Does the Health Kuznets Curve hypothesis hold for Saudi Arabia? A quantile ARDL analysis of disability-adjusted life years and their burden components

Even though the drivers of public health have been extensively investigated, there is a lack of evidence on what contributes to the public health burden in developing countries. This research bridges this gap by testing the Health Kuznets Curve hypothesis in Saudi Arabia, while accounting for the conditional effects of economic, environmental, and social factors within the Grossman health production framework. Three measures of public health burden are considered: Disability-Adjusted Life Years (DALYs) as an overall indicator, Years of Life Lost (YLLs) as a proxy for premature deaths, and Years Lived with Disability (YLDs) as a proxy for morbidity. Using annual data covering the period 1990-2021, this study employs the Quantile Autoregressive Distributed Lag model to investigate the nonlinear effects of key determinants across different quantiles of public health burden. The results reveal an inverted U-shaped association between income and public health, supporting the Health Kuznets Curve hypothesis for all quantiles of DALYs, with a turning point ranging between $20,543.805 and $21,459.450. The findings also reveal an inverted U-shaped relationship for YLLs and YLDs. However, the turning points for YLLs are slightly higher than those associated with YLDs, suggesting that economic growth reduces non-fatal health burdens before it reduces premature deaths. Finally, the findings reveal that GHG emissions and unemployment deteriorate health outcomes across all quantiles, while the impact of globalization is mixed.