ing o be e heal h ou comes
and educed heal hca e cos s.
HCT a gues ha educa ion enhances heal h h ough mul iple pa h-
ways. Fi s ly, educa ion inc eases heal h li e acy, enabling indi iduals
o unde s and heal h in o ma ion, make in o med decisions abou hei
heal h, and ad oca e o hei heal hca e needs. Secondly, educa ion
os e s c i ical hinking and p oblem-sol ing skills, which a e essen ial
o na iga ing complex heal hca e sys ems and managing ch onic con-
di ions e ec i ely (Schul z, 1982; B adley & Co wyn, 2002).
Mo eo e , HCT highligh s he economic bene i s o in es ing in ed-
uca ion o heal h. Educa ed indi iduals end o ha e highe ea ning
po en ials and be e job s abili y, which ansla es in o imp o ed access
o heal hca e se ices and esou ces. A heal hie wo k o ce con ibu es
o highe p oduc i i y, educed absen eeism, and o e all economic
g ow h, unde sco ing he b oade socie al bene i s o educa ion in p o-
mo ing heal h and well-being (Feins ein e al., 2006).
To conclude his subsec ion, bo h Fundamen al Cause Theo y and
Human Capi al Theo y p o ide comp ehensi e amewo ks o unde -
s anding he in ica e ela ionship be ween educa ion and heal h ou -
comes. FCT emphasizes educa ion’s ole in shaping heal h dispa i ies
h ough socioeconomic pa hways and heal h beha io s, highligh ing i s
endu ing impac on heal h ac oss di e en popula ions. In con as , HCT
unde sco es educa ion’s ole as an in es men in enhancing human
capi al, p omo ing heal hie beha io s, and imp o ing indi idual and
popula ion heal h ou comes. In eg a ing hese heo e ical pe spec i es
enhances ou unde s anding o how educa ion in luences mo ali y a es
ela ed o ch onic and a al diseases, guiding e ec i e policies and in-
e en ions aimed a imp o ing public heal h and educing heal h
inequi ies.
1.2. Empi ical pe spec i e
1.2.1. Educa ion and mo ali y
The s udies p esen ed del e in o he in ica e nexus be ween edu-
ca ion, heal h li e acy, and ch onic diseases, wi h a ocus on CVD,
cance , diabe es, and ch onic espi a o y diseases. These in es iga ions
collec i ely unde sco e he p o ound in luence o educa ion and heal h
li e acy on disease awa eness, p e en ion, managemen , and o e all
heal h ou comes.
In he ealm o cance , Asuquo & Olajide (2015) highligh he pi o al
ole o heal h educa ion in enhancing b eas cance awa eness among
emale unde g adua es, leading o imp o ed unde s anding o symp-
oms and isk ac o s, as well as inc eased sel -examina ion p ac ices.
Del Ca men e al. (2021) emphasize he e ec i eness o educa ional
in e en ions in b eas cance p e en ion and heal h p omo ion, ad o-
ca ing o comp ehensi e s a egies a ge ing bo h men and women
ac oss all li e s ages. Addi ionally, Soni (2007) ci es he in eg a ion o
heal h educa ion in o cu iculums as an e ec i e app oach o enhancing
heal h li e acy and aising awa eness abou b eas cance .
Wi hin he domain o ca dio ascula disease, Boa eng e al. (2017)
unde sco e he impo ance o educa ion and loca ion in shaping un-
de s anding and awa eness o CVD among sub-Saha an A ican pop-
ula ions, pa icula ly among indi iduals wi h low educa ion le els and
hose esiding in u al a eas. Sa ee e al. (2006) emphasize he c i ical
ole o heal h li e acy in p omo ing be e communica ion, adhe ence o
medical ea men s, and o e all heal h, wi h implica ions o p e en ing
hea disease. Fu he mo e, Haw ho ne e al. (1999) highligh he co -
ela ion be ween low li e acy le els and obacco use, a signi ican isk
ac o o hea disease.
Rega ding diabe es, Saeed e al. (2018) highligh s he associa ion
be ween inadequa e educa ion, heal h li e acy, and poo glycemic
con ol, emphasizing he need o educa ional p og ams o enhance
unc ional heal h li e acy among diabe ic pa ien s. Ga a i-Fam e al.
(2020) unde sco e he signi ican p edic i e alue o heal h li e acy and
sel -ca e beha io s in imp o ing heal h- ela ed quali y o li e among
indi iduals wi h ype 2 diabe es melli us. Addi ionally, Reisi e al.
(2016) s ess he impo ance o sel -e icacy heo y in pa ien educa ion
p og ams o success ul diabe es sel -managemen .
In he ealm o ch onic espi a o y diseases, Mackey e al. (2017)
e eal he co ela ion be ween limi ed knowledge, low li e acy le els,
and nega i e belie s abou espi a o y diseases, unde sco ing he
impo ance o heal h li e acy in disease managemen and p e en ion.
Puen e-Maes u e al. (2016) shed ligh on he dispa i y in unde s anding
and li e acy le els among COPD pa ien s, ad oca ing o ailo ed in-
e en ions o imp o e heal h ou comes. Mo eo e , Tagga e al. (2012)
demons a e he impac o inc easing heal h li e acy le els on educing
isk beha io s associa ed wi h ch onic espi a o y diseases.
These s udies collec i ely unde sco e he pi o al ole o educa ion
and heal h li e acy in shaping disease unde s anding, p e en ion, and
managemen ac oss a ious ch onic condi ions, highligh ing he need
o comp ehensi e educa ional in e en ions and a ge ed heal h p o-
mo ion s a egies o add ess heal h dispa i ies and imp o e popula ion
heal h.
