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Measuring intra‐household health inequality: explorations using the body mass index

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  • David E. Sahn
  • Stephen D. Younger

Abstract

This paper examines the relationship between level of well‐being and inequality at inter‐country and intra‐household levels, using individuals' body mass index (BMI) rather than income as the indicator of well‐being. BMI is useful for these purposes because (1) it is measured at the individual rather than household level; (2) it reflects command over food, but also non‐food resources that affect health status like sanitary conditions and labour‐saving technologies; (3) it accounts for caloric consumption relative to needs; (4) it is easily measured; and (5) any measurement error is likely to be random. We do not find any evidence to support the idea of an intra‐household or inter‐country Kuznets curve. We study the correlations between average household well‐being, still measured by BMI, and differences in the BMIs of males and females, parents and children. Here, we find a tendency to protect the BMI of young children when living standards are very low. We find no clear patterns by gender. Perhaps the most striking finding in the paper is that about half of total BMI inequality at the country level is within households. Thus, standard measures of inequality that use household‐level data may drastically understate true inequality. Copyright © 2009 John Wiley & Sons, Ltd.

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  • David E. Sahn & Stephen D. Younger, 2009. "Measuring intra‐household health inequality: explorations using the body mass index," Health Economics, John Wiley & Sons, Ltd., vol. 18(S1), pages 13-36, April.
  • Handle: RePEc:wly:hlthec:v:18:y:2009:i:s1:p:s13-s36
    DOI: 10.1002/hec.1459
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    3. Judith A. Clarke & Ahmed A. Hoque, 2014. "On Variance Estimation for a Gini Coefficient Estimator Obtained from Complex Survey Data," Econometrics Working Papers 1401, Department of Economics, University of Victoria.
    4. Ross, Kara L. & Zereyesus, Yacob & Shanoyan, Aleksan & Amanor-Boadu, Vincent, 2015. "The Health Effects of Women Empowerment: Recent Evidence from Northern Ghana," International Food and Agribusiness Management Review, International Food and Agribusiness Management Association, vol. 18(1), pages 1-17, February.
    5. Rodríguez, Laura, 2016. "Intrahousehold Inequalities in Child Rights and Well-Being. A Barrier to Progress?," World Development, Elsevier, vol. 83(C), pages 111-134.
    6. Eleftherios Giovanis & Oznur Ozdamar, 2018. "Empirical Application of Collective Household Labour Supply Model in Iraq," Working Papers 1180, Economic Research Forum, revised 19 Apr 2018.
    7. Deepak Malghan & Hema Swaminathan, 2021. "Intra-household Gender Inequality, Welfare, and Economic Development," LWS Working papers 34, LIS Cross-National Data Center in Luxembourg.
    8. Molini, Vasco & Nubé, Maarten & van den Boom, Bart, 2010. "Adult BMI as a Health and Nutritional Inequality Measure: Applications at Macro and Micro Levels," World Development, Elsevier, vol. 38(7), pages 1012-1023, July.
    9. Martin Wittenberg, 2013. "The Weight of Success: The Body Mass Index and Economic Well-Being in Southern Africa," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 59, pages 62-83, October.
    10. Ramzi Mabsout, 2011. "Capability and Health Functioning in Ethiopian Households," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 101(3), pages 359-389, May.
    11. Permanyer, Iñaki, 2014. "Assessing individuals' deprivation in a multidimensional framework," Journal of Development Economics, Elsevier, vol. 109(C), pages 1-16.
    12. Joan Costa-Font & Cristina Hernandez-Quevedo & Azusa Sato, 2018. "A Health ‘Kuznets’ Curve’? Cross-Sectional and Longitudinal Evidence on Concentration Indices’," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 136(2), pages 439-452, April.
    13. Roemling, Cornelia & Qaim, Matin, 2013. "Dual burden households and intra-household nutritional inequality in Indonesia," Economics & Human Biology, Elsevier, vol. 11(4), pages 563-573.
    14. Maria Emma Santos, 2014. "Measuring Multidimensional Poverty in Latin America: Previous Experience and the Way Forward," OPHI Working Papers 66, Queen Elizabeth House, University of Oxford.
    15. Heather Brown & Arne Risa Hole & Jennifer Roberts, 2010. "Going the same 'weigh': spousal correlations in obesity in the UK," Working Papers 2010012, The University of Sheffield, Department of Economics, revised Jun 2010.
    16. Wilman Javier Iglesias Pinedo & Alexandre Bragança Coelho, 2018. "Using A Collective Model To Evaluate Intra-Household Inequality And Individual Poverty In Brazil," Anais do XLIV Encontro Nacional de Economia [Proceedings of the 44th Brazilian Economics Meeting] 131, ANPEC - Associação Nacional dos Centros de Pós-Graduação em Economia [Brazilian Association of Graduate Programs in Economics].
    17. Naschold, Felix, 2017. "Constructing internally consistent BMI Z-Scores for adults and children to examine intra-household health effects," 2017 Annual Meeting, July 30-August 1, Chicago, Illinois 258345, Agricultural and Applied Economics Association.
    18. Malghan, Deepak & Swaminathan, Hema, 2021. "Global trends in intra-household gender inequality," Journal of Economic Behavior & Organization, Elsevier, vol. 189(C), pages 515-546.
    19. Roemling, Cornelia & Qaim, Matin, 2012. "Dual Burden Households and Nutritional Inequality in Indonesia," GlobalFood Discussion Papers 126943, Georg-August-Universitaet Goettingen, GlobalFood, Department of Agricultural Economics and Rural Development.
    20. Martin Ravallion, 2018. "What might explain today’s conflicting narratives on global inequality?," WIDER Working Paper Series 141, World Institute for Development Economic Research (UNU-WIDER).
    21. Joan Costa-i-Font & Cristina Hernandez-Quevedo & Azusa Sato, 2013. "A 'Health Kuznets' Curve'? Cross-Country and Longitudinal Evidence," CESifo Working Paper Series 4446, CESifo.
    22. Martin Wittenberg, 2011. "The Weight of Success: The Body Mass Index and Economic Well-being in South Africa," SALDRU Working Papers 65, Southern Africa Labour and Development Research Unit, University of Cape Town.
    23. Brown, Caitlin & Calvi, Rossella & Penglase, Jacob, 2021. "Sharing the pie: An analysis of undernutrition and individual consumption in Bangladesh," Journal of Public Economics, Elsevier, vol. 200(C).
    24. Wilman J. Iglesias & Alexandre B. Coelho, 2020. "Poverty and inequality within Brazilian households: an application of a collective consumption model," Empirical Economics, Springer, vol. 58(4), pages 1923-1952, April.

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