Inequalities in health in developing countries - swimming against the tide?
AbstractInequalities in health have recently started to receive a good deal of attention in the developing world. But how large are they? An how large are the differences across countries? Recent data from a 42-country study, show large, but varying inequalities in health across countries. The author explores the reasons for these inter-country differences, and concludes that large inequalities in health, are not apparently associated with large inequalities in income, or with small shares of publicly financed health spending. But they are associated with higher per capita incomes. Evidence from trends in health inequalities - in both the developing, and the industrial world - supports the notion that health inequalities rise with rising per capita incomes. The association between health inequalities, and per capita incomes is probably due in part, to technological change going hand-in-hand with economic growth, coupled with a tendency for the better-off to assimilate new technology ahead of the poor. Since increased health inequalities, associated with rising per capita incomes is a bad thing, and increased average health levels associated with rising incomes are a good thing, the author outlines a way of quantifying the tradeoff between health inequalities, and health levels. He also suggests that successful anti-inequality policies can be devised, but that their success cannot be established simply by looking at"headline"health inequality figures, since these reflect the effects of differences, and changes in other variables, including per capita income. The author identifies four approaches that can shed light on the impacts of anti-inequality policies on health inequalities: cross-country comparative studies, country-based before-and-after studies with controls, benefit-incidence analysis, and decomposition analysis. The results of studies based on these four approaches do not give as many clear-cut answers as one might like on how best to swim against the tide of rising per capita incomes, and their apparent inequality-increasing effects. But they ought at least to help us build our stock of knowledge on the subject.
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Bibliographic InfoPaper provided by The World Bank in its series Policy Research Working Paper Series with number 2795.
Date of creation: 28 Feb 2002
Date of revision:
Health Systems Development&Reform; Economic Theory&Research; Public Health Promotion; Early Child and Children's Health; Health Monitoring&Evaluation; Health Monitoring&Evaluation; Inequality; Health Systems Development&Reform; Agricultural Knowledge&Information Systems; Regional Rural Development;
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- Castro-Leal, Florencia & Dayton, Julia & Demery, Lionel & Mehra, Kalpana, 1999. "Public Social Spending in Africa: Do the Poor Benefit?," World Bank Research Observer, World Bank Group, vol. 14(1), pages 49-72, February.
- David E. Sahn & Stephen D. Younger, 2000. "Expenditure incidence in Africa: microeconomic evidence," Fiscal Studies, Institute for Fiscal Studies, vol. 21(3), pages 329-347, September.
- van Doorslaer, Eddy & Wagstaff, Adam & Bleichrodt, Han & Calonge, Samuel & Gerdtham, Ulf-G. & Gerfin, Michael & Geurts, Jose & Gross, Lorna & Hakkinen, Unto & Leu, Robert E., 1997. "Income-related inequalities in health: some international comparisons," Journal of Health Economics, Elsevier, vol. 16(1), pages 93-112, February.
- Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003.
"On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam,"
Journal of Econometrics,
Elsevier, vol. 112(1), pages 207-223, January.
- Wagstaff, Adam & Van Doorslaer, Eddy & Watanabe, Naoko, 2001. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Policy Research Working Paper Series 2714, The World Bank.
- Filmer, Deon & Hammer, Jeffrey & Pritchett, Lant, 1998. "Health policy in poor countries : weak links in the chain," Policy Research Working Paper Series 1874, The World Bank.
- Deon Filmer & Lant Pritchett, 1999. "The Effect of Household Wealth on Educational Attainment: Evidence from 35 Countries," Population and Development Review, The Population Council, Inc., vol. 25(1), pages 85-120.
- Bidani, Benu & Ravallion, Martin, 1995.
"Decomposing social indicators using distributional data,"
Policy Research Working Paper Series
1487, The World Bank.
- Bidani, Benu & Ravallion, Martin, 1997. "Decomposing social indicators using distributional data," Journal of Econometrics, Elsevier, vol. 77(1), pages 125-139, March.
