Degree Of Socioeconomic Inequality Research Articles

Socio-Economic Inequalities in the Double Burden of Malnutrition among under-Five Children: Evidence from 10 Selected Sub-Saharan African Countries

Africa is unlikely to end hunger and all forms of malnutrition by 2030 due to public health problems such as the double burden of malnutrition (DBM). Thus, the aim of this study is to determine the prevalence of DBM and degree of socio-economic inequality in double burden of malnutrition among children under 5 years in sub-Saharan Africa. This study used multi-country data collected by the Demographic and Health Surveys (DHS) Program. Data for this analysis were drawn from the DHS women's questionnaire focusing on children under 5 years. The outcome variable for this study was the double burden of malnutrition (DBM). This variable was computed from four indicators: stunting, wasting, underweight and overweight. Inequalities in DBM among children under 5 years were measured using concentration indices (CI). The total number of children included in this analysis was 55,285. DBM was highest in Burundi (26.74%) and lowest in Senegal (8.80%). The computed adjusted Erreygers Concentration Indices showed pro-poor socio-economic child health inequalities relative to the double burden of malnutrition. The DBM pro-poor inequalities were most intense in Zimbabwe (-0.0294) and least intense in Burundi (-0.2206). This study has shown that across SSA, among under-five children, the poor suffer more from the DBM relative to the wealthy. If we are not to leave any child behind, we must address these socio-economic inequalities in sub-Saharan Africa.

Decomposing socioeconomic disparity in the utilization of screening mammography: A cross-sectional analysis from the RaNCD cohort study

We aimed to examine the degree of socioeconomic inequality in screening mammography among Kurdish women of Iran. Data from the Ravansar Non-Communicable Diseases (RaNCD) Cohort Study were used. A total of 3,219 women aged 35-65 years were studied. The concentration index (CIn) was used to measure the magnitude of socioeconomic-related inequalities in screening mammography. Decomposition analysis was employed to calculate the contribution of each explanatory variable to the observed inequality. The participation rate for screening mammography was 19.7%. The CIn of screening mammography was 0.142 (95% CI: 0.0197, 0.0656), indicating that screening mammography is more concentrated among high-SES women. Socioeconomic status, education level and area of residence were the main contributors to the observed inequality, respectively. We found a pro-rich inequality in screening mammography among Iranian Kurdish women. For mitigating socioeconomic inequality in screening mammography policymakers should focus more on the poor and rural communities.

Decomposing socioeconomic inequalities in alcohol use by men living in South African urban informal settlements

BackgroundThe prevalence of alcohol consumption among males living in urban settlements in South Africa is high. This paper aims to measure socioeconomic inequalities in alcohol use among men residing in informal settlements and also to examine the factors associated with inequality in alcohol use among men living in informal settlements.MethodsThe study uses data from the 2016 Study of South African Informal Settlements. Multiple correspondence analysis is used to calculate a wealth index as a measure of socioeconomic status. The Erreygers concentration index is employed to quantify the degree of socioeconomic inequality in alcohol use and decomposition analysis is conducted to assess the factors associated with inequality in alcohol use by men of various age groups.ResultsThere is a socioeconomic-related inequality in alcohol use in informal settlements that discriminates against poor men. Inequality is especially pronounced in the case of males aged 15–34 years and males aged 35–44 years. Wealth status makes the biggest contribution to socioeconomic inequality in alcohol use. The contribution of social determinants of health like marital status and employment status differ across age groups. Employment status contribute more to the alcohol use inequality among males aged 15–34 years while marital status contribute more to the alcohol use inequality among males aged 35–44 years. Being single substantially increases inequality in alcohol use.ConclusionInequality in alcohol use exists among both younger and older males and discriminate against the poor. Public policies aimed at promoting public health and the prevention of unhealthy behaviours should target younger and middle-aged men from socioeconomically disadvantaged groups. We also suggest policies that target single males in informal settlements.

