On inequalities in proximate determinants, we aimed to reflect medical and social scientific published work on: (a) the proximate determinants; and (b) their socioeconomic distribution. On the role of policy makers, we aimed to reflect medical and social scientific published work on: (a) the underlying determinants of child-health outcomes; (b) their socioeconomic distribution; and (c) the effect and socioeconomic aspects of child health and related programmes–eg, maternal and child-health
SeriesApplying an equity lens to child health and mortality: more of the same is not enough
Section snippets
Why do poor children die earlier?
The breakdown of national household survey data by socioeconomic status (panel 4)18, 19, 20, 21 has contributed greatly to our understanding of why poor children are less likely to survive than their better-off peers. Results of systematic analyses of demographic and health surveys show consistent inequities in child health across dozens of countries.6, 7
By contrast with children born to better-off families, poor children are more exposed to risks for disease through inadequate water and
Can policy makers reduce child survival gaps?
Poor countries–and poor people within countries–have multiple deprivations. These, in turn, account for the high levels of exposure, low levels of resistance, inadequate careseeking, and low probabilities of receiving prompt and effective treatment described in the preceding section. For a start, poor people tend to have less money than those better off. They are the least able to afford water connection and usage charges, non-polluting heating and cooking fuels, and houses of appropriate size.
Translating knowledge into action at national and subnational levels
The preceding sections show that several approaches have been proposed for improvement of health conditions in poor people. Yet few, if any, of these approaches have been implemented on a large scale. Effective large-scale implementation is the next challenge.
Surmounting that challenge will require adoption of suitable health strategies and creation of a conducive policy environment.
Child survival interventions do not take place in a vacuum, but rather are implemented in societies in which
Increasing coverage in poor communities with child survival interventions
Two basic approaches can raise coverage in poor population groups. One approach focuses on particular programmes or interventions that mainly benefit poor people, usually referred to as targeting. The other approach achieves universal coverage with programmes or interventions that address conditions that are especially important for disadvantaged groups. Table 2 presents characteristics of situations that affect decisions about the choice of approach. Both targeting or universal coverage
Improvement of accountability
Poverty-oriented approaches–like those just described–are much more likely to be accepted in environments characterised by a strong commitment to equity among policy makers and programme managers. Even in societies in which other inequalities are tolerated, health is usually seen as a basic human right meriting special attention. Development and maintenance of a commitment to equity is more likely if policy makers, programme managers, and communities have a role in policy formulation.
The challenge at international level
We have shown that inequities in child health are unacceptably wide, both between and within countries. In many cases, they are rising. Health and other services that could lessen these inequities are generally reinforcing them instead, by reaching upper-income children more effectively than disadvantaged ones. This targeting is happening despite avowed commitments of international agencies, and despite repeated attempts to make diseases of the poor a priority.
This occurrence is why more of the
Search strategy
References (47)
- et al.
How many child deaths can we prevent this year?
Lancet
(2003) - et al.
Where and why are 10 million children dying every year?
Lancet
(2003) - et al.
Public policy and anthropometric outcomes in the Cote d'Ivoire.
J Public Econ
(1996) - et al.
Quality of care, survival and health outcomes in Ghana.
J Health Econ
(1996) - et al.
Inequities among the very poor: health care for children in rural southern Tanzania.
Lancet
(2003) - et al.
Targeting the poor in Mexico: an evaluation of the selection of households into PROGRESA.
World Dev
(2001) - et al.
Explaining trends in inequities: evidence from Brazilian child health studies.
Lancet
(2000) - et al.
Reducing child mortality: can public health deliver?
Lancet
(2003) Progress since the World Summit for Children: a statistical review.
(2001)World Development Indicators 2002.
(2002)
Socioeconomic inequalities in child mortality: comparisons across nine developing countries.
Bull World Health Organ
Poverty and survival prospects of Vietnamese children under Doi Moi: policy research working paper no 2832.
Inter-temporal changes in welfare: preliminary results from nine African countries–Cornell food and nutrition policy program working paper no 94.
Socioeconomic differences in health, nutrition and population: health, nutrition and population discussion paper.
Poverty and health
An analytic framework for the study of child survival in developing countries.
Report of the International Conference on Primary Health Care; Alma-Ata, Sept 6–12, 1978.
Reducing child mortality in India in the new millennium.
Bull World Health Organ
A report on Indian women from birth to twenty.
Gender disparity in South Asia: comparison between and within countries–policy research working paper 1867.
Selective discrimination against female children in rural Punjab, India.
Popul Dev Rev
Better health for poor people.
The World Health Report 1999: making a difference.
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