Inequality Of Opportunity In Health Research Articles

Childhood Circumstances and Health of American and Chinese Older Adults: A Machine Learning Evaluation of Inequality of Opportunity in Health

Childhood Circumstances and Health of American and Chinese Older Adults: A Machine Learning Evaluation of Inequality of Opportunity in Health

School feeding program and urban–rural inequality of child health: Evidence from China

AbstractSchool feeding programs have served as go‐to policies for addressing child malnutrition in both developed and developing countries. While an increasing number of studies have investigated the health consequences of school feeding programs, empirical evidence regarding their effects on children's health inequality remains limited. This study examines the impact of China's Nutrition Improvement Program (NIP)—A program that provides free meals for rural students at the compulsory education stage—on rural children's health status and urban–rural health status differentials. The analysis uses data from the 2004–2015 China Health and Nutrition Survey. Leveraging county‐by‐county rollouts of the program, we employ difference‐in‐differences approaches as our identification strategy. The results show that the NIP significantly improves children's height‐for‐age z‐scores by 0.136 standard deviations. Moreover, we find that the NIP alleviates the inequality of opportunity in health between urban and rural children by 21.6% in pilot counties. These findings are robust to a series of validity checks. The effect is more pronounced among students who have a younger age, and live in low social status families. Our findings suggest that school feeding programs are effective in decreasing child malnutrition levels and reducing urban‐rural inequality in the long run. [EconLit citations: I10, I18, D63].

Inequality of Opportunity in Health Among Urban, Rural, and Migrant Children: Evidence from China

Abstract Rural-urban migrants, though facing unique social and institutional constraints, remain a largely overlooked population in research on health inequality in China. This study applies the inequality of opportunity (IOp) framework to investigate health inequality among children in China. Instead of comparing only urban and rural children, we include rural-urban migrants. Drawing upon three waves of a nation-wide survey, we find that migrant children in China remain disadvantaged in terms of health when compared to urban and rural children. The decomposition of the determinants indicates that while the direct influence of hukou, China’s household registration system, on IOp in health is low and has decreased, particularly between 2007 and 2013, one’s province of residence still matters. Parental health contributes substantially to IOp in health, which likely is an indirect effect of hukou that creates barriers for migrant parents in regard to accessing healthcare. The policy implication of these findings is that although the direct influence of hukou has decreased, when coupled with the continued lack of local government support for the welfare of migrant workers, it perpetuates health inequalities.

A Summary Indicator Providing a Snapshot of Political Opinions when Variables are Ordinal

This paper deals with the evaluation of the relative performance of different groups when the achievements of the members of a group are summarised by the relative distribution of these achievements across various ordered categories. After reviewing a previous attempt by Herrero and Vilar to deal with this issue, we propose to adopt an approach introduced recently by Apouey, Silber and Xu who derived a measure of achievement that, in the case of ordinal variables, takes account of both the inequality and the location of a distribution. Their approach is then applied to the analysis of political opinions, using the International Social Survey Programme for the year 2009. We compare questions dealing with respectively the need for the government to reduce income inequality, the duty of the government to help poor and unemployed individuals and the inequality of opportunity in health and education. It appears that the correlations obtained for our summary indicator of political opinions, based on the data covering 41 countries, reflect quite well the distinction we made between the three types of questions on political opinions. In addition, regression results show that generally the higher the inequality in a country, the more likely it is that people will approve government intervention aimed at reducing inequality and poverty.

Trends in inequality of opportunity in health over the life cycle: The role of early-life conditions

This paper explores the evolution of inequality of opportunity in the prevalence of chronic diseases along the life cycle and across different birth cohorts for individuals aged 50 or older and residing in 13 European countries. We adopt an ex-ante parametric approach and rely on the dissimilarity index as our reference inequality metric. In addition to a commonly used set of circumstances, we pay particular attention to the role of adverse early-life conditions, such as the experience of harm and the quality of the relationship with parents. In order to quantify the relative importance of each circumstance, we apply the Shapley inequality decomposition method. Our results suggest that inequality of opportunity in health is not stable over the life cycle - it is generally lower at younger ages and then monotonically increases. Moreover, it varies between different birth cohorts and is generally higher for younger individuals than for older age groups. Finally, the contribution of adverse early life conditions ranges between 25% and 45%, which is comparable to the share of socio-economic circumstances but significantly higher than the relative contribution of other demographic characteristics, especially at younger ages.