1.2.2. CO2 emissions and mo ali y
Jona han (2007) del es in o he in ica e ela ionship be ween
clima e change and i s heal h impac s, pa icula ly ocusing on ch onic
diseases. I emphasizes he disp opo iona e bu den aced by ulne able
popula ions, such as child en unde 5 yea s old, and discusses he
concep o “na u al deb ” o quan i y he esponsibili y o cu en
wa ming. The s udy ad oca es o equi able solu ions o p o ec hese
ulne able g oups and mi iga e he heal h impac s o clima e change-
ela ed ch onic diseases. In line wi h his pe spec i e, Bie wi h e al.
(2018) and Jacobson e al. (2019) explo e he heal h isks associa ed
wi h ele a ed ca bon dioxide (CO2) le els, speci ically ch onic diseases.
They discuss he po en ial ad e se e ec s o ch onic exposu e o high
CO2 concen a ions indoo s, including in lamma ion, cogni i e
impai men , bone demine aliza ion, and kidney calci ica ion. These
s udies highligh he u gen need o u he esea ch o quan i y hese
isks and de elop e ec i e mi iga ion s a egies o p o ec ulne able
popula ions om ch onic diseases linked o CO2 exposu e.
In a ela ed con ex , E dogan e al. (2020) analyze he ela ionship
be ween ca bon dioxide emissions and heal h expendi u es in BRICS-T
coun ies, wi h a speci ic ocus on ch onic diseases. Thei indings sug-
ges ha inc easing CO2 emissions con ibu e o highe heal h expen-
di u es, indica ing he economic impac o ca bon emissions on ch onic
disease managemen and heal hca e cos s. Fu he mo e, Ehsan e al.
(2020) explo e he in ica e ela ionship be ween economic g ow h,
ossil uel consump ion, en i onmen al pollu ion, and mo ali y due o
ch onic diseases in CIS coun ies. Thei s udy e eals ha a ia ions in
CO2 emissions and inc eased ossil uel consump ion co ela e posi i ely
wi h mo ali y a es om ca dio ascula disease, diabe es melli us,
cance , and ch onic espi a o y diseases. These indings unde sco e he
c i ical necessi y o policy in e en ions aimed a ansi ioning owa ds
enewable ene gy sou ces o alle ia e he bu den o ch onic diseases
linked o en i onmen al pollu ion.
Pon ze (2021) syn hesizes exis ing e idence o elucida e he in-
e connec ions be ween clima e change and ch onic diseases, empha-
sizing humani y’s eliance on ex e nal ene gy sou ces as a cen al ac o .
The s udy highligh s he ad e se heal h impac s o indus ializa ion and
ossil uel consump ion, which signi ican ly con ibu e o he p e alence
o ch onic diseases. I ad oca es o u gen ac ion owa ds adop ing
ca bon–neu al ene gy solu ions o mi iga e clima e change and educe
he heal h isks associa ed wi h ch onic diseases. Addi ionally, Pon ze
unde sco es he impo ance o comp ehensi e s a egies ha add ess he
mul i ace ed ac o s in luencing ch onic disease p e alence in global
heal h con ex s.
Globaliza ion and mo ali y. Globaliza ion’s impac on ch onic and a al
diseases is mul i ace ed, necessi a ing in-dep h examina ion. This
M. Zouine e al.
Resea ch in Globaliza ion 9 (2024) 100236
4
in e sec ion encompasses a ious ac o s such as die a y pa e ns, eco-
nomic policies, and en i onmen al changes. Unde s anding hese com-
plexi ies is c ucial o de ising e ec i e public heal h in e en ions.
Analyzing he links be ween globaliza ion and disease bu den equi es a
comp ehensi e app oach ha conside s socio-economic dispa i ies,
cul u al in luences, and policy amewo ks. Add essing his in ica e
ela ionship is essen ial o mi iga ing he global bu den o ch onic and
a al diseases.
Hawkes (2006) del es in o he phenomenon o he “nu i ion an-
si ion” d i en by globaliza ion, which has led o inc eased consump ion
o oods high in a s and swee ene s, con ibu ing o he ise o obesi y
and die - ela ed ch onic diseases wo ldwide. The pape examines how
globaliza ion a ec s ag i- ood sys ems, al e ing he a ailabili y, ype,
cos , and desi abili y o oods. Speci ic mechanisms o ma ke in eg a-
ion, such as p oduc ion and ade o ag icul u al goods, o eign di ec
in es men in ood p ocessing and e ailing, and global ood ad e ising
and p omo ion, a e highligh ed as d i e s o die a y change. The pape
emphasizes he need o policymake s o unde s and hese links o
de elop e ec i e policies add essing he global bu den o ch onic
disease.
Weisz and Vignola-Gagn´
e (2015) p o ide insigh s in o he policy
landscape su ounding ch onic noncommunicable diseases (NCDs) in
low- and middle-income coun ies. The eme gence o NCDs as a majo
conce n is aced back o collabo a i e e o s be ween expe s om
Eas e n and Wes e n Eu ope in he la e 1980 s. The Global Bu den o
Disease s udy p o ided c i ical e idence o NCD ac i ism, leading o
e i aliza ion o he Wo ld Heal h O ganiza ion’s no ma i e and coo -
dina i e unc ions. Howe e , despi e widening conce n, majo eallo-
ca ion o unding owa d NCD p og ams in he de eloping wo ld has no
ye ma e ialized.
Siiba e al. (2021) explo e he in e wined challenges o clima e
change and NCDs, pa icula ly in A ica, whe e hese syne gis ic e ec s
pose signi ican isks o achie ing sus ainable de elopmen goals. The
e iew iden i ies pa hways h ough which clima e change and global-
iza ion in luence NCDs, including educ ion in ood p oduc ion and
nu i ion, u baniza ion, and ans o ma ion o ood sys ems. The ind-
ings unde sco e he need o e ec i e policy and public heal h in-
e en ions o mi iga e he e ec s o clima e change and globaliza ion
on he ising bu den o NCDs.
