Exploring Different Configurations of Health Determinants in European Countries

ABSTRACT The macro‐level determinants of health are well documented in the literature. However, the causal interrelations among these health determinants are less comprehensively understood. This study examines the potential causal relationships between health determinants and population health, measured using the Disability Adjusted Life Years (DALY) indicator. Rather than focusing on isolated causal links, this study seeks to identify causal configurations of health determinants contributing to high and low DALY levels. To this end, a fuzzy‐set qualitative comparative analysis (fsQCA) is conducted, allowing for the identification of complex causal patterns across a range of causal conditions for 25 European countries over the period 2000–2019. The findings reveal three configurations associated with high DALY levels and six configurations linked to low DALY values. Low Public health expenditures, GDP per capita, and financial development are critical factors shared by all the configurations leading to a high DALY. Other core conditions for this outcome are low private health expenditures and public debt to GDP ratio (Configurations 1 and 3) and low urbanization (Configurations 1 and 2). For low DALY, high public health expenditures (Configurations 2, 4, 5, and 6), high GDP per capita (Configurations 3, 4, 5, and 6), high financial development (Configurations 1, 2, 3, and 5), and low PM2.5 emissions (Configurations 1, 3, and 6) emerge as core conditions. Recognizing multiple causal combinations is particularly important for policymakers when addressing causal conditions requiring sustained long‐term interventions with varying intervention costs.