Abstract
BackgroundSocioeconomic inequalities in health have been documented in many countries including those in the Southern African Development Community (SADC). However, a comprehensive assessment of health inequalities and inequalities in the distribution of health risk factors is scarce. This study specifically investigates inequalities both in poor self-assessed health (SAH) and in the distribution of selected risk factors of ill-health among the adult populations in six SADC countries.MethodsData come from the 2002/04 World Health Survey (WHS) using six SADC countries (Malawi, Mauritius, South Africa, Swaziland, Zambia and Zimbabwe) where the WHS was conducted. Poor SAH is reporting bad or very bad health status. Risk factors such as smoking, heavy drinking, low fruit and vegetable consumption and physical inactivity were considered. Other environmental factors were also considered. Socioeconomic status was assessed using household expenditures. Standardised and normalised concentration indices (CIs) were used to assess socioeconomic inequalities. A positive (negative) concentration index means a pro-rich (pro-poor) distribution where the variable is reported more among the rich (poor).ResultsGenerally, a pro-poor socioeconomic inequality exists in poor SAH in the six countries. However, this is only significant for South Africa (CI = − 0.0573; p < 0.05), and marginally significant for Zambia (CI = − 0.0341; P < 0.1) and Zimbabwe (CI = − 0.0357; p < 0.1). Smoking and inadequate fruit and vegetable consumption were significantly concentrated among the poor. Similarly, the use of biomass energy, unimproved water and sanitation were significantly concentrated among the poor. However, inequalities in heavy drinking and physical inactivity are mixed. Overall, a positive relationship exists between inequalities in ill-health and inequalities in risk factors of ill-health.ConclusionThere is a need for concerted efforts to tackle the significant socioeconomic inequalities in ill-health and health risk factors in the region. Because some of the determinants of ill-health lie outside the health sector, inter-sectoral action is required.
Highlights
Socioeconomic inequalities in health have been documented in many countries including those in the Southern African Development Community (SADC)
Studies indicate that health disparities caused by social and economic determinants are deemed unfair and avoidable because they are produced by circumstances that can be addressed through policies [16, 17]
Data Data come from the 2002/04 World Health Survey (WHS) conducted by the World Health Organization (WHO)
Summary
Socioeconomic inequalities in health have been documented in many countries including those in the Southern African Development Community (SADC). Reducing inequalities in health remains a major concern [1, 2] It is well established, both in developing and developed countries, that (ill)health follows a socioeconomic gradient, to the disadvantage of poorer households, for a large number of diseases and health conditions [1, 3, 4]. Studies indicate that health disparities caused by social and economic determinants are deemed unfair and avoidable because they are produced by circumstances that can be addressed through policies [16, 17] This is the case with many health risk behaviours (e.g. smoking, alcohol abuse, physical inactivity and unhealthy diet) that are found to exert a strong influence on health [15] and are disproportionately distributed among individuals of low socioeconomic status (SES). They perpetuate the burden of ill-health and poverty within this group [18, 19]
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