Cue as e al. (2019) in es iga e he ole o economic globaliza ion
and ade libe aliza ion in shaping nu i ional ou comes, pa icula ly in
low- and middle-income coun ies. While he impac s o globaliza ion on
nu i ional ou comes emain mixed, o eign di ec in es men (FDI) is
associa ed wi h inc eases in o e nu i ion and NCD p e alence. The
s udy highligh s he impo ance o nu i ion-sensi i e ade policy and
egula ion o FDI o add ess all o ms o malnu i ion e ec i ely.
Jani e al. (2019) empi ically analyzes he impac o globaliza ion on
heal h indica o s using panel da a. They ind ha globaliza ion has a
posi i e impac on heal h, wi h economic globaliza ion exe ing he
highes in luence on heal h indica o s in less de eloped coun ies.
Howe e , as coun ies de elop, he social dimension o globaliza ion
becomes mo e impo an , indica ing a nuanced ela ionship be ween
globaliza ion and heal h ou comes.
Quasinowski and Liu (2020) adop a sociological app oach o un-
de s and he eme gence o ca dio ascula diseases as global heal h
conce ns. They ace he globalisa ion o ca diology, pa icula ly hea
ailu e esea ch, iden i ying p econdi ions such as echnological in-
no a ions, o ganiza ional in as uc u e, and in e na ionally s anda d-
ized nomencla u e. The s udy sheds ligh on he social mechanisms ha
ha e p opelled ca dio ascula diseases on o he global heal h agenda.
1.2.3. GDP and mo ali y
Unde s anding how economic g ow h impac s ch onic and a al
diseases is c ucial o public heal h and economic de elopmen . As
economies g ow, li es yle changes o en lead o an inc eased p e alence
o ch onic condi ions like ca dio ascula diseases and diabe es.
The e o e, in es iga ing his ela ionship is i al o de eloping e ec i e
policies o add ess he ising bu den o such diseases.
Bloom e al. (2020) p opose an inno a i e amewo k o assess he
mac oeconomic impac o economic g ow h on ch onic and a al dis-
eases, pa icula ly non-communicable diseases (NCDs). By in eg a ing
disease p e alence in o a human capi al augmen ed p oduc ion unc-
ion, hey quan i y he economic bu den o ch onic heal h condi ions in
e ms o o egone GDP. Applying his me hodology o China, Japan, and
Sou h Ko ea, hey es ima e subs an ial losses associa ed wi h ca dio-
ascula diseases, cance , ch onic espi a o y diseases, diabe es, and
men al heal h condi ions o e he pe iod 2010–2030.
Dadga and No s ¨
om (2022) in es iga e he in ica e ela ionship
be ween mac oeconomic luc ua ions d i en by economic g ow h and
he p e alence o ch onic and a al diseases ac oss 21 OECD coun ies
om 1960 o 2018. Thei analysis e eals ha inc eases in unemploy-
men a e associa ed wi h dec eases in mos mo ali y ou comes, while
GDP g ow h exhibi s long- e m p o ec i e e ec s on mo ali y, high-
ligh ing he mul i ace ed dynamics be ween economic condi ions and
popula ion heal h.
Su and Zheng (2023) del e in o China’s mo ali y ends o e he
pas ou decades, emphasizing he impac o economic g ow h on he
ansi ion om in ec ious diseases o ch onic and a al diseases, pa ic-
ula ly non-communicable diseases (NCDs). They a ibu e his shi o
isk ac o s like smoking, poo die , and physical inac i i y, which ha e
led o a su ge in ch onic condi ions such as ca dio ascula diseases,
cance s, ch onic espi a o y diso de s, and diabe es. Addi ionally, hey
unde sco e he impo ance o p io i izing ch onic disease p e en ion
and s eng hening p ima y heal hca e o add ess his e ol ing heal h
landscape amids economic g ow h.
Cupido (2020) explo es he mo ali y modeling o mul iple pop-
ula ions wi h a ocus on he impac o economic g ow h on ch onic and
a al diseases. En iching ac o -based mo ali y models wi h socio-
economic de e minan s, Cupido highligh s he signi icance o in e -
p e able spa ial model ea u es in unde s anding he spa ial impac o
economic g ow h on mo ali y. By ex ending he Li-Lee ac o -based
s ochas ic mo ali y modeling amewo k o include economic g ow h
and spa ial pa e ns o mo ali y, he s udy sheds ligh on he complex
in e play be ween economic g ow h and ch onic and a al diseases.
2. Resea ch design and me hodology
In ou s udy, we aimed o assess he impac o highe educa ion,
globaliza ion, economic g ow h, and CO2 emissions on mo ali y a es
ela ed o ch onic and a al diseases. To achie e his, we u ilized a
da ase p ima ily sou ced om he Wo ld Bank, p o iding comp ehen-
si e da a on mo ali y om ca dio ascula diseases, cance , diabe es,
and ch onic espi a o y diseases ac oss a ious coun ies.
Ou panel analysis encompasses 16 MENA coun ies, selec ed based
on con ex ual ele ance de eloped in he in oduc ion and da a a ail-
abili y. The able below p o ides a concise o e iew o he a iables
in eg a ed in o ou esea ch model, emphasizing key indica o s ele an
o mo ali y and socioeconomic ac o s.
The Table 1 desc ibe he a iables used in ou model.
2.1. Empi ical model and es ima ion
Ou s udy unde akes a comp ehensi e explo a ion o he in ica e
nexus be ween highe educa ion, globaliza ion, economic g ow h, and
CO2 emissions in he con ex o ch onic and a al diseases ac oss MENA
coun ies om 2000 o 2020.
To es ablish a obus analy ical amewo k, we me iculously
collec ed ex ensi e da a o key a iables.