Physical Social Capital and Psychosocial Social Capital as Mediators Between Socio-economic Inequality and Expressions of Well-being and Health in Israeli Kibbutz Populations

A large number of studies show that degree of socio-economic inequality ‘within’ a social entity negatively determines levels of well-being and life expectancy, and is positively associated with morbidity and mortality. This relationship holds over and above the impact of average income level. This initially suggested model put forward a causal flow with mediating variables of ‘relative deprivation’ and followed it up with the expressions of ‘social capital’ in the social psychological sense. This article tests, besides these, the role of an additional (relatively little referred to) mediating set of variables between economic inequality and measures of well-being and health, namely levels of physical investments by society (physical social capital [PHSC]) for fulfilling its individual members’ needs. It is proposed that the higher the level of inequality, the lower would be a society’s investments in PHSC (such as in education, health services, job creation, ecology conservation, public transportation and the like) that contribute to health, well-being and survival. The proposition is tested out in two kinds of kibbutz communities: one, ‘traditional’ with strong adherence to social and economic equality among members; and another, ‘transformed’ kibbutzim, where salaries are differential and are based on position or occupation. The two groups of kibbutzim were roughly equated on size, years since settlement, political belonging, economic standing and geographical location. Findings show that the degree of inequality is associated with the level of both psychosocial social capital and PHSC, which in turn contribute independently and cumulatively to levels of peoples’ health and well-being. Transformed kibbutzim are seen as an expression of neoliberal ideology results in the negative effects on health and well-being of individuals and their communities.

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

This paper analyses the trend of the socioeconomic inequalities in infant mortality rates in Egypt over the period 1995–2014, using repeated cross-sectional data from the National Demographic and Health Survey. A multivariate logistic regression and concentration indices are used to examine the demographic and socioeconomic correlates of infant mortality, and how the degree of socioeconomic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. However, analyzing trends over the study period reveals no corresponding progress in narrowing the socioeconomic disparities in childhood mortality. Infant mortality rates remain higher in rural areas and among low-income families than the national average. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socioeconomic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socioeconomic inequality in child mortality is not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. We find no statistically significant association between infant mortality and child’s sex, access to safe water, mothers’ work, and mothers’ nutritional status. Infant mortality is negatively associated with household wealth and regular health care during pregnancy. Concerted effort and targeting intervention measures are still needed to reduce the degree of socioeconomic and regional inequalities in child health, including infant mortality, in Egypt.

Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh

Demand-side financing (DSF) is used in the less-developed countries of the world to improve access to healthcare and to encourage market supply. Under DSF, households receive vouchers that can be used to pay for healthcare services. This study evaluated the effects of a universal DSF on maternal healthcare service utilization in Bangladesh. A household survey was conducted in and around the voucher scheme area one year after the initiation of the project. Women who gave birth within a year prior to the survey were interviewed. The utilization rates of maternal health services were found to be higher for all socioeconomic groups in the project area than in the comparison areas. Voucher recipients in the project area were 3.6 times more likely to be assisted by skilled health personnel during delivery, 2.5 times more likely to deliver the baby in a health facility, 2.8 times more likely to receive postnatal care (PNC), 2.0 times more likely to get antenatal care (ANC) services and 1.5 times more likely to seek treatment for obstetric complications than pregnant women not in the program. The degree of socioeconomic inequality in maternal health service utilization was also lower in the project area than in the comparison area. The use of vouchers evidenced much stronger demand-increasing effects on the poor. Poor voucher recipients were 4.3 times more likely to deliver in a health facility and two times more likely to use skilled health personnel at delivery than the non-poor recipients. Contrary to the inverse equity hypothesis, the voucher scheme reduced inequality even in the short run. Despite these improvements, socioeconomic disparity in the use of maternal health services has remained pro-rich, implying that demand-side financing alone will be insufficient to achieve the Millennium Development Goal for maternal health. A comprehensive system-wide approach, including supply-side strengthening, will be needed to adequately address maternal health concerns in poor developing countries.

