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Assessing Health Inequalities amongIndian Children:

A Decomposition Analysis

By

Jalandhar PradhanGuide: Advisory Committee:Dr. P. Arokiasamy Prof. S. Parasuraman

Dr. L. Ladu Singh



Introduction

T he distributive dimension of health or health inequality hasbecome prominent on global policy agenda, as researchershave come to regard average health status as aninadequate summary of country s health performance(WHO, 2000).

In recent times there is renewed interest in assessinghealth related inequalities in both developed anddeveloping countries. Addressing health inequalities is anurgent concern in developing countries especially in south

Asian countries.

T he millennium development goals (MDGs) view thereduction of health inequalities as its primary health relatedgoals.



Ba ckground of this study

Most health inequality studies until now have in fact documented differences in average health status acrossgroups of people.

Sociological focus- examined inequalities in average healthstatus among social classes (Marmot et al; 1991).

Other scholars- racial or ethnic groups or by educationalattainment or occupation (Kunst 1995; Mackenbach, 1997).

Demographers- age, sex, education and racial groups(Preston, 1991). In low- and middle-income countries thereexists a rich demographic literature on levels and trends inchild mortality and causes associated with them (Hill 1999;Brockerhoff 2000).



Qu a ntifying he al th inequ al ity

Comparison Absolute and relative difference AggregationSensitivity to meanSensitivity to population sizeSubgroup consideration



Indi a n scen a rio

India is the nation with high-level regional inequality;social hierarchy; and multicultural society.

With high level of economic and social inequality; healthand nutrition inequalities are also pervasive.

A greater inequality in health and nutrition among thechildren of deprived group challenging to achieve

millennium development goals set forth by United Nation.National



Contd

Performance was found to be very uneven acrosslocations (rural/urban; north/south), wealth quintiles, andgender.

While health and gender inequalities in child mortality,nutrition and immunization persist in some parts of India,and understanding this phenomenon is important in thecontext of economic development, policy implications fromevidence of health and nutrition inequalities are not directly related to the health care system .



Need for the study

Most demographic studies concentrated on examining betweengroup" differences. However within group" differences is critical toassess total health inequality.

Assessing health inequalities within class is an research agenda;

more importantly, comparative analyses of their determinants.

In common parlance poor are more deprived in health but healthinequality within poor is also significant. One should address thisquestion scientifically so that one can measure the inequalitieswithin the deprived groups (poor, SC/S T , rural, illiterate etc.).

T hese comparative studies are essential for formulating effectivepolicies, with which governments will be able to reduce theseinequalities.



Total Health Inequality

Between Group Among states

Within GroupSocioeconomic inequality

Ethnic inequalityGender inequality

Total= µBetween Group¶+ µWithin Group¶



Obj ectivesT

o study health inequalities in terms of child survivalacross Indian states using new sets of inequality index.

To ass ess total h ealth in equ ality in t erm s of be tw ee n and within group in eq ualiti es .To compar e th e e stimat es o f n ew in eq uality indic es with conv entional

in eq uality estimat es i .e. varianc e, th e G ini co effici ent, th e co e ffici ent of variation .

To acc ess h ealth in eq ualiti es with r egard to nutrition,curativ e car e and immunisation .

To int err e lat e l ev e l of summary indicators of h ealth and socio economic d ev e lopm ent with th e l ev e l of h ealth in eq uality .



D a t a

National Family Health Survey-2, 1998-99

CMIE

Census

NSS



Methodology

Objective 1Bet w ee n gr oup

Fir st: T he fi r st ste p is to estimate the dist r ibu tion of thepr obability of death ( un de r t w o) ac r oss child r en in each statesam p le. T hese pr obabilities w ill be estimated u sin g theexte n ded beta-bi n omial model.

Seco n d: T he seco n d ste p is to t r an sfo r m the estimated

pr obability of death bet w ee n bir th a n d age t w o fo r eachchild (2q0) to the ex p ected s ur vival time i n the fi r st t w oyea r s of life, S.





W ithin Group

So cio econo mi c in eq u alit y (Con centr a tion in dex by W ags t aff)

Ethni c in eq u alit y (Bro cke rho ff a n d Hewe tt )

Gen de r in eq u alit y (W HO)

Ran kin g o f s t a t es w ith r es p ec t to ab o ve in eq u alit y in di ces



For comparison, estimates of child survival inequality will becalculated for three other commonly uses summary measures of distributions-the variance, the Gini Index, and the coefficient of variation.

After that the states will be ranked according to their values. Apair wise rank order correlation will be done to examine theirconsistency.



Objective 2

T he achievement can be measure by the followingindex:

))(1()( vC v I ! Q

§!

!

n

i

v R iwin yivC 1

),()./(1)( Q

v= the degree of inequality a v ersion

C(v )= Concentration index

n= Sample size

yi= ill health indicator of person i

Ri= Fractional rank in the li v ing standards distribution of the i th person





Objective 3

T he following indicators will be used to interrelate with thelevel of health inequality

Per ca p ita inco m eShare of SDP s p ent on healthLevel of p overtyInco m e inequalityMean p robability of death (2q0)

Regression analysis will be e mp loyed to interrelate abovesocioecono m ic indicators with health inequality indices.



T hank You

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