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Equity and the child health Millennium Development Goal: the role of pro-poor health policies
  1. Margaret E Kruk1,2,
  2. Marta R Prescott3,
  3. Helen de Pinho2,
  4. Sandro Galea3
  1. 1Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
  2. 2Averting Maternal Death and Disability Program, Columbia University Mailman School of Public Health, New York, New York, USA
  3. 3Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
  1. Correspondence to Assistant Professor Margaret Kruk, Columbia University, Mailman School of Public Health, 600 W. 168th Street, Room 606, New York, NY 10032, USA. mkruk{at}columbia.edu

Abstract

Background There are substantial disparities in mortality between rich and poor children in developing countries. As a result, there is a call for explicitly pro-poor health programming in efforts to reach the child health Millennium Development Goals.

Aim To estimate the contribution made by pro-poor health policy to reduction in wealth disparities in under-5 mortality.

Methods An ecological, cross-sectional analysis was performed using Demographic and Health Survey data from 47 developing countries. Multivariate analysis was used to estimate the association between government health expenditure, the wealth distribution of two essential child health services (concentration indices of immunisation and treatment for acute respiratory infection) and aggregate under-5 mortality, as well as two measures of poor–rich equity in mortality outcomes—the quintile ratio and the concentration index of under-5 mortality—while confounders were controlled for.

Results Lower concentration (more pro-poor) indices for immunisation and treatment for acute respiratory infection were found to be associated with a reduction in inequity in under-5 mortality to the benefit of the poor. Government health expenditures were associated with lower overall national mortality reductions but had no effect on equity of mortality outcomes.

Conclusions Redistributive health policies that promote pro-poor distribution of health services may reduce the gap in under-5 mortality between rich and poor in low-income and middle-income countries. To ensure that the poor gain from the current efforts to reach the Millennium Development Goals, essential child health services should explicitly target the poor. Failing that, the gains from these services will tend to accrue to the wealthier children in countries, magnifying inequalities in mortality.

  • Child mortality
  • equity
  • health systems
  • health economics
  • healthcare financing
  • Millennium Development Goals
  • developing counter
  • health policy
  • inequalities

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Footnotes

  • Funding This study was supported by the University of Michigan School of Public Health and the Averting Maternal Death and Disability Program (AMDD) at the Mailman School of Public Health, Columbia University. AMDD is funded by the Bill and Melinda Gates Foundation. Neither the University of Michigan nor AMDD had any role in the design, analysis or writing of this paper or in the decision to submit the paper for publication.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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