Equity and the child health Millennium Development Goal: the role of pro-poor health policies
Equity and the child health Millennium Development Goal: the role of pro-poor health policies
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DOI：
10.1136/jech.2009.096081
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发表时间：
2011-04-01
影响因子：
6.3
通讯作者：
Galea, Sandro
中科院分区：
文献类型：
--
作者：
Kruk, Margaret E.;Prescott, Marta R.;Galea, Sandro
在发展中国家，富裕儿童和贫穷儿童的死亡率存在巨大差异。因此，人们呼吁在实现儿童健康千年发展目标的努力中明确制定有利于穷人的保健方案。目的估计扶贫保健政策对缩小5岁以下儿童死亡率方面的贫富差距的贡献。方法对来自47个发展中国家的人口与健康调查数据进行生态、横断面分析。使用多变量分析来估计政府卫生支出、两项基本儿童卫生服务的财富分配（免疫接种和急性呼吸道感染治疗的集中指数）与5岁以下儿童总死亡率之间的关联，以及两项衡量贫富平等的死亡率结果的指标——五分位数比和5岁以下儿童死亡率的集中指数——同时控制混杂因素。结果发现，免疫接种和急性呼吸道感染治疗的集中度较低（更有利于穷人）指数与减少5岁以下儿童死亡率的不平等有关，这有利于穷人。政府卫生支出与较低的全国总体死亡率下降有关，但对死亡率结果的公平性没有影响。在低收入和中等收入国家，促进有利于穷人的卫生服务分配的再分配卫生政策可以缩小贫富之间5岁以下儿童死亡率的差距。为确保穷人从目前实现千年发展目标的努力中获益，基本儿童保健服务应明确针对穷人。如果做不到这一点，这些服务的收益将倾向于向国家中较富裕的儿童积累，从而扩大死亡率的不平等。
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.