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The link between inequality and population health in low and middle income countries: policy myth or social reality?

ABSTRACT: An influential policy idea states that reducing inequality is beneficial for improving health in the low and middle income countries (LMICs). Our study provides an empirical test of this idea: we utilized data collected by the Demographic and Health Surveys between 2000 and 2011 in as much as 52 LMICs, and we examined the relationship between household wealth inequality and two health outcomes: anemia status (of the children and their mothers) and the women' experience of child mortality. Based on multi-level analyses, we found that higher levels of household wealth inequality related to worse health, but this effect was strongly reduced when we took into account the level of individuals' wealth. However, even after accounting for the differences between individuals in terms of household wealth and other characteristics, in those LMICs with higher household wealth inequality more women experienced child mortality and more children were tested with anemia. This effect was partially mediated by the country's level and coverage of the health services and infrastructure. Furthermore, we found higher inequality to be related to a larger health gap between the poor and the rich in only one of the three examined samples. We conclude that an effective way to improve the health in the LMICs is to increase the wealth among the poor, which in turn also would lead to lower overall inequality and potential investments in public health infrastructure and services.

SUBMITTER: van Deurzen I

PROVIDER: S-EPMC4263747 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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The link between inequality and population health in low and middle income countries: policy myth or social reality?

van Deurzen Ioana I van Oorschot Wim W van Ingen Erik E

PloS one 20141211 12

An influential policy idea states that reducing inequality is beneficial for improving health in the low and middle income countries (LMICs). Our study provides an empirical test of this idea: we utilized data collected by the Demographic and Health Surveys between 2000 and 2011 in as much as 52 LMICs, and we examined the relationship between household wealth inequality and two health outcomes: anemia status (of the children and their mothers) and the women' experience of child mortality. Based ...[more]

PMID: 25501652

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Project description:BackgroundExpanding social protection programme is a major target of the Sustainable Development Goals. Previous studies provided evidence for the relationship of social protection programme to greater use of health services and some improved health outcomes for children. Yet, its impact on child mortality has not been clearly revealed. In this study, we examined the association between social protection programmes and child mortality.MethodsWe obtained child mortality data from 379 nationally representative surveys involving 101 low- and middle-income countries (LMICs). We included five child mortality outcomes in the study, which were neonatal mortality rate (NMR), post-neonatal mortality rate (PMR), childhood mortality rate (CMR), infant mortality rate (IMR), and under-5 mortality rate (U5MR). We extracted data on social protection programmes from multiple data sources (eg, Atlas of Social Protection Indicators of Resilience and Equity). Social protection and labour programme (SPL) was the major type of social protection we included. We also included four subtypes of SPL - social assistance, cash transfer, social insurance, and labour market protection. Both unadjusted and adjusted regressions were conducted to measure the associations between characteristics of social protection programmes and child mortality, as well as inequalities in child mortality.ResultsAmong the 101 countries, the median coverage rate of SPL was 28.5%, with an interquartile range between 6.5% and 55.2%. Using the adjusted model, we found a one-percentage-point increase in SPL coverage is associated with a reduction of 0.09 (95% confidence interval (CI) = 0.04, 0.14) per 1000 live births in NMR, 0.11 (95% CI = 0.04, 0.18) in PMR, and 0.25 (95% CI = 0.11, 0.38) in CMR. Social assistance programme was the only subtype of SPL to be significantly associated with lower mortality rates. A higher SPL coverage was associated with better equity in child mortality - as the coverage of SPL increased by one percentage point, the concentration index of CMR would increase by 0.08 (95% CI = 0.03, 0.13) in the adjusted model, suggesting an improvement in equity.ConclusionsThe strong association between social protection programme and child mortality suggests that to achieve the SDG targets of universal social protection and to reduce child mortality, LMICs shall consider prioritizing the expansion of social protection programmes.

Project description:Background: Child and adolescent mental health (CAMH) policy is essential for the rational development of mental health systems for children and adolescents. However, there is a universal lack of CAMH policy, especially in low- and middle-income countries (LMICs). Therefore, this review aims to identify challenges and lessons for LMICs to develop and implement CAMH policy. Methods: PubMed (1781-), MEDLINE (1950-), EMBASE (1966-), and PsycINFO (1895-) were searched from inception to December 31, 2018, for publications on CAMH policy development and/or implementation. Abstracts and main texts of articles were double screened, and extracted data were analyzed through thematic synthesis. Results: A total of 31 publications were included through the systematic review. Six major challenges were identified for CAMH policy in LMICs: (i) poor public awareness and low political willingness; (ii) stigma against mental disorders; (iii) biased culture values toward children, adolescents and CAMH, from developmental nihilism to medicalization; (iv) the lack of CAMH data and evidence, from service statistics to program evaluation; (v) the shortage of CAMH resources, including human resources, service facilities, and funding; and (vi) unintended consequence of international support, including reducing local responsibilities, planning fragmentation, and unsustainability. Six lessons to overcome challenges were summarized: (i) rethinking the concept of CAMH, (ii) encouraging a stand-alone CAMH policy and budget, (iii) involving stakeholders, (iv) reinforcing the role of research and researchers in policy process, (v) innovating the usage of human and service resources, and (vi) maximizing the positive influence of international organizations and non-governmental organizations. Conclusion: Many LMICs are still facing various challenges for their CAMH policy development and implementation. To overcome the challenges, great and long-term efforts are needed, which include great determination of from domestic and global agents, multidisciplinary innovations, and collaboration and coordination from different sectors.

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The link between inequality and population health in low and middle income countries: policy myth or social reality?

Publications

The link between inequality and population health in low and middle income countries: policy myth or social reality?

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