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Inequalities in child health: Who is reaching the absolute poor?. Emmanuela Gakidou, Margaret Hogan, Christopher JL Murray, Angelica Sousa, Ajay Tandon, Cecilia Vidal. Workshop on Inequalities in Financing and Health Mexico City, April 22, 2004. Data Sources.

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inequalities in child health who is reaching the absolute poor

Inequalities in child health:Who is reaching the absolute poor?

Emmanuela Gakidou, Margaret Hogan, Christopher JL Murray, Angelica Sousa, Ajay Tandon, Cecilia Vidal

Workshop on Inequalities in Financing and Health

Mexico City, April 22, 2004

Harvard Center for Basic Research in the Social Sciences

Harvard University Initiative for Global Health

data sources
Data Sources
  • Inequalities analysis requires data on outcomes and outputs of the health system and rich information on socio-economic status
  • Economic status: Perhaps most important SES variable, but least measured in health surveys
  • Best suited data sources for health inequalities analyses:
    • Demographic and Health Surveys (112 surveys in 65 countries)
    • World Health Surveys (71 surveys in 71 countries)

Harvard Center for Basic Research in the Social Sciences

Harvard University Initiative for Global Health

information available in dhs
Socio-demographic

Age & sex

Economic status

Education

Place of residence

Race / Ethnicity

Household size

Health

Child mortality

Immunizations

Birth attendance

Antenatal care

Information available in DHS

Harvard Center for Basic Research in the Social Sciences

Harvard University Initiative for Global Health

economic status estimation
Economic status estimation
  • Use all available indicators including consumer and non-traded goods. All must be normal goods.
    • ownership of radio, television, car, motorbike, phone; material of floor, wall, roof; type of water and sanitation facilities; electricity
  • Estimate permanent income on the same scale across all countries
  • Divide “global” population into quintiles

Cross-country comparable estimates of health status of the poor

Harvard Center for Basic Research in the Social Sciences

Harvard University Initiative for Global Health

results from the dhs
Results from the DHS
  • Trends over time for Bolivia, Egypt, Indonesia and Zimbabwe
    • under-2 mortality
    • DTP3 immunization
    • skilled birth attendance

Harvard Center for Basic Research in the Social Sciences

Harvard University Initiative for Global Health

slide6

Trends in under 2 mortality by income quintile

Harvard Center for Basic Research in the Social Sciences

Harvard University Initiative for Global Health

slide7

Trends in DTP3 by income quintile

Harvard Center for Basic Research in the Social Sciences

Harvard University Initiative for Global Health

slide8

Trends in skilled birth attendance by income quintile

Harvard Center for Basic Research in the Social Sciences

Harvard University Initiative for Global Health

within quintile inequalities
Within-quintile inequalities
  • How do the poor compare across countries?
  • How much worse off are the rural poor?

Harvard Center for Basic Research in the Social Sciences

Harvard University Initiative for Global Health

within quintile inequalities across countries
Within quintile inequalities across countries

Harvard Center for Basic Research in the Social Sciences

Harvard University Initiative for Global Health

skilled birth attendance by quintile in urban and rural populations 4 regions
Skilled birth attendance by quintile in Urban and Rural Populations: 4 regions

Harvard Center for Basic Research in the Social Sciences

Harvard University Initiative for Global Health

conclusions
Conclusions
  • Health status of absolute poor varies substantially across countries
  • Some countries are more effective at reaching the absolute poor
  • Simple interventions are easier to deliver to the absolute poor; the more complex the intervention the greater the gradient
  • Poverty may not be the most important social determinant in all settings

Harvard Center for Basic Research in the Social Sciences

Harvard University Initiative for Global Health