The o mula ed model:
ln(MORT)i =
α
+β1ln(EDU)i +β2ln(GLOB)i +β3ln(GDP)i
+β4ln(CO2)i +ei (1)
M. Zouine e al.
Resea ch in Globaliza ion 9 (2024) 100236
5
was c a ed o del e in o he nuanced impac o highe educa ion,
globaliza ion, economic g ow h, and CO2 emissions on mo ali y a es
associa ed wi h ch onic and a al diseases.
Ou me hodological app oach encompasses a comp ehensi e sui e o
es s, anging om explo a o y da a analysis and diagnos ic assessmen s
o mul icollinea i y checks and co ela ion analyses. Speci ically, we
u ilized Kao’s coin eg a ion es o examine long- e m ela ionships
among a iables and he Q-s a is ic o assess model diagnos ics,
including he de ec ion o se ial au oco ela ion.
Mo eo e , we conduc ed GLS, FMOLS, and DOLS analyses o ho -
oughly in es iga e po en ial e ec s and ensu e he obus ness o ou
indings. This anspa en and eplicable me hodology enhances he
s udy’s c edibili y, con ibu ing o an ad anced unde s anding o he
mul i ace ed dynamics a he in e sec ion o educa ion, globaliza ion,
economic g ow h, CO2 emissions, and mo ali y a es om ch onic and
a al diseases in he MENA egion.
In ou s udy, he co e ocus lies in examining whe he highe edu-
ca ion con ibu es o he mi iga ion o ch onic diseases, speci ically
a ge ing he oles o globaliza ion, CO2 emissions, and GDP. The in-
clusion o hese a iables is jus i ied by hei signi ican impac s on bo h
heal h ou comes and en i onmen al sus ainabili y in he MENA egion.
This selec ion aligns wi h he egion’s economic dynamics, cha ac e -
ized by apid globaliza ion, subs an ial CO2 emissions, and GDP g ow h.
We hypo hesize ha highe educa ion will demons a e a nega i e
coe icien , indica ing a po en ial associa ion wi h lowe ch onic disease
a es. This expec a ion is suppo ed by heo ies such as Human Capi al
Theo y, which posi s ha educa ion enhances heal h li e acy and p o-
mo es heal hie li es yles, he eby educing disease incidence.
Con e sely, CO2 emissions a e expec ed o show a posi i e coe i-
cien , sugges ing a po en ial exace ba ing e ec on ch onic diseases.
Ex ensi e li e a u e has documen ed he ad e se heal h impac s o
en i onmen al pollu ion om CO2 emissions, including espi a o y and
ca dio ascula diseases. Ou s udy seeks o quan i y his ela ionship
wi hin he MENA con ex , highligh ing he u gen need o en i on-
men al policies ha p omo e sus ainable de elopmen and mi iga e
heal h isks.
Globaliza ion is an icipa ed o exhibi a nega i e coe icien ,
e lec ing i s po en ial ole in dissemina ing medical knowledge, ech-
nologies, and esou ces ha con ibu e o imp o ed heal h ou comes.
Howe e , globaliza ion’s impac on heal h ou comes can a y, in lu-
enced by ac o s such as ade policies, heal hca e access, and socio-
economic dispa i ies ac oss di e en coun ies wi hin he MENA egion.
GDP g ow h is expec ed o co ela e nega i ely wi h ch onic disease
mo ali y a es, indica i e o imp o ed heal hca e in as uc u e and
s anda ds o li ing associa ed wi h economic de elopmen . This ela-
ionship unde sco es he impo ance o economic policies ha p io i ize
public heal h in es men s and access o quali y heal hca e se ices.
2.2. Es ima ion model
This a icle employs h ee dis inc es ima ing app oaches o in es-
iga e he ela ionship be ween highe educa ion and ch onic and a al
diseases. Ini ially, we u ilize panel da a comp ising 16 coun ies,
le e aging he GLS e ec me hod. GLS e ec i ely add esses he e o-
scedas ici y and enhances es ima e p ecision by adjus ing o cha ac-
e is ics ha emain cons an o e ime o among indi iduals.
Fu he mo e, GLS is pa icula ly sui able o panel da a analysis,
accommoda ing ixed e ec s ha cap u e unique indi idual o en i y
a ibu es. This me hod aims o yield obus es ima es by simul aneously
conside ing he e oscedas ici y and ixed e ec s wi hin ou analy ical
amewo k.
No ing ha es ima ing speci ica ion h ough GLS yields exac ly he
same esul s as he OLS es ima ion (F ondel,& Vance, 2010) as we can
p o e:
yi =β0+βʹxi +ξi+
ν
i ,i=1,⋯,N, =1,⋯,T(2)
The s anda d panel da a model in equa ion (2) speci ies yi as a unc ion
o ime- a ying i , indi idual-speci ic ξi and idiosync a ic e o s
ν ν
i ,
To es ima e bo h ixed and be ween-g oups e ec s, equa ion (3) e-
ines his model by inco po a ing de ia ions o xi om i s mean x−i
cap u ed by w and b espec i ely:
yi =β0+wʹ(xi −x−i) + bʹx−i+ξi+
ν
i (3)
Using OLS, we can simul aneously es ima e hese e ec s. A e aging
equa ion (3) o e ime cancels ou he e m in ol ing w, making i
equi alen o he ime-a e aged o m o equa ion (1):
y−i=β0+bʹx−i+ξi+ −i(4)
sub ac ing his a e aged equa ion om Equa ion (3) esul s in:
yi −y−i=wʹ(xi −x−i) +
ν
i − −i(5)
Thus, demeaning Equa ion 2 o 3 and es ima ing ia OLS p o ides ixed-
e ec s es ima es.
