Four Essays on the Links Between Poverty, Inequality and Health with Empirical Application to Developing Countries: Africa Compared to the Rest of the World (original) (raw)
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Poverty and inequality – but of what - as social determinants of health in Africa?
African Health Sciences, 2016
Background: Many African economies have achieved substantial economic growth over the past recent years, yet several of the Millennium Development Goals (MDGs) including those concerned with health, remain considerably behind target. This paper examines whether progress towards these goals is being hampered by existing levels of poverty and income inequality. It also considers whether the inequality hypothesis of Wilkinson and Pickett 1 applies to population health outcomes in African states. Methods: Correlation analysis and scatter plots were used to assess graphically the link between variations in health outcomes, level of poverty and income inequality in different countries. Health status outcomes were measured by using four indicators: infant and under-five (child) mortality rates; maternal mortality ratios; and life expectancy at birth. In each of the 52 African nations, the proportion of the population living below the poverty line is used as an indicator of the level of poverty and Gini coefficient as a measure of income inequality. The study used a comprehensive review of secondary and relevant literature that are pertinent in the subject area. The data datasets obtained online from UNICEF 2 and UNDP 3 (2009) used to test the research questions. World Health Organization the three broad dimensions to consider when moving towards better population health outcome through Universal Health Coverage and the Social Determinants of Health framework reviewed to establish the poverty and income inequality link in African countries population health outcomes. Results: The study shows that poverty is strongly associated with all health outcome differences in Africa (IMR, cc = 0.63; U5MR, cc = 0.64; MMR, cc = 0.49; life expectancy at birth, cc =-0.67); income inequality with only one of the four indicators (IMR, cc = 0.14; U5MR, cc = 0.07; MMR, cc = 0.22; life expectancy at birth, cc =-0.49), whereas income inequality is associated with one of the four indicators. Conclusion: The study shows that tackling poverty should be the immediate concern in Africaas a means of promoting better health for all. There is a question mark over whether the findings of Wilkinson and Pickett 1 on the relationship between income inequality and health apply to Africa. The reasons for this question mark are discussed. More research is needed to investigate whether the inequality results found in this study are replicated in other studies of African health.
SSRN Electronic Journal, 2000
This paper describes changes over the past 15-20 years in non-income measures of wellbeing -education and health -in Africa. We expected to find, as we did in Latin America, that progress in the provision of public services and the focus of public spending in the social sector would contribute to declining poverty and inequality in health and education, even in an environment of stagnant or worsening levels of income poverty. Unfortunately, our results indicate that in the area of health, little progress is being made in terms of reducing pre-school age stunting, a clear manifestation of poor overall health. Likewise, our health inequality measure showed that while there were a few instances of reduced inequality along this dimension, there was, on balance, little evidence of success in improving equality of outcomes. Similar results were found in our examination of underweight women as an indicator of general current health status of adults. With regard to education, the story is somewhat more positive. However, the overall picture gives little cause for complacency or optimism that Africa has, or will soon reap the potential benefits of the process of globalization.
Measuring variations and gaps in health and wellbeing across individuals, social groups and societies is a critical issue confronting social scientists in their quest to explain why gaps in health between the rich and the poor persist within and across societies. This article provides a systematic review of the measurement of inequalities and their implications on rural and remote health. A comprehensive literature review was conducted using online databases and other collections of published research on measuring health gaps between the rich and the poor in order to trace the development of this field of inquiry. Despite the enormous information on the subject area, it is not always easy to disentangle the independent effects of social class or socio-economic status (SES) on health inequalities from genetic or biological differences when analyzing racial/ethnic, gender or age gaps in mortality and morbidity. The meaning of SES or social class also varies from one culture to the other. Despite decades of work in this field, it is not clear what it is about SES or social class that is associated with inequalities in health. Is it simply a question of access to resources? And on the issue of measurement, studies from various disciplines have shown that it is important to employ a raft of measures in order to measure and present the distributions fully from various angles and value judgments. In the rural African context, tackling vertical and horizontal inequalities in health requires tackling the root causes of poverty and promoting social policies that empower individuals and communities. Hence, the review discusses recent methodological developments that hold promise for addressing the knowledge gap that remain. We hope that researchers will reflect on the dynamics in measures of inequalities discussed in this paper as they continue to assess the status of health in Africa's contemporary and largely dominated rural population.
Health and poverty: Past, present and prospects for the future
Social Science & Medicine, 1993
Periodically the results of class comparisons in mortality rates have been reported. These reports have permitted comparisons since the earlier part of this century to the present period. The data thus available enables us to make some tentative predictions about the likely magnitude of class inequalities in mortality in the future. We consequently argue that:
Inequity in poverty: the emerging public health challenge in Johannesburg
Development Southern Africa, 2009
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International Journal of Health Services, 2013
There is a growing interest in health policy in the social determinants of health. This has increased the demand for a paradigm shift within the discipline of health economics from health care economics to health economics. While the former involves what is essentially a medical model that emphasises the maximization of individual health outcomes and considers the social organization of the health system as merely instrumental, the latter emphasises that health and its distribution result from political, social, economic and cultural structures. The discipline of health economics needs to refocus its energy on the social determinants of health but in doing so must dig deeper into the reasons for structurally embedded inequalities that give rise to inequalities in health outcomes. Especially is this the case in Africa and other low and middle income regions. This paper seeks to provide empirical evidence from sub-Saharan Africa, including Ghana and Nigeria, on why such inequalities exist, arguing that these are in large part a product of hangovers from historically entrenched institutions. It argues that there is a need for research in health economics to embrace the social determinants of health, especially inequality, and to move away from its current mono-cultural focus.
