Background: Studies have revealed large variations in average
health status across social, economic, and other groups. No study
exists on the distribution of the risk of ill-health across
individuals, either within groups or across all people in a society,
and as such a crucial piece of total health inequality has been
overlooked. Some of the reason for this neglect has been that the risk
of death, which forms the basis for most measures, is impossible to
observe directly and difficult to estimate.
Methods: We
develop a measure of total health inequality -- encompassing all
inequalities among people in a society, including variation between
and within groups -- by adapting a beta-binomial regression
model. We apply it to children under age two in 50 low- and
middle-income countries. Our method has been adopted by the World
Health Organization and is being implemented in surveys around the
world; preliminary estimates have appeared in the World Health Report
(2000).
Results: Countries with similar average child
mortality differ considerably in total health inequality. Liberia and
Mozambique have the largest inequalities in child survival, while
Colombia, the Philippines and Kazakhstan have the lowest levels among
the countries measured. Conclusions: Total health inequality
estimates should be routinely reported alongside average levels of
health in populations and groups, as they reveal important
policy-related information not otherwise knowable. This approach
enables meaningful comparisons of inequality across countries and
future analyses of the determinants of inequality.
Also see related research.