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Achieving better measles immunization in developing countries: does higher coverage imply lower inequality?

Listed author(s):
  • Meheus, Filip
  • Van Doorslaer, Eddy

Changes in measles immunization are commonly expressed in terms of a change in mean coverage rates but these mean changes may conceal substantial disparities within societies by poverty status. This paper analyzes trends in both the level and the socio-economic distribution of measles immunization coverage in the 1990s for 21 developing countries with two rounds of Demographic and Health Surveys available. We examine these trends using "achievement" indices that combine trends in means and in inequality. We propose and employ "achievement contours" to illustrate graphically how a greater degree of societal aversion to inequality may affect the ranking of countries in terms of achieved measles immunization coverage. The results indicate that most countries have experienced an improvement in their mean measles immunization rate but that this improvement was often unequally distributed across wealth groups, disfavouring the poor in all countries. Mean improvements were found to be associated with both increasing and decreasing inequality. When the trend in the mean and in the degree of inequality was opposite, the trend in the overall "achievement" score is determined by the assumed underlying degree of inequality aversion. As such, the achievement measure "penalizes" coverage improvements that leave the poor lagging behind.

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Article provided by Elsevier in its journal Social Science & Medicine.

Volume (Year): 66 (2008)
Issue (Month): 8 (April)
Pages: 1709-1718

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Handle: RePEc:eee:socmed:v:66:y:2008:i:8:p:1709-1718
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  1. 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.
  2. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications, The World Bank, number 6896.
  3. FFF1Alberto NNN1Minujin & FFF2Enrique NNN2Delamonica, 2004. "Socio-economic inequalities in mortality and health in the developing world," Demographic Research Special Collections, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 2(13), pages 331-354, April.
  4. Bonu, Sekhar & Rani, Manju & Baker, Timothy D., 2003. "The impact of the national polio immunization campaign on levels and equity in immunization coverage: evidence from rural North India," Social Science & Medicine, Elsevier, vol. 57(10), pages 1807-1819, November.
  5. Wagstaff, Adam, 2002. "Inequality aversion, health inequalities and health achievement," Journal of Health Economics, Elsevier, vol. 21(4), pages 627-641, July.
  6. Adam Wagstaff, 2005. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 429-432.
  7. Yitzhaki, Shlomo, 1983. "On an Extension of the Gini Inequality Index," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 24(3), pages 617-628, October.
  8. 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.
  9. 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.
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