Ex ante Inequality of Opportunity in Health among the Elderly in China: A Distributional Decomposition Analysis of Biomarkers

Using pooled data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS) linked with the 2014 CHARLS Life History Survey, we analyse ex ante inequality of opportunity (IOp) in blood‐based biomarkers among Chinese adults aged 60+. We apply a re‐centered influence function approach and a Shapley‐Shorrocks decomposition to partition the contributions of different sets of measured circumstances and find that these account for between 2.01 percent and 23.95 percent of total health inequality across the range of biomarkers. The decompositions show that spatial circumstances such as urban/rural and province of residence at birth are the dominant factors for most of the biomarkers. Distributional decompositions further reveal that the relative contributions of household socioeconomic status and health and nutrition in childhood increase in the right tails of the distribution, where the clinical risk is focused, for most of the biomarkers.

Ranking populations in terms of inequality of health opportunity: A flexible latent type approach.

We offer a flexible latent type approach to rank populations according to unequal health opportunities. Building upon the latent-class method, an approch increasingly adopted to estimate health inequalities, our contribution is to let the number of socioeconomic groups considered vary to obtain an opportunity-inequality curve for a population that gives how the between-type inequality varies with the number of types. A population A is said to have less inequality of opportunity than population B if its curve is statistically below that of population B. This version of the latent class approach allows for a robust ranking of 31 European countries regarding inequality of opportunity in health.

Assessing and decomposing inequality of opportunity in access to child health and nutrition in sub-Saharan Africa: evidence from three countries with low human development index

BackgroundInequality of opportunity in health and nutrition is a major public health issue in the developing regions. This study analyzed the patterns and extent of inequality of opportunity in health and nutrition among children under-five across three countries sub-Saharan Africa with low Human development index (HDI).MethodsWe used data from the Multiple Indicator Cluster Survey of the Democratic Republic of Congo (20,792 households, 21,756 women aged 15 to 49 and 21,456 children under five), Guinea Bissau (6601 households, 10,234 women aged 15–49 and 7573 children under five) and Mali (11,830 households, 18,409 women in 15–49 years and 16,468 children under five) to compute the human opportunity index (HOI) and the dissimilarity index (D-index). Secondly, the Shapley decomposition method was used to estimate the relative contribution of circumstances that are beyond the control of children under-five and affecting their development outcomes in later life stages.ResultsThe study revealed that children belonging to the most favorable group had higher access rates for immunization (93.64%) and water and sanitation facilities (73.59%) in Guinea Bissau. In Congo DR, the access rate was high for immunization (93.9%) for children in the most favorable group. In Mali, access rates stood at 6.56% for children in the most favorable group. In Guinea Bissau, the inequality of opportunity was important in access to health services before and after delivery (43.85%). In Congo DR, the inequality of opportunity was only high for the immunization composite indicator (83.79%) while in Mali, inequality of opportunity was higher for access to health services before and after delivery (41.67%).ConclusionThe results show that there are efforts in some places to promote access to health and nutrition services in order to make access equal without distinction linked to the socio-economic and demographic characteristics in which the children live. However, the inequalities of opportunity observed between the children of the most favorable group and those of the least favorable group, remain in general at significant levels and call on government of these countries to implement policies taking them into account.

Ex Ante Inequality of Opportunity in Health Among the Elderly in China: A Distributional Decomposition Analysis of Biomarkers

We present a comprehensive analysis of ex ante inequality of opportunity (IOp) in health among Chinese adults aged 60+ and decompose the contributions of different sets of circumstances. Data are drawn from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS) linked with the 2014 CHARLS Life History Survey. We use a range of blood-based biomarkers, and apply a re-centered influence function (RIF) approach and a Shapley-Shorrocks decomposition to partition the contribution of circumstances across different quantiles of the biomarker distributions. We find that IOp accounts for between 3.75% and 29.57% of total health inequality in old age across the range of biomarkers. Shapley-Shorrocks decompositions show that spatial circumstances such as urban/rural residence and province of residence are the dominant determinants of IOp for most of the biomarkers. Distributional decompositions further reveal that the relative contributions to IOp in health of household socioeconomic status and health and nutrition conditions in childhood increase towards the right tails of the distribution for most of the biomarkers, where the clinical risk is focused.

