Health outcomes are invariably worse among the poor—often markedly so. The chance of a newborn baby in Bolivia dying before his or her fi fth birthday is more than three times higher if the parents are in the poorest fifth of the population than if they are in the richest fi fth (120‰ compared with 37‰). Reducing inequalities such as these is widely perceived as intrinsically important as a development goal. But as the World Bank’s 2006 World Development Report, Equity and Development, argued, inequalities in health refl ect and reinforce inequalities in other domains, and these inequalities together act as a brake on economic growth and development.

One challenge is to move from general statements such as that above to monitoring progress over time and evaluating development programs with regard to their effects on specifi c inequalities. Another is to identify countries or provinces in countries in which these inequalities are relatively small and discover the secrets of their success in relation to the policies and institutions that make for small inequalities.

This book sets out to help analysts in these tasks. It shows how to implement a variety of analytic tools that allow health equity—along different dimensions and in different spheres—to be quantifi ed. Questions that the techniques can help provide answers for include the following: Have gaps in health outcomes between the poor and the better-off grown in specifi c countries or in the developing world as a whole? Are they larger in one country than in another? Are health sector subsidies more equally distributed in some countries than in others? Is health care utilization equitably distributed in the sense that people in equal need receive similar amounts of health care irrespective of their income? Are health care payments more progressive in one health care fi nancing system than in another? What are catastrophic payments? How can they be measured? How far do health care payments impoverish households?

Typically, each chapter is oriented toward one specifi c method previously outlined in a journal article, usually by one or more of the book’s authors. For example, one chapter shows how to decompose inequalities in a health variable (be it a health outcome or utilization) into contributions from different sources—the contribution from education inequalities, the contribution from insurance coverage inequalities, and so on. The chapter shows the reader how to apply the method through worked examples complete with Stata code.

Most chapters were originally written as technical notes downloadable from the World Bank’s Poverty and Health Web site (www.worldbank.org/povertyandhealth). They have proved popular with government officials, academic researchers, graduate students, nongovernmental organizations, and international organization staff, including operations staff in the World Bank. They have also been used in training exercises run by the World Bank and universities. These technical notes were all extensively revised for the book in light of this “market testing.” By collecting these revised notes in the form of a book, we hope to increase their use and usefulness and thereby to encourage further empirical work on health equity that ultimately will help shape policies to reduce the stark gaps in health outcomes seen in the developing world today.

François J. Bourguignon
Senior Vice President and Chief Economist
The World Bank

“Health equity is an area of major interest to health service researchers and policy makers, particularly those with a concern for low- and middle-income countries. This volume provides a practical hands-on guide to data and methods for the measurement and interpretation of health equity. It will act as a bridge between the academic literature that ‘tends to neglect practical details’ and the needs of practitioners for a clear guide on ‘how to do it.’ In my judgment this volume will become a standard text in the field of health equity analysis and will attract a wide international audience.”
Andrew M. Jones
Professor of Economics and Director of the Graduate Program in Health Economics
University of York, UK

“This is an excellent and exciting collection of knowledge of analytical techniques for measuring health status and equity. This will be a very useful and widely cited book.”
Hugh Waters
Assistant Professor, Bloomberg School of Public Health
Johns Hopkins University, USA

Visit Analyzing Health Equity Using Household Survey Data Download Page

You can download complete book in pdf format.

A Guide to Techniques and Their Implementation
By Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff, Magnus Lindelow

©2008 The International Bank for Reconstruction and Development / The World Bank
1818 H Street, NW
Washington, DC 20433
Telephone: 202-473-1000

Download Analyzing Health Equity Using Household Survey Data

PDF format, 6.5MB, 234Pages.

Preface:

This volume has a simple aim: to provide researchers and analysts with a step-bystep practical guide to the measurement of a variety of aspects of health equity.

Each chapter includes worked examples and computer code. We hope that these guides, and the easy-to-implement computer routines contained in them, will stimulate yet more analysis in the fi eld of health equity, especially in developing countries.

We hope this, in turn, will lead to more comprehensive monitoring of trends in health equity, a better understanding of the causes of these inequities, more extensive evaluation of the impacts of development programs on health equity, and more effective policies and programs to reduce inequities in the health sector.

Owen O’Donnell
Eddy van Doorslaer
Adam Wagstaff
Magnus Lindelow

Introduction:

Equity has long been considered an important goal in the health sector. Yet inequalities between the poor and the better-off persist. The poor tend to suffer higher rates of mortality and morbidity than do the better-off. They often use health services less, despite having higher levels of need. And, notwithstanding their lower levels of utilization, the poor often spend more on health care as a share of income than the better-off. Indeed, some nonpoor households may be made poor precisely because of health shocks that necessitate out-of-pocket spending on health.

Most commentators accept that these inequalities refl ect mainly differences in constraints between the poor and the better-off—lower incomes, higher time costs, less access to health insurance, living conditions that are more likely to encourage the spread of disease, and so on—rather than differences in preferences (cf. e.g., Alleyne et al. 2000; Braveman et al. 2001; Evans et al. 2001a; Le Grand 1987; Wagstaff 2001; Whitehead 1992). Such inequalities tend therefore to be seen not simply as inequalities but as inequities (Wagstaff and van Doorslaer 2000).

Some commentators, including Nobel prize winners James Tobin (1970) and Amartya Sen (2002), argue that inequalities in health are especially worrisome— more worrisome than inequalities in most other spheres. Health and health care are integral to people’s capability to function—their ability to fl ourish as human beings. As Sen puts it, “Health is among the most important conditions of human life and a critically signifi cant constituent of human capabilities which we have reason to value” (Sen 2002). Society is not especially concerned that, say, ownership of sports utility vehicles is low among the poor. But it is concerned that poor children are systematically more likely to die before they reach their fi fth birthday and that the poor are systematically more likely to develop chronic illnesses. Inequalities in out-of-pocket spending matter too, because if the poor— through no fault of their own—are forced into spending large amounts of their limited incomes on health care, they may well end up with insuffi cient resources to feed and shelter themselves. ...

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