IDEAS home Printed from https://ideas.repec.org/p/wbk/wbrwps/2795.html
   My bibliography  Save this paper

Inequalities in health in developing countries - swimming against the tide?

Author

Listed:
  • Wagstaff, Adam

Abstract

Inequalities in health have recently started to receive a good deal of attention in the developing world. But how large are they? An how large are the differences across countries? Recent data from a 42-country study, show large, but varying inequalities in health across countries. The author explores the reasons for these inter-country differences, and concludes that large inequalities in health, are not apparently associated with large inequalities in income, or with small shares of publicly financed health spending. But they are associated with higher per capita incomes. Evidence from trends in health inequalities - in both the developing, and the industrial world - supports the notion that health inequalities rise with rising per capita incomes. The association between health inequalities, and per capita incomes is probably due in part, to technological change going hand-in-hand with economic growth, coupled with a tendency for the better-off to assimilate new technology ahead of the poor. Since increased health inequalities, associated with rising per capita incomes is a bad thing, and increased average health levels associated with rising incomes are a good thing, the author outlines a way of quantifying the tradeoff between health inequalities, and health levels. He also suggests that successful anti-inequality policies can be devised, but that their success cannot be established simply by looking at"headline"health inequality figures, since these reflect the effects of differences, and changes in other variables, including per capita income. The author identifies four approaches that can shed light on the impacts of anti-inequality policies on health inequalities: cross-country comparative studies, country-based before-and-after studies with controls, benefit-incidence analysis, and decomposition analysis. The results of studies based on these four approaches do not give as many clear-cut answers as one might like on how best to swim against the tide of rising per capita incomes, and their apparent inequality-increasing effects. But they ought at least to help us build our stock of knowledge on the subject.

Suggested Citation

  • Wagstaff, Adam, 2002. "Inequalities in health in developing countries - swimming against the tide?," Policy Research Working Paper Series 2795, The World Bank.
  • Handle: RePEc:wbk:wbrwps:2795
    as

