This study investigated disparities in full immunisation coverage across and within 86 low- and middle-income countries. In May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, the authors investigated inequalities in full immunisation coverage – i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine – in 86 low- or middle-income countries. The authors then investigated temporal trends in the level and inequality of such coverage in eight of the countries. In each of the World Health Organisation’s regions, it appeared that about 56–69% of eligible children in the low- and middle-income countries had received full immunisation. However, within each region, the mean recorded level of such coverage varied greatly. In the African Region, for example, it varied from 11.4% in Chad to 90.3% in Rwanda. The authors detected pro-rich inequality in such coverage in 45 of the 83 countries for which the relevant data were available and pro-urban inequality in 35 of the 86 study countries. Among the countries in which the authors investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunisation coverage over the last two decades, particularly among the poorest quintiles of their populations. Most low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunisation coverage that are not apparent when only national mean values of such coverage are reported.
Equity in Health
This study investigates inequalities both in poor self-assessed health (SAH) and in the distribution of selected risk factors of ill-health among the adult populations in six SADC countries. Data come from the 2002/04 World Health Survey (WHS) using six SADC countries (Malawi, Mauritius, South Africa, Swaziland, Zambia and Zimbabwe) where the WHS was conducted. Poor SAH is reporting bad or very bad health status. Risk factors such as smoking, heavy drinking, low fruit and vegetable consumption and physical inactivity were considered, as were other environmental factors. Socioeconomic status was assessed using household expenditures. Generally, a pro-poor socioeconomic inequality exists in poor SAH in the six countries. However, this is only significant for South Africa, and marginally significant for Zambia and Zimbabwe. Smoking and inadequate fruit and vegetable consumption were significantly concentrated among the poor. Similarly, the use of biomass energy, unimproved water and sanitation were significantly concentrated among the poor. However, inequalities in heavy drinking and physical inactivity are mixed. Overall, a positive relationship exists between inequalities in ill-health and inequalities in risk factors of ill-health. The authors argue that there is a need for concerted efforts to tackle the significant socioeconomic inequalities in ill-health and health risk factors in the region. With some of the determinants of ill-health lying outside the health sector, inter-sectoral action is required.
This study investigates inequalities both in poor self-assessed health (SAH) and in the distribution of selected risk factors of ill-health among the adult populations in six Southern African Development Community (SADC) countries. Generally, a pro-poor socioeconomic inequality exists in poor SAH in the six countries. However, this is only statistically significant for South Africa, and marginally significant for Zambia and Zimbabwe. Smoking and inadequate fruit and vegetable consumption were significantly concentrated among poor people. Similarly, the use of biomass energy, unimproved water and sanitation were significantly concentrated among poor. people However, inequalities in heavy drinking and physical inactivity are mixed. Overall, a positive relationship exists between inequalities in ill-health and inequalities in risk factors of ill-health. The authors argue for concerted efforts to tackle the significant socioeconomic inequalities in ill-health and health risk factors in the region. Because some of the determinants of ill-health lie outside the health sector, they also indicate that inter-sectoral action is required
This article defines and distinguishes between unavoidable health inequalities and unjust and preventable health inequities. The authors describe the dimensions along which health inequalities are commonly examined, including across the global population, between countries or states, and within geographies, by socially relevant groupings such as race/ethnicity, gender, education, caste, income, occupation, and more. Different theories attempt to explain group-level differences in health, including psychosocial, material deprivation, health behaviour, environmental, and selection explanations. Concepts of relative versus absolute; dose–response versus threshold; composition versus context; place versus space; the life course perspective on health; causal pathways to health; conditional health effects; and group-level versus individual differences are vital in understanding health inequalities. The authors close by reflecting on what conditions make health inequalities unjust, and consider the merits of policies that prioritise the elimination of health disparities versus those that focus on raising the overall standard of health in a population.
Very little is known about socioeconomic related inequalities in multi-morbidity, especially in developing countries. Traditionally, studies on health inequalities have mainly focused on a single disease condition or different conditions in isolation. This paper examines socioeconomic inequality in multi-morbidity in illness and disability in South
Africa between 2005 and 2008. Data were drawn from the 2005, 2006, 2007, and 2008 rounds of the nationally representative annual South African General Household Surveys. Indirectly standardised concentration indices were used to assess socioeconomic inequality. A proxy index of socioeconomic status was constructed, for each year, using a selected set
of variables that are available in all the GHS rounds. Multi-morbidity in illness and disability were constructed using data on nine illnesses and six disabilities contained in the GHS. Multi-morbidity was found to affect a substantial number of South Africans. Most often, based on the nine illness conditions and six disability conditions considered, multi-morbidity in illness and multi-morbidity in disability were each found to
involve only two conditions. In 2008 in South Africa, the multi-morbidity that affected the greatest number of individuals combined high blood pressure with at least one other illness. Between 2005 and 2008, multi-morbidity in illness and disability was more prevalent among poor people; in disabilities this is yet more consistent. While there is a dearth of information on the socioeconomic distribution of multi-morbidity in many
developing countries, the paper shows that its distribution in South Africa indicates that the poor bear a greater burden of multi-morbidity. The author argues that, given the high burden and skewed socioeconomic distribution of multi-morbidity, there is a need to design policies to address this situation, and surveys that specifically assess multi-morbidity.
