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Inequalities in health in developing countries - swimming against the tide?


  • Wagstaff, Adam


Inequalities 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.

Suggested Citation

  • Wagstaff, Adam, 2002. "Inequalities in health in developing countries - swimming against the tide?," Policy Research Working Paper Series 2795, The World Bank.
  • Handle: RePEc:wbk:wbrwps:2795

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    References listed on IDEAS

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    1. 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.
    2. Mary Schooling, C. & Lau, Elaine W.L. & Tin, Keith Y.K. & Leung, Gabriel M., 2010. "Social disparities and cause-specific mortality during economic development," Social Science & Medicine, Elsevier, vol. 70(10), pages 1550-1557, May.
    3. Omilola, Babatunde, 2010. "Patterns and trends of child and maternal nutrition inequalities in Nigeria," IFPRI discussion papers 968, International Food Policy Research Institute (IFPRI).
    4. Dror, David Mark & Koren, Ruth & Steinberg, David Mark, 2006. "The impact of filipino micro health-insurance units on income-related equality of access to healthcare," Health Policy, Elsevier, vol. 77(3), pages 304-317, August.
    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. Makate, Marshall & Makate, Clifton, 2016. "The Evolution of Socioeconomic-Related Inequalities in Maternal Healthcare Utilization: Evidence from Zimbabwe, 1994-2011," MPRA Paper 72718, University Library of Munich, Germany, revised 24 Jul 2016.
    7. Florence Jusot & Sabine Mage & Marta Menendez, 2014. "Inequality of Opportunity in Health in Indonesia," Working Papers DT/2014/06, DIAL (Développement, Institutions et Mondialisation).
    8. repec:idb:idbbks:7200 is not listed on IDEAS
    9. 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.
    10. repec:dau:papers:123456789/13753 is not listed on IDEAS
    11. Yusuf, Shahid & Nabeshima, Kaoru & Wei Ha, 2007. "What makes cities healthy ?," Policy Research Working Paper Series 4107, The World Bank.
    12. Srinivas, Goli, 2014. "Demographic convergence and its linkage with health inequalities in India," MPRA Paper 79823, University Library of Munich, Germany, revised 05 Dec 2014.
    13. Duclos, Jean-Yves & Leblanc, Josée & Sahn, David E., 2011. "Comparing population distributions from bin-aggregated sample data: An application to historical height data from France," Economics & Human Biology, Elsevier, vol. 9(4), pages 419-437.
    14. Udaya S. Mishra, 2016. "Measuring Progress Towards MDGs in Child Health: Should Base Line Sensitivity and Inequity Matter?," Working Papers id:10705, eSocialSciences.
    15. -, 2004. "Social Panorama of Latin America 2002-2003," Panorama Social de América Latina, Naciones Unidas Comisión Económica para América Latina y el Caribe (CEPAL), number 1218 edited by Eclac, September.
    16. 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.
    17. Narayan Sastry, 2002. "Trends in Socioeconomic Inequalities in Under-Five Mortality: Evidence from Sao Paulo, Brazil, 1970-1991," Working Papers 02-15, RAND Corporation.
    18. 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.
    19. Mishra, Udaya S., 2016. "Measuring progress towards MDGs in child health: Should base level sensitivity and inequity matter?," Evaluation and Program Planning, Elsevier, vol. 58(C), pages 70-81.


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