Inequalities in Health inDeveloping Countries: Swimming Against the Tide?

Wagstaff, Adam

World Bank, Washington, D.C

关键词: AID PROGRAMS;    AVERAGE INCOME;    AVERAGE INCOMES;    COMPARATIVE STUDIES;    CONSTANT ELASTICITY;   

DOI  :  10.1596/1813-9450-2795
RP-ID  :  WPS2795

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Inequalities in health have recentlystarted to receive a good deal of attention in thedeveloping world. But how large are they? An how large arethe differences across countries? Recent data from a42-country study, show large, but varying inequalities inhealth across countries. The author explores the reasons forthese inter-country differences, and concludes that largeinequalities in health, are not apparently associated withlarge inequalities in income, or with small shares ofpublicly financed health spending. But they are associatedwith higher per capita incomes. Evidence from trends inhealth inequalities - in both the developing, and theindustrial world - supports the notion that healthinequalities rise with rising per capita incomes. Theassociation between health inequalities, and per capitaincomes is probably due in part, to technological changegoing hand-in-hand with economic growth, coupled with atendency for the better-off to assimilate new technologyahead of the poor. Since increased health inequalities,associated with rising per capita incomes is a bad thing,and increased average health levels associated with risingincomes are a good thing, the author outlines a way ofquantifying the tradeoff between health inequalities, andhealth levels. He also suggests that successfulanti-inequality policies can be devised, but that theirsuccess cannot be established simply by looking at"headline" health inequality figures, since thesereflect the effects of differences, and changes in othervariables, including per capita income. The authoridentifies four approaches that can shed light on theimpacts of anti-inequality policies on health inequalities:cross-country comparative studies, country-basedbefore-and-after studies with controls, benefit-incidenceanalysis, and decomposition analysis. The results of studiesbased on these four approaches do not give as many clear-cutanswers as one might like on how best to swim against thetide of rising per capita incomes, and their apparentinequality-increasing effects. But they ought at least tohelp us build our stock of knowledge on the subject.