Abstract
Background and objectivesMost studies on health inequalities use average measures, but describing the distribution of health can also provide valuable knowledge. In this paper, we estimate and compare within-group and between-group inequalities in length of life for population groups in Ethiopia in 2000 and 2011.MethodsWe used data from the 2011 and 2000 Ethiopia Demographic and Health Survey and the Global Burden of Disease study 2010, and the MODMATCH modified logit life table system developed by the World Health Organization to model mortality rates, life expectancy, and length of life for Ethiopian population groups stratified by wealth quintiles, gender and residence. We then estimated and compared within-group and between-group inequality in length of life using the Gini index and absolute length of life inequality.ResultsLength of life inequality has decreased and life expectancy has increased for all population groups between 2000 and 2011. Length of life inequality within wealth quintiles is about three times larger than the between-group inequality of 9 years. Total length of life inequality in Ethiopia was 27.6 years in 2011.ConclusionLongevity has increased and the distribution of health in Ethiopia is more equal in 2011 than 2000, with length of life inequality reduced for all population groups. Still there is considerable potential for further improvement. In the Ethiopian context with a poor and highly rural population, inequality in length of life within wealth quintiles is considerably larger than between them. This suggests that other factors than wealth substantially contribute to total health inequality in Ethiopia and that identification and quantification of these factors will be important for identifying proper measures to further reduce length of life inequality.
Highlights
The need to measure and document health inequality is well established [1,2,3], but exactly what to measure and how to do it have not been fully agreed see i.e. [4,5,6,7]
Measuring length of life inequality is one among several ways of capturing overall health inequality. This was first done by Julian Le Grand [11], and in their 2009 paper Smits and Monden [12] highlight four reasons why this is a feasible measure: 1) a long and healthy life is valued across most societies and cultures, making it useful for comparisons among them; 2) as income and wealth are instrumental for reaching more essential goals, such as a long life, variations in length of life provide insight into these background factors; 3) inequality in length of life is more directly linked to absolute deprivation than, for example, inequality in income; and 4) the information needed to estimate length of life inequality is already available
We have calculated within-group length of life inequality which we present in Table 2 together with betweengroup inequality for the wealth quintiles
Summary
The need to measure and document health inequality is well established [1,2,3], but exactly what to measure and how to do it have not been fully agreed see i.e. [4,5,6,7]. Most studies measure average health, as life expectancy and under-five mortality, and compare outcomes among pre-defined groups [7]. Measuring such between-group inequalities based on differences of means does not provide sufficient information about the individual distribution of health [8]. We looked at length of life inequality in different population groups in Ethiopia. Most studies on health inequalities use average measures, but describing the distribution of health can provide valuable knowledge. We estimate and compare within-group and between-group inequalities in length of life for population groups in Ethiopia in 2000 and 2011
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