Poverty and health

This paper provides an overview of the research on two aspects of equity, poverty and health - inequalities in health that are to the disadvantage of the poor, and the impoverishment and income redistribution associated with out-of-pocket payments for health care. The paper covers the issue of measurement, both of health gaps and impoverishment, and presents some empirical findings on both.

Paper concludes that:

• measurement issues are well understood - measures of health sector inequalities are available that are firmly grounded in the inequality literature and hence have properties that are well understood
• evidence is accumulating on health inequalities. There is extensive evidence now on poor-nonpoor inequalities in health outcomes for children in the developing world. There is much less on adult health outcomes, but what there is suggests the existence of poor-nonpoor inequalities
• a good deal is known about inequalities in health service utilisation, but less is known about the inequalities in the other proximate determinants of health—feeding and sanitary practices, etc. Virtually nothing seems to be known in the developing world about the extent to which inequalities in different proximate determinants of health are responsible for inequalities in health outcomes
• there is a good deal of evidence on inequalities in the socioeconomic or underlying determinants of health, but this evidence is scattered and does not lend itself to making comparisons between the size of inequalities in, say, accessibility of health services and inequalities in, say, insurance coverage. The evidence to date suggests that it is not so much inequalities in the availability and accessibility of health services that accounts for inequalities in survival and malnutrition between poor and better-off children, but rather inequalities in income, mother’s education and sanitation
• there is now evidence for the developing world on the impact of out-of-pocket payments on the distribution of income and on poverty. This shows that more often than not, out-of-pocket payments absorb a higher share of income of the better-off than the poor (i.e. are progressive) and hence tend to narrow the income distribution rather than widen it
• less is known about the effects of policies and programmes. Far too little empirical work has been undertaken on the impact of policies and programmes on health inequalities. There is mixed evidence on whether public spending on health and promoting female education reduces health inequalities. It is on the issue of evaluating the distributional impact of policies and programmes that much more work needs doing