Ex ante inequality of opportunity in health, decomposition and distributional analysis of biomarkers

We use a set of biomarkers to measure inequality of opportunity (IOp) in the risk of major chronic conditions in the UK. Applying a direct ex ante IOp approach, we find that inequalities in biomarkers attributed to circumstances account for a non-trivial part of the total variation. For example, observed circumstances account for 20 % of the total inequalities in our composite measure of multi-system health risk, allostatic load. We propose an extension to the decomposition of ex ante IOp to complement the mean-based approach, analysing the contribution of circumstances across the quantiles of the biomarker distributions. Shapley decompositions show that, for most of the biomarkers, the percentage contribution of socioeconomic circumstances (education and childhood socioeconomic status), relative to differences attributable to age and gender, increase towards the right tail of the biomarker distribution, where health risks are more pronounced.

Equity, opportunity and health

This article sets out the foundations for a programme of research that aims to explore equality of opportunity in health by drawing on the statistical tools of causal and mediation analysis, while developing a normative approach to the role of early life circumstances and education as a source of inequality of opportunity in health.

Inequality of opportunity in health: A decomposition-based approach.

This paper presents new decomposition-based approaches to measure inequality of opportunity in health that capture Roemer's distinction between circumstances and effort and are consistent with both compensation and reward principles. Our approach is fully nonparametric in the way that it handles differences in circumstances and provides decompositions of both a rank-dependent relative (the Gini coefficient) and a rank-independent absolute inequality index (the variance). The decompositions distinguish the contribution of effort from the direct and indirect (through effort) contribution of circumstances to the total inequality. Our approach is illustrated by an empirical application that uses objectively measured biomarkers as health outcomes and as proxies for relevant effort variables. Using data from the Health Survey for England from 2003 to 2012, we find that circumstances are the leading determinant of inequality in cholesterol, glycated haemoglobin, and in a combined ill-health index whereas effort plays a substantial role in explaining inequality in fibrinogen only.

Inequality of opportunity in health: evidence from Chile.

ABSTRACTOBJECTIVE To assess the possible presence of inequality of opportunities in the health status of Chileans, according to sociodemographic circumstances.METHODS Self-rated health data were used from the Chilean National Health Survey of 2010 to test the hypothesis of strong and weak equality of opportunities in the health status of the Chilean population. These hypotheses were tested using nonparametric techniques and second-order stochastic dominance criteria.RESULTS Robust empirical evidence was obtained, which indicate that the education level of the mother, household socioeconomic status, sex, zone, and region of residence determine opportunities to achieve good health in Chile.CONCLUSIONS Better health status was identified for Chilean adults whenever their mothers had a higher education level, their household income was higher, they were men, or lived in urban areas. The region of residence also affects opportunities to achieve good health in Chile.

Do Tunisian Young Children Have Equal Chances in Access to Basic Services? A Special Focus on Opportunities in Healthcare and Nutrition

It is widely recognized in the public health literature that healthcare and nutrition during the early childhood period have important long-term and sometimes irreversible consequences on health and wellbeing later in life. In this paper, we endeavor to investigate deeply the patterns of inequality of opportunity in health and nutrition outcomes among under-five children in Tunisia. Several tools are used to do such analysis including comparison of distributions of the considered outcomes across circumstances groups; estimation of the Human Opportunity Index; and measurement of the relative contributions of different circumstances using the Shapley decomposition. The main findings reveal reasonable and low levels of inequality in access to all basic healthcare services and nutrition except access to improved water and sanitation. Besides, parents’ education, wealth status and location of residence are found to be key factors causing low level of inequalities. Thus, it is easy to conclude that without more inclusive and pro-poor policy interventions, there are few chances for children belonging in poor families and living in marginalized rural areas to spring out of the poverty lived by their parents.

Inequality of opportunity in health among adolescents: does predetermined circumstances still play a role?

Inequality of opportunity in health among adolescents: does predetermined circumstances still play a role?

Quels enseignements tirer des théories de la justice en matière de lutte contre les inégalités de santé ?

