Abstract
OBJECTIVE: To describe the effects of social inequities on the health and nutrition of children in low and middle income countries. METHODS: We reviewed existing data on socioeconomic disparities within-countries relative to the use of services, nutritional status, morbidity, and mortality. A conceptual framework including five major hierarchical categories affecting inequities was adopted: socioeconomic context and position, differential exposure, differential vulnerability, differential health outcomes, and differential consequences. The search of the PubMed database since 1990 identified 244 articles related to the theme. Results were also analyzed from almost 100 recent national surveys, including Demographic Health Surveys and the UNICEF Multiple Indicator Cluster Surveys. RESULTS: Children from poor families are more likely, relative to those from better-off families, to be exposed to pathogenic agents; once they are exposed, they are more likely to become ill because of their lower resistance and lower coverage with preventive interventions. Once they become ill, they are less likely to have access to health services and the quality of these services is likely to be lower, with less access to life-saving treatments. As a consequence, children from poor family have higher mortality rates and are more likely to be undernourished. CONCLUSIONS: Except for child obesity and inadequate breastfeeding practices, all the other adverse conditions analyzed were more prevalent in children from less well-off families. Careful documentation of the multiple levels of determination of socioeconomic inequities in child health is essential for understanding the nature of this problem and for establishing interventions that can reduce these differences.
Highlights
Equity in health implies that ideally all individuals should attain their full health potential
Careful documentation of the multiple levels of determination of socioeconomic inequities in child health is essential for understanding the nature of this problem and for establishing interventions that can reduce these differences
Under-five mortality rates have recently declined in most low and middle income countries (LMICs), equity analyses have shown that the relative mortality gap is widening, between rich and poor countries and widening within most countries between rich and poor children, because mortality reductions tend to be greater among the better-off.[43,65]
Summary
Equity in health implies that ideally all individuals should attain their full health potential. Because young children are developing physically and mentally and because they depend on others to ensure their health, they are susceptible to socioeconomic inequities that lead to marked differences in terms of morbidity and mortality. Addressing socioeconomic inequities in child health and nutrition will be essential to achieve the Millennium Development Goals, as current rates of progress in most LMICs are insufficient.[59] countries can get on track “if they can combine good policies with expanded funding for programs that address both the direct and the underlying determinants of the healthrelated goals”,69 meaning, effective programs take equity considerations into account
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