Academic journal article Health Sociology Review

Measuring Health Equity in Small Areas: Findings from Demographic Surveillance Systems

Academic journal article Health Sociology Review

Measuring Health Equity in Small Areas: Findings from Demographic Surveillance Systems

Article excerpt

MEASURING HEALTH EQUITY IN SMALL AREAS: FINDINGS FROM DEMOGRAPHIC SURVEILLANCE SYSTEMS INDEPTH Network Hampshire, England: Ashgate, HB 201 pp, AUD 132.52 (inc GST) ISBN 0-7546-44944

Measuring Health Equity in Small Areas: Findings From Demographic Surveillance Systems concerns the measurement of socio-economic health inequalities in ten, severely resource-constrained areas in countries of Asia and Africa. The book presents studies from the INDEPTH network of sentinel surveillance sites (33 across 18 countries), which have the goal to provide quantitative health information to help policy makers set health priorities and policies. Although a description of the network is not included in the book, it can be found on their website (www.indepthnetwork.org).

The book begins with a discussion of the difficulties of measuring wealth/poverty and the social relations associated with it (the 'socio-' of 'socio-economic' status). It argues that measures of income are particularly inadequate in these settings because of income irregularity, the difficulty in calculating income separate from business costs among the self employed, and problems establishing the number of people dependant on single incomes. The ten sites in the book instead try to conceptualise socioeconomic status through varying composite indices of wealth that include aspects of material, human and social capital. All ten sites indices include measures of material assets, four include measures of human capital (education level), and two of social capital (social relationships). The different methods for creating the indices are discussed.

The book then provides a scientific paper from each of the ten sites reporting on what analysis using their index reveals about socio-economic inequalities in child mortality in small areas. The Bandim health surveillance system in West Africa, for example, describes how they developed an index of socio-economic status using principal components analysis of variables such as type of roof, electricity, television, type of toilet, number of rooms and mean number of people per bed. This surveillance system also has created measures level of mother's education and a range of social capital and health beliefs factors such as favouritism and care taker vulnerability (husband's interference, very young care takers and inability to get help from family when needed). The paper then examines the effect of these material, human and social capital factors on child mortality.

The studies as a whole demonstrate the persistent presence of geographically concentrated health inequalities in health status and health service use across the settings. They are a sobering reminder that in many places child death is still common - so common that some studies found it difficult to identify statistical risk factors because everyone had experienced child death and researchers had to construct outcome measures of multiple deaths per family. …

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