Es ima ing panel model in equa ion (2) ia GLS is equi alen o
es ima ing:
yi −λ⋅y−i=β0⋅(1−λ) + βʹ(xi −λ⋅x−i) + ξi−λ⋅ξi+
ν
i −λ⋅ −i(6)
ia OLS, whe e λ adjus s o he ime ho izon and e o a iances ξi and
i . Employing he same ans o ma ion o Equa ion (3) yields:
yi −λ⋅y−i=β0⋅(1−λ) + wʹ(xi −λ⋅x−i) − λ⋅wʹ(xi −x) + bʹx−i
−λ⋅bʹx−i+ξi−λ⋅ξi+
ν
i −λ⋅ −i(7)
Recognizing ha (xi −x) = 0 and ea anging gi es:
Table 1
desc ip i e a iables.
Va iable Desc ip ion
Mo ali y om CVD, cance , diabe es o CRD be ween
exac ages 30 and 70 (%)
Likelihood o dea h om CVD, cance , diabe es, o CRD be ween ages 30 and 70.
G oss en ollmen a es. Te ia y The e ia y educa ion en ollmen a e e e s o he o al p opo ion o indi iduals en olled in e ia y educa ion,
ega dless o age, exp essed as a pe cen age o he o al popula ion o a g oup o indi iduals o e a i e-yea pe iod a e
comple ion o seconda y school
Co2 Emission Sou ces o ca bon dioxide emissions include ossil uel combus ion and cemen p oduc ion, which gene a e ca bon
dioxide h ough he consump ion o solid, liquid and gaseous uels, as well as h ough he la ing o gases.
GDP pe capi a (cu en US$) To calcula e GDP pe capi a, we di ide he g oss domes ic p oduc by he popula ion in he middle o he yea . in u n, is
he sum o he g oss alue added by all p oduce s who eside in he economy, including any axes on p oduc s and
excluding any subsidies no ac o ed in o he p oduc alue.
KOF Globaliza ion Index The KOF Globaliza ion Index is designed o assess he deg ee o globaliza ion o na ions wo ldwide. I is based on h ee
undamen al dimensions: economy, socie y and poli ics. Using hese dimensions, he index seeks o measu e economic
exchanges, economic cons ain s, in o ma ion lows, people- o-people con ac s and cul u al p oximi y o he coun ies
unde s udy. I s objec i e is o p o ide a comp ehensi e assessmen o globaliza ion
M. Zouine e al.
Resea ch in Globaliza ion 9 (2024) 100236
6
yi =β0+wʹ(xi −x−i) + bʹx−i+ξi+
ν
i +λ⋅(y−i−β0−bʹx−i−ξi− −i)
(8)
whe e(y−−β0−bʹx−i−ξi− −i) = 0
Which conclude ha bo h ans o ma ions and speci ica ions a e iden-
ical, demons a ing ha OLS es ima ion o equa ion (2) yields he same
esul s as es ima ing he ans o med equa ions ia OLS, which is
equi alen o es ima ing equa ion (3) ia GLS.
Nex , o assess coin eg a ion and asce ain po en ial long- e m e-
la ionships among a iables, we employ he panel uni oo es and Kao
coin eg a ion es . Addi ionally, we adop dynamic FMOLS and DOLS,
in oduced by Saikkonen (1991) and S ock and Wa son (1993), o es i-
ma e equilib ium coe icien s in highe -o de coin eg a ion sys ems.
These me hods add ess issues such as small sample bias, simul anei y
bias, and endogenei y, enhancing he accu acy o ou long- e m e ec
analysis.
To de i e esul s o speci ic panels, panel uni - oo es s ans o m
indi idual ADF uni - oo es s in o a single panel. Bal agi (2008) no ed
ha he high powe o hese es s has inc eased hei accep ance and
popula i y among econome icians and economis s. The undamen al
o m o he panel uni - oo es is exp essed as:
yi =Θiyi, −1+Xi ʹδi+∊i (9)
whe e i =1,2,…,Ni =1, 2,…,N c oss-sec ion uni s o se ies unde
obse a ion o e ime ame =1,2,…,Ti.Xi is he exogenous a iable
in he model, wi h any indi idual ends o ixed e ec s. The symbol
Θi ep esen s he au o eg essi e coe icien , while he e o e m ∊i is
assumed o be a mu ually independen indi idual dis u bance.
The lag o de ppp is allowed o a y ac oss indi iduals. The p ocess
ope a es as ollows: i s , he ADF es is un o each c oss-sec ion, as
shown in equa ion (10)
Δyi =Θiyi, −1+∑θiLΔyi, −L+amidm +ei (10)
In he second s ep, wo auxilia y eg essions we e compu ed:
Δyi on Δyi, −L and dm o ob ain he esiduals ei and yi, −1 on
Δyi, −L and dm o ob ain he esiduals i
, −1. In he nex s ep, esidual
s anda diza ion was ca ied ou by pe o ming he ollowing calcula-
ions:
ei =∊i /
σ
i(11)
yi
, −1=∊i
, −1/
σ
i(12)
whe e
σ
i signi ies he s anda d e o ob ained om each ADF. Finally,
he pooled OLS eg ession was compu ed using Equa ion (13):
ei =
ρ
yi
, −1+∊i (13)
In he con ex o he LLC es , he null hypo hesis assumes no uni oo .
The s anda d de ia ion, o -s a is ics, mus be adjus ed o accu a e
es ing. The LLC es equi es ce ain condi ions o be me o alidi y,
in ol ing speci ic ela ionships be ween he c oss-sec ional and ime
dimensions. To e i y he obus ness o he esul s, addi ional uni - oo
es s, such as he PP-Fishe and ADF-Fishe Chi-squa e es s, a e used.
