Are the poorest poor being left behind? Estimating global inequalities in reproductive, maternal, newborn and child health
Are the poorest poor being left behind? Estimating global inequalities in reproductive, maternal, newborn and child health
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DOI：
10.1136/bmjgh-2019-002229
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发表时间：
2020-01-01
影响因子：
8.1
通讯作者：
Victora, Cesar G.
中科院分区：
文献类型：
--
作者：
Barros, Aluisio J. D.;Wehrmeister, Fernando C.;Victora, Cesar G.
简介通过将人口分为五等分，生殖、产妇、新生儿和儿童健康中与财富相关的不平等得到了广泛的研究。我们使用2010年以来进行的国家健康调查，使用财富十进制和绝对收入估计作为分层变量，对综合覆盖指数(CCI)的财富不平等进行了全面分析，并展示了这些新方法如何在传统公平分析的基础上进行扩展。方法对83个低收入和中等收入国家进行调查。CCI是一项覆盖范围的综合衡量标准，包括八项关键的生殖、孕产妇、新生儿和儿童健康干预措施。它按财富十进制分类，用于目测不平等，并估计了不平等的斜率指数(SII)。评估了十进制中的覆盖率与SII之间的相关性。最后，我们使用多水平模型来检验CCI如何随着调查中每个财富五分之一的估计绝对收入而变化。结果对财富十进制和绝对收入覆盖率的分析表明，不平等主要是由穷人的覆盖率驱动的，而不同国家之间的穷人覆盖率比富人的覆盖率更具变异性。无论覆盖全国，在61个国家中，最富有的十分之一的人实现了70%或更高的CCI覆盖率。在实现穷人的高复盖率方面，表现良好的国家尤其有效。相比之下，表现不佳的国家未能触及最贫穷的国家，尽管它们触及了较富裕的国家。结论在大多数国家，最富有和最贫穷的妇女和儿童之间存在着巨大的不平等。最贫穷群体的低覆盖率是造成这些不平等的主要原因，因为最富有的群体无论居住在哪里都实现了高覆盖率，克服了阻碍其他群体的任何障碍。考虑到绝对财富水平，那些在覆盖范围上超出其自身重量的国家，是那些最能接触到最贫穷的妇女和儿童的国家。
Introduction Wealth-related inequalities in reproductive, maternal, neonatal and child health have been widely studied by dividing the population into quintiles. We present a comprehensive analysis of wealth inequalities for the composite coverage index (CCI) using national health surveys carried out since 2010, using wealth deciles and absolute income estimates as stratification variables, and show how these new approaches expand on traditional equity analyses. Methods 83 low-income and middle-income countries were studied. The CCI is a combined measure of coverage with eight key reproductive, maternal, newborn and child health interventions. It was disaggregated by wealth deciles for visual inspection of inequalities, and the slope index of inequality (SII) was estimated. The correlation between coverage in the extreme deciles and SII was assessed. Finally, we used multilevel models to examine how the CCI varies according to the estimated absolute income for each wealth quintile in the surveys. Results The analyses of coverage by wealth deciles and by absolute income show that inequality is mostly driven by coverage among the poor, which is much more variable than coverage among the rich across countries. Regardless of national coverage, in 61 of the countries, the wealthiest decile achieved 70% or higher CCI coverage. Well-performing countries were particularly effective in achieving high coverage among the poor. In contrast, underperforming countries failed to reach the poorest, despite reaching the better-off. Conclusion There are huge inequalities between the richest and the poorest women and children in most countries. These inequalities are strongly driven by low coverage among the poorest given the wealthiest groups achieve high coverage irrespective of where they live, overcoming any barriers that are an impediment to others. Countries that 'punched above their weight' in coverage, given their level of absolute wealth, were those that best managed to reach their poorest women and children.