The objective of this study was to quantify inequalities in selected Millennium Development Goal (MDG) indicators in all the 192 WHO Member States using descriptive statistics, the Gini coefficient and the Theil coefficient. The data on all the indicators were obtained from The World Health Report 2004. The main findings were as follows: (i) generally, all the MDG indicators are significantly worse in low-income countries than in the other three income groupings; (ii) for all the MDG indicators, there are inequalities within individual countries, within the four income groups, and across income groups of countries; (iii) the inequalities in the MDG indicators are higher among the low-income countries than in high-income countries; and (iv) the ranking of income groups, by various indicators, is fairly stable whether one employs the Gini coefficient or Theil coefficient. Member States striving to expand the effective coverage of heatlh strategies and interventions need to do this in a manner that redresses the inequalities in various MDG indicators, and to monitor aggregate changes in MDG indicators and inequalities across the various income quintiles. The lessons learnt from the monitoring should inform the design and targeting of MDG-related policies, strategies and interventions to eradicate inequalities.
William Easterly, Center for Global Development - Institute for International Economics, Working Paper No.1, January 2002.
This paper argues that the conflicting results in the voluminous recent literature on inequality and growth are missing the big picture on inequality and long-run economic development. Consistent with the provocative hypothesis of Engerman and Sokoloff 1997 and Sokoloff and Engerman 2000, this paper confirms with cross-country data that commodity endowments predict the middle class share of income and the middle class share predicts development. The use of commodity endowments as instruments for middle class share addresses problems of measurement and endogeneity of inequality. The paper tests the mechanisms - institutions, redistributive policies, and schooling - by which the literature has argued that a higher middle class share raises per capita income. It tests the inequality hypothesis for institutional quality, redistributive policies, and schooling against other recent hypotheses in the literature. The results were subjet to testing for over-identifying restrictions, reverse causality, and other checks for robustness. While finding some evidence consistent with other development fundamentals, the paper finds high inequality to independently be a large and statistically significant barrier to developing the mechanisms by which prosperity is achieved.
Evidence on trends and determinants of disability-free life expectancies (DFLEs) are available in high-income countries but less in low and middle-income countries (LMICs). This study examines the levels of and inequalities in life expectancy(LE), disability and DFLE between men and women across different age groups aged 50 years and over in six countries with developing economies. This study utilised the cross-sectional data (n=32 724) from the WHO Study on global AGEing and adult health in China, Ghana, India, Mexico, the Russian Federation and South Africa in 2007–2010. Disability was measured with the activity of daily living instrument.. The disability prevalence ranged from 13% in China to 54% in India. Women were more disadvantaged with higher prevalence of disability across all age groups. Though women had higher LE, their proportion of remaining LE free from disability was lower than men. There are inequalities in the levels of disability and DFLE among men and women in different age groups among people aged over 50 years in these six countries. Countermeasures to decrease intercountry and gender gaps in DFLE, including improvements in health promotion and healthcare distribution, with a gender equity focus, are needed.
South Africa remains one of the most unequal societies in the world. In its third South Africa Economic Update in 2012, the World Bank pointed out that the potential for economic growth has been held back by industrial concentration, skills shortages, labour market rigidities and chronically low savings and investment rates. The bank further stated that the economic growth has also been highly uneven in distribution and this continues to perpetuate inequality and economic exclusion. Despite this, the country is making some strides in tackling the socioeconomic ills faced by its poor majority. In this paper the author week’s writes that economic growth usually leads to increasing levels of inequality in developing countries. He notes, however, that as economies develop, larger portions of their populations move from agriculture into other sectors of the economy and their skills base expand to a point where inequality falls. He warns that there are no quick and easy solutions to South Africa’s inequality problem, adding that without substantive improvements in the human capital of the poor, income inequality will remain unacceptably wide.
This fact sheet outlines trends in key dimensions of socio-economic inequality in the BRICS countries (Brazil, Russia, India, China and South Africa), looking especially at education, gender, health, social expenditure and environmental sustainability. The BRICS countries have growing influence in the global economy, but face challenges in reducing inequality. For instance, growth in the informal jobs sector is associated with deepening inequality, and working women are particularly affected. In South Africa, India and China, rural dwellers are increasingly poorer than their urban counterparts; 50.3% of China’s rural population is excluded from public benefits such as health insurance and higher levels of education. In all the BRICS, girls are disadvantaged in levels of access to education, especially in rural areas. Gaps in women’s and men’s economic participation are high, although the number of women in political leadership in Brazil and South Africa has increased. Regressive taxation systems, dependent on consumption rather than income, and subscription-based social security schemes, mean that the poorest are disproportionately taxed and lack security nets such as health insurance. And with climate change disproportionately impacting poor and vulnerable populations, strategies for ‘green growth’ must also address inequalities in people’s exposure to environmental risks.