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Notes
1. In 1990, communicable diseases caused 59
per cent of deaths and 64 per cent of DALY
(disability-adjusted life year) loss among
the 20 per cent of the world's population that
live in countries with the lowest per capita
incomes, compared to 34 per cent of deaths
and 44 per cent of DALY loss among the
world's population as a whole. Communicable
diseases also contribute disproportionately
to mortality gap and the DALY gap than do
non-communicable diseases. See: Gwatkin,
D. R., and M. Guillot. 2000. The Burden of
Disease among the Global Poor. Washington,
D.C.: The World Bank.
2. The World Bank. 2001. World Development
Report 2000/2001: Attacking Poverty.
Washington, D.C.: The World Bank and
Oxford University Press.
3. Narayan, D.et al. 1999. "Global Synthesis:
Consultations with the Poor."Draft discussion
paper prepared for the Global Synthesis Workshop:
Conslutations with the Poor, Washington, D.C., 22-23
September 1999. Washington, D.C.: The World Bank.
4. WHO and the World Bank. 2002. Dying for
Change: Poor People's Experience of Health
and Ill Health.The Voices of the Poor Study.
Geneva: WHO.
5. Strauss, J. A., and D. Thomas. 1995. "Human
Resources: Empirical Modeling of Household
and Family Decisions." Ch. 34 in: Handbook
of Development Economics, vol. 3A, edited
by T. N. Srinivasan and J. Behrman. 1995.
Amsterdam: North Holland.
6 AbouZahr, C., and J. P. Vaughan. 2000.
"Assessing the Burden of Sexual and
Reproductive Ill Health: Questions regarding
the Use of Disability-Adjusted Life Years."
Bulletin of the World Health Organization
78(5): 655-666.
7. As AbouZahr and Vaughan (2000) note,
these estimates of disease burdens were
made in 1993, prior to full appreciation of the
impacts of HIV/AIDS. For this and for technical
reasons (related to the DALY measure,
see the citation and the concluding chapter
of this report), these are most likely very
conservative estimates.
8. Loewenson, R., and A. Whiteside. 2001.
HIV/AIDS: Implications for Poverty
Reduction. United Nations Development
Programme Policy Paper. New York: UNDP.
9. WHO and the World Bank 2002.
10. Ibid., p. 16.
11. This applies not only to the sexual contact of
the individual, but also to worries generated
when the partner has other sexual contacts.
12. Jensen, E. R., and D. A. Ahlburg. 1999.
"A Multicountry Analysis of the Impact of
nwantedness and Number of Children on
Child Health and Preventive Curative Care."
Washington, D.C.: POLICY Project, the
Futures Group International. Accessible on
the web site: www.tfgi.com.
13 "Domestic violence against women is
frequent in all countries covered by the study,
and is mentioned in 90 per cent of the
communities. Since this subject is so often
taboo, it is notable that it was discussed
at all. In groups in Ethiopia and the Kyrgyz
Republic it was impossible to mention the
subject, and in Bangladesh discussions
were held in hushed voices." WHO and the
World Bank 2002, p. 17.
14. Ibid., p.15.
15. Jensen and Ahlburg 1999.
16. The differentials presented here and
following sections are based on the reports
in the series, Socio-economic Differences
in Health, Nutrition and Population in
[Country], prepared by Davidson R. Gwatkin,
Shea Rutstein, Kiersten Johnson, Rohini P.
