Tuesday, April 1, 2008

[EQ] Socioeconomic inequality in malnutrition in developing countries

Socioeconomic inequality in malnutrition in developing countries

Ellen Van de Poel, Erasmus University Rotterdam, Rotterdam, the Netherlands
Ahmad Reza Hosseinpoor, World Health Organization, Geneva, Switzerland
Niko Speybroeck, Institute for Tropical Medicine Antwerp, Antwerp, Belgium
Tom Van Ourti, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Jeanette Vega, World Health Organization, Geneva, Switzerland

Bulletin of the World Health Organization (BLT) - Volume 86, Number 4, April 2008, 241-320

Available online at: http://www.who.int/bulletin/volumes/86/4/07-044800/en/index.html

“…..Epidemiological evidence points to a small set of primary causes of child mortality that are the main killers of children aged less than 5 years: pneumonia, diarrhoea, low birth weight, asphyxia and, in some parts of the world, HIV and malaria. Malnutrition is the underlying cause of one out of every two such deaths.^1,2 The evidence also shows that child death and malnutrition are not equally distributed throughout the world. They cluster in sub-Saharan Africa and south Asia, and in poor communities within these regions.^3,4

Disparities in health outcomes between the poor and the rich are increasingly attracting attention from researchers and policy-makers, thereby fostering a substantial growth in the literature on health equity.^5–8 “Socioeconomic inequality” in malnutrition refers to the degree to which childhood malnutrition rates differ between more and less socially and economically advantaged groups. This is different from “pure inequality”, which takes into account all factors influencing childhood malnutrition.

The available literature documenting socioeconomic inequality in malnutrition focuses mainly on individual countries or regions.^9–14 At a more global level, Wagstaff and Watanabe¹⁵ provided evidence on socioeconomic inequality in malnutrition across 20 developing countries. Other relevant cross-country studies include those of Pradhan et al.,¹⁶ who describe total inequality, and Smith et al.,¹⁷ who describe inequalities between urban and rural populations. The latter two studies, however, provide no evidence on socioeconomic inequality within developing countries.

This paper contributes to the literature in several ways. First, it updates and enlarges the evidence base on average malnutrition and socioeconomic inequality in malnutrition using the most recent Demographic and Health Survey (DHS) data from 47 developing countries.

The inclusion of such a large number of countries makes it possible to obtain insights into the regional clustering of poor–rich malnutrition disparities in the developing world and into the association between the average level of malnutrition and socioeconomic inequality. Given the focus on average rates of malnutrition in international development targets, it is of interest to establish how countries compare in terms of average rates of malnutrition and inequality in malnutrition. In addition to quantifying the degree of socioeconomic inequality using a single index, this paper also illustrates the different patterns found for the distribution of malnutrition across socioeconomic groups….”

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[EQ] The Prevention of Lifestyle-Related Chronic Diseases: an Economic Framework

THE PREVENTION OF LIFESTYLE-RELATED CHRONIC DISEASES:
AN ECONOMIC FRAMEWORK

Franco Sassi and Jeremy Hurst

Organisation for Economic Co-operation and Development - 25-Mar-2008

OECD HEALTH WORKING PAPER NO. 32

Available online as PDF file [78p.] at: http://www.oecd.org/dataoecd/57/14/40324263.pdf

“………This paper provides an economic perspective on the prevention of chronic diseases, focusing in particular on diseases linked to lifestyle choices. The proposed economic framework is centred on the hypothesis that the prevention of chronic diseases may provide the means for increasing social welfare, enhancing health equity, or both, relative to a situation in which chronic diseases are simply treated once they emerge.

Testing this hypothesis requires the completion of several conceptual and methodological steps. The pathways through which chronic diseases are generated must be identified as well as the levers that could modify those pathways. Justification for action must be sought by examining whether the determinants of chronic diseases are simply the outcome of efficient market dynamics, or the effect of market and rationality failures preventing individuals from achieving the best possible outcomes. Where failures exist, possible preventive interventions must be conceived, whose expected impact on individual choices should be commensurate to the extent of those failures and to the severity of the outcomes arising from them.

A positive impact of such interventions on social welfare and health equity should be assessed empirically through a comprehensive evaluation before interventions are implemented…..”

EXECUTIVE SUMMARY

INTRODUCTION

Section 1 - Chronic diseases: an economic problem?

1.1. The burden of chronic diseases on health and longevity

1.2. The implications for social welfare and the role of prevention

1.3. Will preventive interventions improve social welfare? Testing the hypothesis

1.4. The determinants of health and disease

1.5. Main messages and conclusions

Section 2 - Are interventions to prevent chronic diseases justified?

2.1. Is there an economic case for intervention?

2.2. Market failures in lifestyle choices: a neoclassical economics perspective

2.3. Failures of rationality in lifestyle choices

2.4. Market failures and the determinants of health

2.5. Unintended health consequences of existing government policies

2.6. Main messages and conclusions

Section 3 - Preventive interventions: the options and the actors

3.1. Government intervention and theories of paternalism

3.2. Non-governmental and concerted action

3.3. Establishing what interventions are viable

3.4. A taxonomy of preventive interventions

3.5. Main messages and conclusions

Section 4 - Assessing the efficiency and distributional impact of preventive interventions

4.1. The economic evaluation of health interventions

4.2. Assessing the health impact of prevention programmes

4.3. Discounting long term impacts

4.4. Assessing the distributional impacts of prevention programmes

4.5. Main messages and conclusions

Section 5 - Conclusions. The role of economics in the prevention of chronic diseases

REFERENCES

APPENDIX . A TAXONOMY OF PREVENTIVE INTERVENTIONS
Boxes

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