We survey the burgeoning literature on inequality of opportunity in health. We focus on ways to tackle health inequalities. We are of the opinion that the main contribution so far of this literature is in inviting us to choose a new indicator of the relative success of the public policy, which aims at reducing health inequalities. This indicator is the part of explained health inequalities due to lifestyles. We can defend the use of this indicator on the basis of a value judgment but we will restrain us to do so here. Our argument is mainly positive. It resorts on the fact that, so far, we do not know how to tackle health inequalities coming from differences in lifestyles. These inequalities seem more irreducible than inherited health inequalities, as the Great Britain example shows us. When these inequalities are quite high in proportion of total explained inequalities, it means that we are not so far from a public health policy, which is going to reach his main objective in reducing health inequalities.

EX‐ANTE AND EX‐POST MEASUREMENT OF EQUALITY OF OPPORTUNITY IN HEALTH: A NORMATIVE DECOMPOSITION

This paper proposes and discusses two different approaches to the definition of inequality in health: the ex-ante and the ex-post approach. It proposes strategies for measuring inequality of opportunity in health based on the path-independent Atkinson equality index. The proposed methodology is illustrated using data from the British Household Panel Survey; the results suggest that in the period 2000-2005, at least one-third of the observed health equalities in the UK were equalities of opportunity.

Inequality of Opportunity in Child Health in the Arab World and Turkey

It is by now well established in the public health literature that health and nutrition in the first years of life are critical to health and wellbeing later in life. In this paper, we examine the patterns of inequality of opportunity in health and nutrition outcomes, such as height-for-age and weight-for-height, for children under 5 years of age in selected Arab Countries and Turkey, using Demographic and Health Survey (DHS) data. Our objective is to decompose inequality into a portion that is due to inequality of opportunity and a portion that is due to other factors, such as random variations in health and genetics. Inequality of opportunity is defined as the inequality that is due to differences in circumstances, such as parental characteristics, household wealth, place of birth and gender. We measure inequality using decomposable general entropy measures, such as the Theil-T index, and use parametric decomposition methods to determine the share of inequality of opportunity in total inequality.Results show that different levels and trends are evident across countries in both the overall inequality of child health outcomes and in the share of inequality of opportunity in total inequality. Inequality of opportunity is shown to contribute substantially to the inequality of child health outcomes, but its share in total inequality varies significantly both across countries and within countries over time. To further highlight the relative contribution of circumstances to the inequality of child health outcomes in different countries, we simulate height and weight outcomes for a most and least advantaged child in each context. Since these simulations set observed circumstances at their best and worst levels, the larger the difference in predicted outcomes between the most and least advantaged child, the larger is the inequality of opportunity facing children in that country.

Quality of schooling and inequality of opportunity in health

This paper explores the role of quality of schooling as a source of inequality of opportunity in health. Substantiating earlier literature that links differences in education to health disparities, the paper uses variation in quality of schooling to test for inequality of opportunity in health. Analysis of the 1958 NCDS cohort exploits the variation in type and quality of schools generated by the comprehensive schooling reforms in England and Wales. The analysis provides evidence of a statistically significant and economically sizable association between some dimensions of quality of education and a range of health and health-related outcomes. For some outcomes the association persists, over and above the effects of measured ability, social development, academic qualifications and adult socioeconomic status and lifestyle.

Modelling opportunity in health under partial observability of circumstances

This paper proposes a behavioural model of inequality of opportunity in health that integrates John Roemer's framework of inequality of opportunity with the Grossman model of health capital and demand for health. The model generates a recursive system of equations for health and lifestyles, which is then jointly estimated by full information maximum likelihood with freely correlated error terms. The analysis innovates by accounting for the presence of unobserved heterogeneity, therefore addressing the partial-circumstance problem, and by extending the examination of inequality of opportunity to health outcomes other than self-assessed health, such as long-standing illness, disability and mental health. The results provide evidence for the existence of third factors that simultaneously influence health outcomes and lifestyle choices, supporting the empirical relevance of the partial-circumstance problem. Accounting for these factors, the paper corroborates that the effect of parental and early circumstances on adult health disparities is paramount. However, the particular set of circumstances that affect each of the analysed health outcomes differs substantially. The results also show that differences in educational opportunities, and in social development in childhood, are crucial determinants of lifestyles in adulthood, which, in turn, shape the observed health inequalities.