Rega ding he panel coin eg a ion es s, he p esence o a long- e m
ela ionship was examined using he Ped oni, Kao, and Johansen Fishe
coin eg a ion es s. Ped oni in oduced se e al es p oposals in 1999
ha accommoda e he e ogenei y in coin eg a ion analysis (As e iou and
Hall, 2007) Ped oni’s es allows o he e ogenei y among coin eg a ed
ec o s in bo h he sho e m and he long e m. Simila ly, he Kao
(1999) coin eg a ion es acknowledges he he e ogenei y be ween
coin eg a ion ec o s, bu i iola es he ule o endogenei y o inde-
penden a iables due o asymp o ic equi alence. The coin eg a ion
eg ession equa ion is ep esen ed as ollows:
yi =
α
i+δi +β1ix1i +β2ix2i +⋯+βMixMi +ei (14)
In equa ion (14), T ep esen s he numbe o obse a ions, N ep esen s
he numbe o indi iduals on he panel, and M ep esen s he numbe o
eg ession a iables. Since he e a e N indi iduals on he panel, he e
will be N di e en equa ions o each o he M eg esso s. The co-
e icien s β1i,β2i,…,βMi ep esen he di e ences be ween indi iduals in
he panel. The pa ame e
α
i is he cons an e ec s pa ame e ha cap-
u es indi idual-speci ic di e ences. Addi ionally, i he e is a de e -
minis ic end among indi iduals in he panel, he pa ame e δi is added
o he equa ion.
The FMOLS me hod, o iginally de eloped by Phillips and Hansen
(1990), is designed o op imal co-in eg a ing eg ession es ima ion.
Howe e , in his s udy, he Ped oni (1999) he e ogeneous FMOLS es i-
ma o was u ilized o he panel coin eg a ion eg ession. This choice
o e s ad an ages such as co ec ing o endogenei y bias and add essing
se ial co ela ion issues (Ped oni, 1999; Hami -Hagga , 2012). Acco d-
ing o Hami -Hagga (2012), FMOLS is pa icula ly sui able o panel
da a analysis in ol ing he e ogeneous coin eg a ion s uc u es.
In he panel FMOLS es ima o applied o he coe icien β o he
model, he me hodology accoun s o hese complexi ies in he da a
s uc u e, enhancing he obus ness and eliabili y o he eg ession e-
sul s, he equa ion is:
β*
NT −β=(∑N
i=1L−2
22i∑T
=1(Xi −Xi)2)−1∑N
i=1L−1
11iL−1
22i(∑T
=1(Xi
−Xi)
μ
*
i −Tγi)
(15)
whe e
μ
*
i =
μ
i −L21i
L22i
ΔXi ,γi= 21i
Ω0
21i−L21i
L22i(Γ22i+
Ω0
21i)
Finaly, DOLS es ima o sha es he same asymp o ic dis ibu ion as he
panel FMOLS es ima o de i ed by Ped oni (1999). Bo h he DOLS and
FMOLS es ima ions we e conduc ed o ensu e he consis ency and eli-
abili y o he esul s.
2.3. Resul and discussion
Be o e p esen ing he es ima ion o he empi ical model, he able
p o ides an o e iew o he desc ip i e s a is ics o all a iables, as
explained below.
au ho ’s es ima ion on EVIEWS 12.
Table 2 shows ha he mean mo ali y a e is 9.16, wi h a median o
3.19. The highes eco ded mo ali y a e is app oxima ely 47.65, and
he lowes is a ound 0.96. Fo educa ion, he mean is abou 33.48. The
G oss Domes ic P oduc mean is app oxima ely 13771.11. The global-
iza ion index mean is a ound 59.98. Ca bon dioxide emissions ha e a
mean o app oxima ely 24199401.
The no able dispa i y be ween he mean and median alues o he
a iables indica es a non- andom dis ibu ion wi hin he da ase .
Table 2
Desc ip i e S a is ic o he Va iables.
MORT EDU GDP GLOB CO2
Mean 9.162752 33.47576 13771.11 59.97860 24,199,401
Median 3.187006 31.76469 4146.407 62.26858 10,094,561
Maximum 47.65131 72.96105 98041.36 79.48945 1.04E +08
Minimum 0.962827 9.314580 664.3417 31.90133 678831.0
S d. De . 11.28613 15.42167 19277.72 11.96264 28,495,436
Sum 1969.992 7197.287 2960788. 12895.40 5.20E +09
Sum Sq. De . 27258.64 50895.20 7.95E +
10
30624.41 1.74E +17
Obse a ions 215 215 215 215 215
M. Zouine e al.
Resea ch in Globaliza ion 9 (2024) 100236
7
Speci ically, when he mean subs an ially di e s om he median, i
sugges s ha he dis ibu ion is skewed o asymme ical. In his con ex ,
such a di e ence implies ha he dis ibu ion o he da a poin s is no
e enly sp ead a ound he cen e bu a he clus e ed owa ds one end o
he dis ibu ion.
The subsequen analysis will ocus on e i ying he no mali y
assump ion wi hin he da ase , as indica ed in he o hcoming able.
au ho ’s es ima ion on EVIEWS 12 *, **, ***indica e signi icance
espec i ely a he 1 %, 5 % and.
Table 3 demons a e ha he esul s o he Ja que-Be a es sugges
ha he e is insu icien e idence o ejec he null hypo hesis, implying
ha he esiduals ollow a no mal dis ibu ion. Howe e , i ’s wo h
no ing ha he da a exhibi s sligh skewness owa ds he nega i e side,
as e idenced by he nega i e skewness alue. This sugges s ha while
he o e all dis ibu ion may app oxima e no mali y, he e a e de-
ia ions ha wa an conside a ion, pa icula ly in e ms o he skewed
ail owa ds lowe alues. Fu he examina ion and po en ially addi-
ional s a is ical es s may be wa an ed o ully assess he no mali y
assump ion and i s implica ions o he analysis.