Are urban children really healthier? Evidence from 47 developing countries

On average, child health outcomes are better in urban than in rural areas of developing countries. Understanding the nature and the causes of this rural–urban disparity is essential in contemplating the health consequences of the rapid urbanization taking place throughout the developing world and in targeting resources appropriately to raise population health. Using micro-data on child health taken from the most recent Demographic and Health Surveys for 47 developing countries, the purpose of this paper is threefold. First, we document the magnitude of rural–urban disparities in child nutritional status and under-5 mortality across all 47 developing countries. Second, we adjust these disparities for differences in population characteristics across urban and rural settings. Third, we examine rural–urban differences in the degree of socioeconomic inequality in these health outcomes. The results demonstrate that there are considerable rural–urban differences in mean child health outcomes in the entire developing world. The rural–urban gap in stunting does not entirely mirror the gap in under-5 mortality. The most striking difference between the two is in the Latin American and Caribbean region, where the gap in growth stunting is more than 1.5 times higher than that in mortality. On average, the rural–urban risk ratios of stunting and under-5 mortality fall by, respectively, 53% and 59% after controlling for household wealth. Controlling thereafter for socio-demographic factors reduces the risk ratios by another 22% and 25%. We confirm earlier findings of higher socioeconomic inequality in stunting in urban areas and demonstrate that this also holds for under-5 mortality. In a considerable number of countries, the urban poor actually have higher rates of stunting and mortality than their rural counterparts. The findings imply that there is a need for programs that target the urban poor, and that this is becoming more necessary as the size of the urban population grows.

Are Urban Children Really Healthier?

textabstractOn average, child health outcomes are better in urban than in rural areas of developing countries. Understanding the nature and the causes of this rural-urban disparity is essential in contemplating the health consequences of the rapid urbanization taking place throughout the developing world and in targeting resources appropriately to raise population health. We use micro data on child health taken from the most recent Demographic and Health Surveys for 47 developing countries. First, we document the magnitude of rural-urban disparities in child nutritional status and under-five mortality across all 47 developing countries. Second, we adjust these disparities for differences in population characteristics across urban and rural settings. Third, we examine rural-urban differences in the degree of socioeconomic inequality in these health outcomes. We find considerable rural-urban differences in mean child health outcomes. The rural-urban gap in stunting does not entirely mirror the gap in under-five mortality. The most striking difference between the two is in the Latin American and Caribbean region, where the gap in stunting is more than 1.5 times higher than that in mortality. On average, the rural-urban risk ratios of stunting and under-five mortality fall by respectively 53% and 59% after controlling for household wealth. Controlling thereafter for socio-demographic factors reduces the risk ratios by another 22% and 25%. In a considerable number of countries, the urban poor actually have higher rates of stunting and mortality than their rural counterparts. The findings imply that there is a need for programs that target the urban poor, and that this is becoming more necessary as the size of the urban population grows.

Socioeconomic inequality of obesity in the United States: do gender, age, and ethnicity matter?

This study introduces the concentration index (CI) to assess socioeconomic inequality in the distribution of obesity among American adults aged 18–60 years old. The CI provides a summary measure of socioeconomic inequality, and enabled comparisons across gender, age, and ethnicity. Data from the National Health and Nutrition Examination Survey III, 1988–1994 (NHANES III) were used. The degree of socioeconomic inequality in obesity varied considerably across gender, age, and ethnic groups. Among women, we found a stronger, inverse association between socioeconomic status (SES) and obesity compared with men, as well as greater socioeconomic inequality among middle-aged adults (41–49) compared to other age groups. Consistent with previous studies, we found remarkable ethnic differences in the relationship between SES and obesity. Although the extant literature documented a higher prevalence of obesity among minorities than in whites, our results presented a lower socioeconomic inequality in obesity within minority groups. Our analyses suggested that gender, age, and ethnicity could be important factors on socioeconomic inequality in obesity.

Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations.

This paper outlines a framework for comparing empirically overall health inequality and socioeconomic health inequality. The framework, which is developed for both individual-level data and grouped data, is illustrated using data on malnutrition amongst Vietnamese children and on health utility amongst Canadian adults. In both cases, the degree of socioeconomic inequality is estimated at around 25% of overall inequality.

Why justice is good for our health: the social determinants of health inequalities.

We have known for over 150 years that an individual’s chances of life and death are patterned according to social class: the more affluent and educated people are, the longer and healthier their lives. These patterns persist even when there is universal access to health care – a fact quite surprising to those who think financial access to medical services is the primary determinant of health status. In fact, recent cross-national evidence suggests that the greater the degree of socioeconomic inequality that exists within a society, the steeper the gradient of health inequality. As a result, middle-income groups in a less equal society will have worse health than comparable or even poorer groups in a society with greater equality.