• Display

an Eldis Resource

 

 In the United Nations Millennium Declaration, 189 member states announced their commitment to a more equitable future. However, some specific Millennium Development Goals fail to address equity. The pressure to achieve some targets could lead to policies that actually leave poorer people worse off.
A paper from Brunel University, the London School of Economics and Save the Children, in the UK, analyses Millennium Development Goal 4 (MDG4) on the under-five mortality rate (U5MR) to argue for indicators of success that are more sensitive to equity concerns.

MDG4 aims to reduce the U5MR by two thirds by 2015. Because this is the raw average rate for a country as a whole, such a reduction can be achieved through policies that leave the children of poor people worse off. Inequities may also be spread across social differences other than wealth, such as gender, ethnicity or religion.

The paper presents data on a hypothetical country with a U5MR of around 200 deaths per 1000 live births per year. To achieve its MDG4 target, the country would have to reduce this rate to 66.7 by 2015. The authors show this reduction could be achieved by three different policy options:

• Reduce the U5MR equally for each quintile of wealth, with the burden of mortality spread across all wealth groups.
• Focus with decreasing effort from the richest to the second poorest quintile, ignoring the poorest quintile entirely; their U5MR will be 10 times higher than that of the richest.
• Adopt an approach in between, so the U5MR of the poorest quintile is five times greater than that of the richest, as in Peru (where the child mortality rate was 68.4 in 1996).

The poorest populations tend to be the hardest to reach and hold little political weight, so there is often little incentive for governments to prioritise their needs. Policymakers face a trade-off between lowering the mortality rate and minimising inequity. Achieving greater equity in under-five mortality involves targeting investment and spreading resources to boost the supply and demand for services amongst poor and socially excluded populations. To measure the success of these strategies, the authors recommend developing an equity-adjusted measure of child mortality. Such an indicator would:

• encourage better resource distribution
• balance the desirable properties of child mortality reduction against the desirable properties of health equity
• better capture the spirit of the Millennium Declaration

• Full text of document
• Publisher details
• Send to a friend