Table 4 shows ha he Cen e ed Va iance In la ion Fac o (VIF) as-
sesses mul icollinea i y in eg ession models. In his analysis, he VIF
alues o he a iables—EDU (4.12), GDP (2.31), GLOB (4.85), and
CO2 (3.01)— a e all below he con en ional h eshold o 10, indica ing
low mul icollinea i y. Wi h no VIF alue su passing his h eshold, he e
is no signi ican e idence o mul icollinea i y among he a iables. This
sugges s ha he p edic o a iables do no excessi ely co ela e wi h
each o he , enhancing he eliabili y o he eg ession analysis.
The absence o mul icollinea i y holds signi ican implica ions o
he in e p e a ion o eg ession esul s. Wi h low mul icollinea i y, he
eg ession coe icien s can be in e p e ed wi h g ea e con idence. Ab-
sen mul icollinea i y- ela ed issues such as in la ed s anda d e o s, he
eg ession coe icien s p o ide a s able ep esen a ion o he ela ion-
ships be ween he p edic o a iables and he ou come a iable. Thus,
he absence o mul icollinea i y ein o ces he alidi y o he eg ession
analysis and inc eases con idence in he in e p e a ion o i s indings.
The analysis o Table 5 e eals ha he Q s a is ics a e consis en ly
non-signi ican ac oss all lag speci ica ions. This means ha he Q es
ails o ejec he null hypo hesis, indica ing ha he e is no signi ican
au oco ela ion o e o s in he model. In o he wo ds, he pa e ns
obse ed in he esiduals a e likely due o andomness a he han sys-
ema ic ends o co ela ions o e ime. This inding ea i ms he
ea lie obse a ion ha he dis ibu ion o esiduals appea s o be
andom, u he bols e ing he con idence in he alidi y o he eg es-
sion model’s esul s.
in Fig. 1 sugges s ha hey con o m o a no mal dis ibu ion, indi-
ca ing he absence o he e oscedas ici y in ou model. This obse a ion
highligh s he obus ness o he model and i s sui abili y o he obse ed
da a.
In he upcoming phase, de ailed in he subsequen able, he ocus
shi s o assessing he p esence o a uni oo h ough h ee dis inc es s:
Le in, Lin, and Chu (LLC), Augmen ed Dickey-Fulle (ADF), and B ei-
ung es s. These es s a e pi o al o in es iga ing he s abili y o mean
and a iance o e ime, o e ing comp ehensi e insigh s in o he s a-
iona i y cha ac e is ics o he a iables unde sc u iny. The o e a ching
objec i e is o es ablish a ho ough unde s anding o hei beha io
be o e del ing in o he analysis o long- e m ela ionships among MENA
coun ies.
To achie e his goal, panel uni - oo es s a e employed, consoli-
da ing he ADF es s conduc ed a he coun y le el in o a single panel.
As emphasized by Bal agi (2008), he e icacy o panel uni - oo es s has
led o hei widesp ead accep ance, u iliza ion, and popula i y among
econome icians and economis s. This app oach enables a holis ic
assessmen o he s a iona i y p ope ies o he a iables ac oss he
MENA egion, laying a solid ounda ion o subsequen analyses o long-
e m ela ionships among he coun ies.
The conduc ed es s in Table 6 indica e ha he a iables in ou
equa ion exhibi s a iona i y a o de 1 (I(1)), wi h he null hypo hesis
(uni oo suppo ) accep ed o I(0) le el alues o he a iables.
Howe e , he null hypo hesis is ejec ed o he i s di e ences.
The e o e, we can in e ha he a iables a e in eg a ed a he i s o de
(I(1)).
Following his con i ma ion, he nex s ep in ol es employing he
Kao es o asce ain he p esence o a coin eg a ing ela ionship.
The Kao coin eg a ion es in Table 7 has con i med he p esence o a
coin eg a ing ela ionship among he a iables unde s udy, as e i-
denced by he Augmen ed Dickey-Fulle (ADF) alues. This inding en-
ables us o quan i y he long- e m impac o he explana o y a iables on
CO2 emissions in MENA coun ies.
The eg ession analysis in Table 8 e eals signi ican insigh s in o he
impac o socio-economic ac o s on mo ali y a es associa ed wi h
ch onic and a al diseases. Highe educa ion eme ges as a c i ical
de e minan , wi h a coe icien o −0.10, indica ing ha highe le els o
educa ion a e associa ed wi h lowe mo ali y a es. This sugges s ha
indi iduals wi h g ea e educa ional a ainmen may ha e be e heal h
ou comes due o imp o ed access o heal hca e esou ces and enhanced
heal h li e acy.
Economic g ow h also plays a signi ican ole, as indica ed by i s
coe icien o 0.21. The posi i e coe icien sugges s ha as economies
g ow, mo ali y a es end o inc ease. This may be a ibu ed o changes
in li es yle beha io s associa ed wi h economic de elopmen , such as
seden a y li es yles and unheal hy die a y habi s, which con ibu e o
ch onic diseases and highe mo ali y a es.
Globaliza ion exhibi s a nega i e coe icien o −0.40, sugges ing
ha inc eased globaliza ion is linked o lowe mo ali y a es. This im-
plies ha globaliza ion acili a es he dissemina ion o medical knowl-
edge and heal hca e inno a ions, leading o imp o ed heal h ou comes
on a global scale.
On he o he hand, CO2 emissions show a posi i e coe icien o 0.44,
indica ing a co ela ion be ween highe CO2 emissions and inc eased
mo ali y a es. This associa ion likely a ises om he ole o CO2
emissions in exace ba ing ai pollu ion, which is a signi ican
Table 3
No mali y es .
Mean Median Maximum Minimum Skewness Ku osis Ja que-Be a P obabili y
−0.09241 0.013444 −1.84542 1.301347 −0.112322 2.84432 2.24144 0.40
Table 4
The Cen e ed Va iance In la ion Fac o (VIF) es .
Va iable Cen e ed VIF
EDU 4.12421
GDP 2.31938
GLOB 4.85412
CO2 3.01314
C NA
Table 5
Q-s a is ic esul s.