- Wagstaff, Adam & Nga Nguyet Nguyen, 2002. "Poverty and survival prospects of Vietnamese children under Doi Moi," Policy Research Working Paper Series 2832, The World Bank.
- Paul Contoyannis & Martin Forster, 1999. "'Our healthier nation'?," Health Economics, John Wiley & Sons, Ltd., vol. 8(4), pages 289-296.
- Pritchett, Lant & Summers, Lawrence H., 1993.
"Wealthier is healthier,"
Policy Research Working Paper Series
1150, The World Bank.
- Contoyannis, Paul & Forster, Martin, 1999.
"The distribution of health and income: a theoretical framework,"
Journal of Health Economics,
Elsevier, vol. 18(5), pages 603-620, October.
- Paul Contoyannis & Martin Forster, . "The Distribution of Health and Income: A Theoretical Framework," Discussion Papers 98/22, Department of Economics, University of York.
- Wagstaff, Adam & Paci, Pierella & van Doorslaer, Eddy, 1991. "On the measurement of inequalities in health," Social Science & Medicine, Elsevier, vol. 33(5), pages 545-557, January.
- Wagstaff, Adam & Watanabe, Naoko, 2000. "Socioeconomic inequalities in child malnutrition in the developing world," Policy Research Working Paper Series 2434, The World Bank.
- Le Grand, Julian, 1987. "Inequalities in health : Some international comparisons," European Economic Review, Elsevier, vol. 31(1-2), pages 182-191.
- Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
- van Doorslaer, Eddy & Wagstaff, Adam, 1992. "Equity in the delivery of health care: some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 389-411, December.
- William Easterly, 2002. "The Elusive Quest for Growth: Economists' Adventures and Misadventures in the Tropics," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262550423, January.
- Narayan Sastry, 2002. "Trends in Socioeconomic Inequalities in Under-Five Mortality: Evidence from Sao Paulo, Brazil, 1970-1991," Working Papers 02-15, RAND Corporation Publications Department.
- Maureen Mackintosh, 2006. "Commercialisation, inequality and the limits to transition in health care: a Polanyian framework for policy analysis," Journal of International Development, John Wiley & Sons, Ltd., vol. 18(3), pages 393-406.
- Yusuf, Shahid & Nabeshima, Kaoru & Wei Ha, 2007. "What makes cities healthy ?," Policy Research Working Paper Series 4107, The World Bank.
- Omilola, Babatunde, 2010. "Patterns and trends of child and maternal nutrition inequalities in Nigeria," IFPRI discussion papers 968, International Food Policy Research Institute (IFPRI).
- Giovanni Andrea Cornia & Luca Tiberti & Stefano Rosignoli & UNICEF Innocenti Research Centre, 2011. "The Impact of the Food and Financial Crises on Child Mortality: The case of sub-Saharan Africa," Innocenti Working Papers inwopa633, UNICEF Innocenti Research Centre.
- Van Ourti, Tom & van Doorslaer, Eddy & Koolman, Xander, 2009. "The effect of income growth and inequality on health inequality: Theory and empirical evidence from the European Panel," Journal of Health Economics, Elsevier, vol. 28(3), pages 525-539, May.
- Raquel Bernal & Mauricio Cárdenas Santa María, 2005. "Race and Ethnic Inequality in Health and Health Care in Colombia," WORKING PAPERS SERIES. DOCUMENTOS DE TRABAJO 003413, FEDESARROLLO.
- Udaya S Mishra & William Joe, 2010. "Socioeconomic Inequalities in Childhood Undernutrition in India An Application of the Corrected Concentration Index," Economics Bulletin, AccessEcon, vol. 30(1), pages 847-854.
- Tom Van Ourti & Eddy Van Doorslaer & Xander Koolman, 2006. "The Effect of Growth and Inequality in Incomes on Health Inequality: Theory and Empirical Evidence from the European Panel," Tinbergen Institute Discussion Papers 06-108/3, Tinbergen Institute.
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