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Measuring inequalities in health in Africa

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    The literature on inequalities in health is growing, as are other scientific research areas, asymmetrically. The body of knowledge to inform citizens, policy decision makers and practitioners to ameliorate the effects of health inequalities is drawn overwhelmingly from northern Europe. The vast majority of our current knowledge on this topic is built on evidence from developed countries. Along with other reasons for this mismatch, like scientific colonialism, the scarcity of measurement tools accepted by the scientific community for settings without sophisticated statistical machinery is certainly not the least important.

    In this number the Theory and Methods section has a contribution from Saul S Morris and colleagues on the validity of estimates of socioeconomic status specially developed for surveys in rural Africa. The authors quantified in their introduction the urgent need for expanding our knowledge of the behaviour of inequalities in Africa, as just 19 papers have been found in their search in MEDLINE on this topic in the past 20 years. In comparison, JECHpublished in the past year 28 papers on inequalities and just one came from a developing country. In the opinion of Morris and colleagues inequalities in health studies in Africa are marred both by poor conceptualisation and poor measurements. In an attempt to overcome the measurement side of the problem they studied the validity of rapid estimates in household surveys, concluding that ...“it is feasible to approximate both household wealth and expenditures in rural African settings without dramatically lengthening questionnaires that have a primary focus on health outcomes...”

    Our editorial section contains a call for a better and more accountable use of resources in organising health conferences by John R Ashton and Maggie Morris who report on their personal experience at a recent international event. I am sure many of the readers of this journal share with them similar experiences. Barbara Starfield and Jose M Paganini, promoters of the new International Society for Equity in Health (ISEqH) discuss in their editorial the relations between social justice and science and call for participants to the ISEqH inaugural meeting in La Habana (Cuba) next month.

    Finally, this issue is very much focused on “the forgotten design” of pre-modern epidemiology—the ecological study—with an insight of the theoretical applications of multilevel analysis from Tony Blakely and Alistair Woodward, calling for stronger theoretical frameworks to fairly apply advanced statistical analysis. In his linked editorial, Neil Pearce reviews the reasons why population level studies are again back with us, and gives pertinent answers to the question “How can epidemiologists learn to think in a multilevel way?”