Lag speci ica ion AC PAC Q-S a is ic P alue
1 0.194 0.194 2.1570 0.142
2 0.194 0.163 4.3518 0.114
3 0.045 −0.019 4.4726 0.215
4 0.056 0.022 4.6646 0.323
M. Zouine e al.
Resea ch in Globaliza ion 9 (2024) 100236
8
con ibu o o espi a o y and ca dio ascula diseases.
The analysis o Table 9 p o ides aluable insigh s in o he long- e m
dynamics be ween highe educa ion, GDP, globaliza ion, and mo ali y
due o ch onic and a al diseases, and hei espec i e impac s on heal h
ou comes. U ilizing bo h FMOLS and DOLS echniques, he coe icien s
e eal nuanced ela ionships be ween hese socio-economic ac o s and
heal h ou comes.
Beginning wi h highe educa ion, bo h FMOLS and DOLS es ima ions
showcase nega i e coe icien s, indica ing an in e se ela ionship be-
ween educa ional a ainmen and mo ali y due o ch onic and a al
diseases. Speci ically, FMOLS yields a coe icien o −0.26, while DOLS
epo s a sligh ly lowe coe icien o −0.20. This sugges s ha highe
le els o educa ion may con ibu e o a educ ion in mo ali y o e he
long e m, possibly h ough inc eased heal h li e acy and access o
be e heal hca e.
Simila ly, he coe icien s o GDP demons a e a nega i e associa-
ion wi h mo ali y due o ch onic and a al diseases in bo h FMOLS and
DOLS es ima ions. FMOLS epo s a coe icien o −0.70, while DOLS
yields a compa able coe icien o −0.69. This implies ha as GDP in-
c eases, he e is a co esponding dec ease in mo ali y, e lec ing po-
en ial imp o emen s in heal hca e in as uc u e and s anda ds o
li ing.
Fu he mo e, he coe icien s o globaliza ion exhibi nega i e
alues ac oss bo h es ima ion echniques, albei wi h sligh a ia ions.
FMOLS indica es a coe icien o −0.37, while DOLS epo s a coe icien
o −0.34. This unde sco es he po en ial ole o globaliza ion in os e ing
be e heal h ou comes h ough he dissemina ion o medical knowl-
edge, echnologies, and esou ces ac oss bo de s.
Las ly, bo h echniques indica e a posi i e ela ionship be ween
ca bon emissions (CO2) and mo ali y due o ch onic and a al diseases.
Howe e , he DOLS coe icien is no ably highe , sugges ing a s onge
associa ion o e he long e m compa ed o FMOLS. This unde sco es
he u gency o add essing ca bon emissions o mi iga e hei impac on
public heal h.
In he MENA egion, ch onic diseases such as CVDs, cance , espi-
a o y diseases, and diabe es impose a signi ican heal h bu den,
con ibu ing o a subs an ial po ion o mo bidi y and mo ali y. Ac-
co ding o he Wo ld Heal h O ganiza ion (WHO), non-communicable
diseases (NCDs) accoun o app oxima ely 70 % o dea hs in he e-
gion, d i en la gely by li es yle ac o s including u baniza ion, seden-
a y li es yles, unheal hy die s, obacco use, and obesi y (WHO, 2020).
Ca dio ascula diseases, pa icula ly ischemic hea disease and
s oke, a e he leading causes o mo ali y in he MENA egion. In 2019
alone, ischemic hea disease was esponsible o mo e han 810,000
dea hs, wi h s oke causing o e 370,000 dea hs (WHO, 2020). Cance
a es a e also ising, wi h b eas , lung, colo ec al, and p os a e cance s
being p e alen o ms. Respi a o y diseases such as ch onic obs uc i e
pulmona y disease (COPD) and as hma p esen signi ican heal h chal-
lenges, wi h COPD alone accoun ing o app oxima ely 3.2 million
disabili y-adjus ed li e yea s (DALYs) los in 2019 (WHO, 2020).
The p e alence o obesi y and hype ension in coun ies like Bah ain,
Egyp , Jo dan, Kuwai , Saudi A abia, and he UAE has eached ala ming
le els. In 2015, obesi y a ec ed 30.9 % o adul men and 45.9 % o adul
women in he egion, while nea ly a qua e o he popula ion su e s
om hype ension (WHO, 2020). Tobacco use emains a p e alen isk
ac o o ch onic diseases, wi h app oxima ely 24.3 % o adul s in he
egion epo ed as smoke s, con ibu ing signi ican ly o CVDs, espi-
a o y diseases, and cance (WHO, 2020).
Despi e hese ala ming s a is ics, public heal h policy esponses o
he g owing bu den o ch onic diseases in he MENA egion ha e been
slow and inadequa e. The e is an u gen need o e idence-based in-
e en ions ha s eng hen esea ch capaci ies and implemen
comp ehensi e s a egies o he p e en ion and managemen o NCDs.
Fig. 1. Sca e plo o Residual, Ac ual, and Fi ed Values o he Dependen Va iable.
Table 6
Uni Roo es .
Tes and a iables CO2 EDU GDP GLOB MORT
LLC I(1)* I(1)* I(1)* I(1)* I(1)*
ADF I(1)* I(1)* I(1)* I(1)* I(1)*
PP I(1)* I(1)* I(1)* I(1)* I(1)*
Sou ce: au ho ’s es ima ion on EVIEWS 12 *, **, ***indica e signi icance
espec i ely a he 1 %, 5 % and 10 % le el.
Table 7
Kao’s coin eg a ion es .
Kao es T-s a is ic
ADF −3.14424*
Residual alue 0.84240
HAC a iance 0.92112
Sou ce: au ho ’s es ima ion on EVIEWS 12 *, **,
***indica e signi icance espec i ely a he 1 %, 5 %
and 10 % le el.
M. Zouine e al.