Social inequality and children’s health in Africa: a cross sectional study
International Journal for Equity in Health, 2016
Background: This study examines socioeconomic inequality in children's health and factors that moderate this inequality. Socioeconomic measures include household wealth, maternal education and urban/rural area of residence. Moderating factors include reproductive behavior, access to health care, time, economic development, health expenditures and foreign aid. Methods: Data are taken from Demographic and Health Surveys conducted between 2003 and 2012 in 26 African countries. Results: Birth spacing, skilled birth attendants, economic development and greater per capita health expenditures benefit the children of disadvantaged mothers, but the wealthy benefit more from the services of a skilled birth attendant and from higher per capita expenditure on health. Conclusion: Some health behavior and policy changeswould reduce social inequality, but the wealthy benefit more than the poor from provision of health services.
Foreword 03 Introduction 04 1- The African heritage 05 2- Key political factors 08 2.1- States led by a strongman 09 2.2- The wars and their consequences on populations 11 2.3- Child soldiers 14 3- Key socio-economic factors 16 3.1- The lack of basic infrastructure 16 3.2- Large families 17 3.3- Unemployment 19 3.4- The brain drain 20 3.5- The greed of the great powers 22 4- Key cultural factors 24 4.1- The ignored AIDS 24 4.2- FGM 26 4.3- Illiteracy 28 4.4- The culture of a corrupt political class 29 Conclusion 32 References 36 Appendix - Current situation (Maps 1 to 17) 39 When we talk about poverty in Africa, it is necessary, first of all define the term poverty. In this paper, the term is meant to encompass the general lack of conditions for an acceptable quality of life, with reference to socio-economic patterns such as average life expectancy, the birth rate, the adult and infant mortality rates, the percentage the elderly population, human development index, the distribution of per capita GDP or the unemployment rate, which, compared to Europeans (given the African colonization had left Europe), allow to illustrate the gulf between the two continents and at the same time, emphasize the precariousness of existence in the overwhelming majority of African countries. However, there are also determinants of political and cultural order that they are both cause and effect in relation to those data, especially the endless armed conflicts decimating rural populations and destroy the fields, the corruption of the political class that often starts at the top of the hierarchy, the ostensible blindness of this in relation to public health issues such as AIDS or Female Genital Mutilation which clash with ancestral traditions which no one remembers the origin and, cumulatively, illiteracy that keeps the people in obscurantism of magical-religious practices and traditions that are detrimental the most basic human rights. All these are factors which, in the author's opinion, determined or gave rise to the difficult living conditions of the majority of African people, which is not strange a European colonial action always ready to squeeze out the maximum giving the minimum in return. And these are also issues that require attention in the work presented here, which still has the ambition, perhaps excessive, that, on a synthesis of the information obtained, to identify a route out of this vicious cycle consisting of war-famine-plague-war, to which not all the world humanitarian aid can halt. There is that caveat, however, that not everything is catastrophic in the panorama of the African continent. Check here and there are many situations to improve this collective misfortune frame, either by growing awareness of the African political class that should work for the common good, either because the people are tired of successive wars and require peace or by a, so far practically inexistent, commitment in conflict resolution by the major powers, whether African or Western, instead of trying to profit from them. Thus, some issues developed here may err on outdated in some cases, since it was favoured the study of Africa's situation as a whole and not country to country. However the vast majority of African peoples still live in the subsistence level or below and, despite the significant improvement recorded in some sectors, still desperately seeking an end to their suffering.
Health Equity: A Challenge and Achievable Goal for Africa
The conditions in which people are born, live, grow and age are important and impact greatly on their health. However, equity is not about sameness but each and every individual deserving the same opportunity concerning health, education, housing, working and living conditions.-Health inequities are found worldwide at different levels and stem from various factors. Africans are experiencing health inequity related to the social, economic, cultural and political environment in which they live. Immediate actions, coupled with a good political will substantially reduce the existing gaps and ensure that we achieve health equity in a nearer future.
POVERTY AND DISEASE: ARE THEY THE MAJOR IMPEDIMENTS IN SUB-SAHARAN AFRICA
Mintage Journal of Pharmaceutical & Medical Sciences , 2019
Background: This was a review of poverty and disease in Sub-Saharan Africa. Poverty related infections are major public health problems worldwide contributing significantly to high morbidity and mortality. With the Sub-Saharan Africa having the world's poorest people, the effects of these infections is predominant in this region of the world. The most significant poverty related infections are malaria, tuberculosis and HIV.