Pande and Adam Wagstaff for the Health,
Nutrition and Poverty (HNP)/Poverty
Thematic Group of the World Bank. Fortyfour
countries with a Demographic and Health
Survey were analysed. Within regions,
the countries included were: East Asia and
the Pacific-the Philippines, Viet Nam and
Indonesia; Europe and Central Asia-Turkey,
Kazakhstan, Kyrgyz Republic and Uzbekistan;
Latin America and the Caribbean-Peru,
Bolivia, Brazil, Guatemala, Nicaragua, Haiti,
Colombia, Paraguay and the Dominican
Republic; Middle East and North Africa-
Egypt, Morocco and Turkey; South Asia-
India, Bangladesh, Nepal and Pakistan; and
sub-Saharan Africa-Mali, United Republic
of Tanzania, Cameroon, Ghana, Cote
d'Ivoire, Togo, Zambia, Zimbabwe, Malawi,
Uganda, Chad, Niger, Mozambique, Central
African Republic, Madagascar, Benin, Kenya,
Senegal, Namibia, Nigeria, Comoros and
Burkina Faso. The sampled countries have
overall fertility levels higher than the 3.6
of the less-developed regions (excluding
China) but lower than the 5.5 of the least
developed countries. The surveys are more
concentrated in lower and middle income
countries where the primary donor for
the surveys (the United States Agency for
International Develop-ment) concentrates
its efforts. There is a bias towards larger
countries and those in need of programme
assistance.
17. Child mortality in Panama from the United
Nations Population Division (special
tabulation). For .S. data see: Guest, A. M.,
G. Almgren, and J. M. Hussey. 1998.
"The Ecology of Race and Socio-economic
Distress: Infant and Working-age Mortality
in Chicago." Demography 35(1): 23-34.
See also: McCord, C., and H. P. Freeman.
1990. "Excess Mortality in Harlem."
The New England Journal of Medicine
322(3): 173-177.
18. Wagstaff, A. 2000. "Socioeconomic
Inequalities in Child Mortality: Comparisons
Across Nine Developing Countries." Bulletin
of the World Health Organization 78(1): 19-29.
19. Jensen and Ahlburg 1999.
20. Shen, C., et al. 1999. "Maternal Mortality,
Women's Status, and Economic Dependency
in Less-Developed Countries: A Cross-National
Analysis." Science and Medicine
49(2): 197-214.
21. Hill, K., C. AbouZahr, and T.Wardlaw. 2001.
"Estimates of Maternal Mortality for 1995."
Bulletin of the World Health Organization
79(3): 182-193.
22. Strong, M. 1992. "The Health of Adults in the
Developing World: The View from Bangladesh."
Health Transition Review 2(2): 215-224.
23. UNFPA. 2000. The State of World
Population 2000: Lives Together, World's
Apart: Men and Women in a Time of Change,
p. 11. New York: UNFPA.
24. This is true of morbidity measures in general.
The absence of effective registration systems
and paucity of wealth or income measures
even renders mortality comparisons within
countries a difficult enterprise. (For discussion,
see: Wagstaff 2000.)
25. Quality of care initiatives are an important
component of most programmes of assistance
to reproductive health care providers.
But high or irregular workloads, poor compensation,
staff turnover and underdeveloped
systems of monitoring and supervision
pose constant challenges to attaining and
maintaining standards.
26. Gwatkin D., and G. Deveshwar-Bahl. 2002.
"Socio-Economic Inequalities in Use of Safe
Motherhood Services in Developing
Countries." A presentation given in London,
6 February 2002.
27. See analyses of African countries in the series:
Gwatkin, D. R., et al. 2000. Socio-economic
Differences in Health, Nutrition and Population
in [Country]. Washington, D.C.: the
Health, Nutrition and Poverty (HNP)/Poverty
Thematic Group, the World Bank.
28. Gwatkin, D. R., et al. 2000.
29. In principle, it should be possible to use the
indicators that characterize intra-national
wealth differences to construct a scale applicable
across all countries. Since programmes
to address underserved populations are formulated
within countries, such an effort
would mostly serve academic needs without
assisting practical strategies.
30. For comparative studies of the efficiency
of service delivery systems, analyses need
to statistically correct for rural-urban
proportions. Comparing access within countries
looks at differentials within urban and
rural places.
31. Gwatkin, D. R., et al. 2000. Socio-economic
Differences in Health, Nutrition and
Population in India. Washington, D.C.: the
Health, Nutrition and Poverty (HNP)/Poverty
Thematic Group, the World Bank.
