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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.

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Paper provided by The World Bank in its series Policy Research Working Paper Series with number 2795.

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Date of creation: 28 Feb 2002
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Handle: RePEc:wbk:wbrwps:2795
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  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. Bidani, Benu & Ravallion, Martin, 1995. "Decomposing social indicators using distributional data," Policy Research Working Paper Series 1487, The World Bank.
  8. Paul Contoyannis & Martin Forster, 1999. "'Our healthier nation'?," Health Economics, John Wiley & Sons, Ltd., vol. 8(4), pages 289-296.
  9. 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.
  10. Pritchett, Lant & Summers, Lawrence H., 1993. "Wealthier is healthier," Policy Research Working Paper Series 1150, The World Bank.
  11. 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.
  12. 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.
  13. Le Grand, Julian, 1987. "Inequalities in health : Some international comparisons," European Economic Review, Elsevier, vol. 31(1-2), pages 182-191.
  14. 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, June.
  15. 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.
  16. Wagstaff, Adam & Watanabe, Naoko, 2000. "Socioeconomic inequalities in child malnutrition in the developing world," Policy Research Working Paper Series 2434, The World Bank.
  17. 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.
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