1

Paper

An Individual-Level Approach to Health Inequality: Child Survival in 50 Countries King, Gary Gakidou, Emmanuela Uploaded 11-27-2000 Keywords beta-binomial health inequality survey research Abstract BACKGROUND: Reducing health inequalities is an important part of the agenda of health policymakers globally. Studies of health inequalities have revealed large variations in average health status across social, economic, and other _groups_. However, no studies have been conducted on the distribution of the risk of ill-health across _individuals_. METHODS: We use an extended beta-binomial model to estimate the distribution the risk of death in children under the age of two in the 50 developing countries where data from a Demographic and Health Survey are available. Inequality in these distributions is measured by the WHO health inequality index. FINDINGS: At the same level of average child mortality, inequality in the risk of death across children can vary considerably across countries. Representing the entire distribution of risk with a single measure of inequality involves normative choices that we delineate and then formalise with quantitative measures. The results are not very sensitive to the choice of measure. Liberia, Mozambique and the Central African Republic have the largest inequalities in child survival, while Colombia, the Philippines and Kazakhstan have the lowest among the 50 countries measured. Exploratory analyses indicate that health inequality is predicted by low GDP, low health expenditures, and poverty, but not by income inequality or democratization. INTERPRETATION: Inequality estimates should routinely be reported alongside average levels of health, as they reveal important information about the distribution of health across individuals within populations. Measuring inequality with individual level data, rather than quantifying differences in average levels of health across social groups, enables meaningful comparisons of inequality across countries and analyses of the determinants of inequality. This approach should be extended to the measurement of inequalities in health expectancy (i.e., life expectancy discounted by expected disabilities).