    Download full text from publisher

    File URL: http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2002/03/22/000094946_02031204013460/Rendered/PDF/multi0page.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Wagstaff, Adam, 1986. "The Demand for Health: A Simplified Grossman Model [On the Concept of Health Capital and the Demand for Health]," Bulletin of Economic Research, Wiley Blackwell, vol. 38(1), pages 93-95, January.
    2. Castro-Leal, Florencia & Dayton, Julia & Demery, Lionel & Mehra, Kalpana, 1999. "Public Social Spending in Africa: Do the Poor Benefit?," The World Bank Research Observer, World Bank, vol. 14(1), pages 49-72, February.
    3. Wagstaff, Adam & Nga Nguyet Nguyen, 2002. "Poverty and survival prospects of Vietnamese children under Doi Moi," Policy Research Working Paper Series 2832, The World Bank.
    4. van Doorslaer, Eddy & Wagstaff, Adam & Bleichrodt, Han & Calonge, Samuel & Gerdtham, Ulf-G. & Gerfin, Michael & Geurts, Jose & Gross, Lorna & Hakkinen, Unto & Leu, Robert E., 1997. "Income-related inequalities in health: some international comparisons," Journal of Health Economics, Elsevier, vol. 16(1), pages 93-112, February.
    5. William Easterly, 2002. "The Elusive Quest for Growth: Economists' Adventures and Misadventures in the Tropics," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262550423, April.
    6. Lant Pritchett & Lawrence H. Summers, 1996. "Wealthier is Healthier," Journal of Human Resources, University of Wisconsin Press, vol. 31(4), pages 841-868.
    7. Paul Contoyannis & Martin Forster, 1999. "‘Our healthier nation’?," Health Economics, John Wiley & Sons, Ltd., vol. 8(4), pages 289-296, June.
    8. Bidani, Benu & Ravallion, Martin, 1997. "Decomposing social indicators using distributional data," Journal of Econometrics, Elsevier, vol. 77(1), pages 125-139, March.
    9. Deon Filmer & Lant Pritchett, 1999. "The Effect of Household Wealth on Educational Attainment: Evidence from 35 Countries," Population and Development Review, The Population Council, Inc., vol. 25(1), pages 85-120, March.
    10. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    11. Contoyannis, Paul & Forster, Martin, 1999. "The distribution of health and income: a theoretical framework," Journal of Health Economics, Elsevier, vol. 18(5), pages 603-620, October.
    12. Wagstaff, Adam & Watanabe, Naoko, 2000. "Socioeconomic inequalities in child malnutrition in the developing world," Policy Research Working Paper Series 2434, The World Bank.
    13. Wagstaff, Adam & Paci, Pierella & van Doorslaer, Eddy, 1991. "On the measurement of inequalities in health," Social Science & Medicine, Elsevier, vol. 33(5), pages 545-557, January.
    14. Mackenbach, Johan P. & Kunst, Anton E., 1997. "Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe," Social Science & Medicine, Elsevier, vol. 44(6), pages 757-771, March.
    15. Filmer, Deon & Hammer, Jeffrey & Pritchett, Lant, 1998. "Health policy in poor countries : weak links in the chain," Policy Research Working Paper Series 1874, The World Bank.
    16. van Doorslaer, Eddy & Wagstaff, Adam, 1992. "Equity in the delivery of health care: some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 389-411, December.
    17. Le Grand, Julian, 1987. "Inequalities in health : Some international comparisons," European Economic Review, Elsevier, vol. 31(1-2), pages 182-191.
    18. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
    19. David E. Sahn & Stephen D. Younger, 2000. "Expenditure incidence in Africa: microeconomic evidence," Fiscal Studies, Institute for Fiscal Studies, vol. 21(3), pages 329-347, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Pradhan, Menno & Sahn, David E. & Younger, Stephen D., 2003. "Decomposing world health inequality," Journal of Health Economics, Elsevier, vol. 22(2), pages 271-293, March.
    2. Wagstaff, Adam, 2002. "Inequality aversion, health inequalities and health achievement," Journal of Health Economics, Elsevier, vol. 21(4), pages 627-641, July.
    3. David Cantarero & Marta Pascual & Jose Maria Sarabia, 2004. "Can income inequality contribute to understand inequalities in health? An empirical approach based on the European Community Household Panel," ERSA conference papers ersa04p230, European Regional Science Association.
    4. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    5. Magnus Lindelow, 2006. "Sometimes more equal than others: how health inequalities depend on the choice of welfare indicator," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 263-279, March.
    6. Lindelow, Magnus, 2004. "Sometimes more equal than others : how health inequalities depend on the choice of welfare indicator," Policy Research Working Paper Series 3329, The World Bank.
    7. Kristina Burström & Magnus Johannesson & Finn Diderichsen, 2005. "Increasing socio‐economic inequalities in life expectancy and QALYs in Sweden 1980–1997," Health Economics, John Wiley & Sons, Ltd., vol. 14(8), pages 831-850, August.
    8. Joan Costa-i-Font & Cristina Hernandez-Quevedo & Azusa Sato, 2013. "A 'Health Kuznets' Curve'? Cross-Country and Longitudinal Evidence," CESifo Working Paper Series 4446, CESifo.
    9. Adam Wagstaff & Naoko Watanabe, 2003. "What difference does the choice of SES make in health inequality measurement?," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 885-890, October.
    10. Magnus Lindelow, 2002. "Sometimes More Equal than Others How the choice of welfare indicator can affect the measurement of health inequalities and the incidence of public spending," Economics Series Working Papers WPS/2002-15, University of Oxford, Department of Economics.
    11. Narayan Sastry, 2002. "Trends in Socioeconomic Inequalities in Under-Five Mortality: Evidence from Sao Paulo, Brazil, 1970-1991," Working Papers 02-15, RAND Corporation.
    12. Gerdtham, Ulf-G & Sundberg, Gun, 1996. "Measuring Income-Related Health Inequalities in Sweden," SSE/EFI Working Paper Series in Economics and Finance 120, Stockholm School of Economics.
    13. Kenya Valeria M. S. Noronha & M™nica Viegas Andrade, 2002. "Desigualdades sociais em saúde: evidências empíricas sobre o caso brasileiro," Textos para Discussão Cedeplar-UFMG td171, Cedeplar, Universidade Federal de Minas Gerais.
    14. Adam Wagstaff & Eddy van Doorslaer, 2004. "Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations," Health Economics, John Wiley & Sons, Ltd., vol. 13(3), pages 297-301, March.
    15. Chen, Zhuo & Roy, Kakoli, 2009. "Calculating concentration index with repetitive values of indicators of economic welfare," Journal of Health Economics, Elsevier, vol. 28(1), pages 169-175, January.
    16. Buhong Zheng, 2011. "A new approach to measure socioeconomic inequality in health," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 9(4), pages 555-577, December.
    17. Wildman, John, 2003. "Income related inequalities in mental health in Great Britain: analysing the causes of health inequality over time," Journal of Health Economics, Elsevier, vol. 22(2), pages 295-312, March.
    18. Martins, Lurdes & Veiga, Paula, 2010. "Do inequalities in parents' education play an important role in PISA students' mathematics achievement test score disparities?," Economics of Education Review, Elsevier, vol. 29(6), pages 1016-1033, December.
    19. Jørgen Lauridsen & Jalandhar Pradhan, 2011. "Socio-economic inequality of immunization coverage in India," Health Economics Review, Springer, vol. 1(1), pages 1-6, December.
    20. Van Ourti, Tom & van Doorslaer, Eddy & Koolman, Xander, 2009. "The effect of income growth and inequality on health inequality: Theory and empirical evidence from the European Panel," Journal of Health Economics, Elsevier, vol. 28(3), pages 525-539, May.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wbk:wbrwps:2795. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Roula I. Yazigi (email available below). General contact details of provider: https://edirc.repec.org/data/dvewbus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.