The current study investigated the association between out-of-pocket health expenditure and poverty using macroeconomic data from a sample of 145 countries from 2000 to 2017. In particular, it was examined whether the relationship between out-of-pocket health expenditure and poverty was contingent on a certain threshold level of out-of-pocket health spending. The dynamic panel threshold method, which allows for the endogeneity of the threshold regressor (out-of-pocket health expenditure), was used. Three indicators were adopted as poverty measures, namely the poverty headcount ratio, the poverty gap index, and the poverty gap squared index. At the same time, out-of-pocket health expenditure was measured as a percentage of total health expenditure. The results showed the validity of the estimated threshold models, indicating that only beyond the turning point, which was about 29 percent, that out-of-pocket health spending led to increased poverty. When heterogeneity was controlled for in the sample, using the World Bank income classification, the findings showed variations in the estimated threshold, with higher values for the low- and lower-middle-income groups, as compared to the high-income group. For the lower-income groups, below the threshold for out-of-pocket health expenditure, it had a positive or insignificant effect on poverty reduction, while it led to higher poverty above the threshold. Further, the sampled countries were divided into regions, according to the World Health Organization. Generally, improving health care systems through tolerable levels of out-of-pocket health expenditure is an inevitable step toward better health coverage and poverty reduction in many developing countries.

The COVID-19 pandemic has renewed the global focus on the role of public health spending, particularly in developing regions where fiscal space is mostly limited. Many African countries have started reassessing the health sector as a core economic resilience component. This study examines how government health expenditure responds to macroeconomic fluctuations in African countries. Attention was given to asymmetries between positive and negative periods of GDP growth and the impact of COVID-19 on these dynamics. The analysis uses annual data from 45 African economies from 2000 to 2022 and applies a panel NARDL framework to capture nonlinear and dynamic relationships. The sample is further disaggregated into low-income and middle-income groups. The results from the full sample indicate a procyclical pattern of health spending, where expenditure rises during economic expansions, but it discloses an acyclical relationship during recessions. Further analysis reveals that health spending in low-income countries follows a similar procyclical trend, while middle-income countries exhibit a countercyclical response to positive and negative growth shocks. Inflation consistently reduces health spending across the sample. The COVID-19 period has altered the cyclical pattern of health expenditure, at least in the short-run, especially for low-income countries. These findings highlight the need for more resilient and countercyclical fiscal strategies in the health sector, specifically during economic downturns, to ensure sustained investment.

The link between economic development and environmental outcomes has become increasingly evident. The study examines how economic growth influences environmental degradation in Sudan, using annual time series data spanning 1980-2022. The analysis accounts for potential structural breaks in unit root and cointegration testing. An Autoregressive Distributed Lag model is employed to assess the long-run relationship. The Environmental Kuznets Curve hypothesis is evaluated using three different approaches. Findings indicate that the EKC does not hold in the case of Sudan. The results suggest that, as developing a country, Sudan’s income level remains below the threshold at which economic growth would start to reduce environmental harm. The study also highlights the significant impact of energy consumption on the country’s carbon emissions. To address these challenges, robust and well-enforced environmental policies are recommended to mitigate the adverse effects of future generations.