An Individual-level Approach to Health Inequality: Child Survival in 50 Countries

a A file with all data and information necessary to replicate the results in this article is available from the authors. Abstract Background: Reducing health inequalities is an important part of the agenda of health policymakers globally. Studies of health inequalities have revealed large variations in average health status across social, economic, and other groups. However, no studies have been conducted on the distribution of the risk of ill-health across individuals. Methods: We use an extended beta-binomial model to estimate the distribution the risk of death in children under the age of two in the 50 developing countries where data from a Demographic and Health Survey are available. Inequality in these distributions is measured by the WHO health inequality index. Findings: At the same level of average child mortality, inequality in the risk of death across children can vary considerably across countries. Representing the entire distribution of risk with an inequality measure involves normative choices that we delineate and formalise with quantitative measures. The results are not very sensitive to the choice of measure. Liberia, Mozambique and the Central African Republic have the largest inequalities in child survival, while Colombia, the Philippines and Kazakhstan have the lowest among the 50 countries measured. Interpretation: Inequality estimates should be routinely reported alongside average levels of health, as they reveal important information about the distribution of health in populations. Measuring inequality with individual level data, rather than quantifying differences in average levels of health across social groups, enables meaningful comparisons of inequality across countries and analyses of the determinants of inequality. This approach should be extended to the measurement of inequalities in healthy life expectancy.