32. United Nations. 2002. World Urbanization
Prospects 2001 (ESA/P/WP.173). New York:
Population Division, Department of Economic
and Social Affairs, nited Nations; and Naylor,
R. L., and W. P. Falcon. 1996. "Is the Locus
of Poverty Changing." Food Policy 21(2): 1.
33. Hewett, P. C., and M. R. Montgomery. 2001.
Poverty and Public Services in Developing
Country Cities. Population Council Policy
Research Division Working Paper. No. 154.
New York: The Population Council.
34. United Nations 2002.
35. Commission on Macro-economics and
Health,World Health Organization
(WHO). 2001. Macro-economics and
Health: Investing in Health for Economic
Development. Geneva: WHO.
36. United Nations. 1999. Key Actions for the
Further Implementation of the Programme
of Action of the International Conference
on Population and Development (A/S-
21/5/Add.1), paragraph 52. New York:
United Nations.
37. Hardee, K., and J. Smith. 2000. "Increasing
Returns on Reproductive Health Services in
the Era of Health Sector Reform." POLICY
Occasional Paper. No. 5. Washington D.C.:
The Futures Group International.
38. Langer, A., G. Nigena, and J. Catino. 2000.
"Health Sector Reform and Reproductive
Health in Latin America and the Caribbean:
Strengthening the Links." Bulletin of the
World Health Organization 78(5): 667-676.
39. Priya, N. 2000. Health Sector Reforms in
Zambia: Implications for Reproductive
Health and Rights. Center for Health and
Gender Equity Working Papers. Takoma
Park, Maryland: Center for Health and
Gender Equity, the Population Council; and
Bennett, S. 1999. "Health Sector Reforms
in Zambia: Putting Them in Perspective."
Pp. 24-28 in: Report of the Meeting on the
Implications of Health Sector Reform on
Reproductive Health and Rights: December
14-15, 1998: Washington, D.C., edited by
J. Jacobson and J. Bruce. Takoma Park,
Maryland: Center for Health and Gender
Equity, the Population Council.
40. Chandani, Y., et al. 2000. Ghana: Implications
of Health Sector Reform for Family
Planning Logistics. Arlington, Virginia: Family
Planning Logistics Management Project,
John Snow Inc. for United States Agency for
International Development (USAID).
41. Bates, J., et al. 2000. Implications of Health
Sector Reform for Contraceptive Logistics:
A Preliminary Assessment for Sub-Saharan
Africa. Arlington, Virginia: Family Planning
Logistics Management Project, John Snow
Inc. for USAID.
42. Newbrander, W., C. J. Cuellar, and B.
Timmons. 2000. "The PROSALUD Model
for Expanding Access to Health Services."
Unpublished paper. Boston, Massachusetts:
Management Sciences for Health.
43. Langer, Nigena, and Catino 2000.
44. UNAIDS. 2000. HIV and Health-care Reform
in Phayao: From Crisis to Opportunity,
p.9. Joint United Nations Programme on
HIV/AIDS Case Study. UNAIDS Best
Practices Collection. Geneva: UNAIDS.
45. The World Bank 2001.
46. Filmer, D., and L. Pritchett. 1999. "The Impact
of Public Spending on Health: Does Money
Matter?" Social Science and Medicine
49(10): 1309-1327. Cited in: The World Bank
2001, p. 81.
47. Castro-Leal, F., et al. 2000. "Public
Spending on Health Care in Africa: Do
the Poor Benefit?" Bulletin of the World
Health Organization 78(1): 66-74.
48. Mahal, A. 2000. "Do the Poor or the
Rich Benefit More from Government Health
Services: The Case of India." Health/
Nutrition/Population and Poverty Seminar
Report, 11 July 2000. Washington, D.C.:
The World Bank.
49. Leighton, C. (No date.) "Decision Making
for Equity in Health Sector Reform," p. 1.
In: PHR Primer. Bethesda, Maryland:
Partnerships for Health Reform Resource
Center, Abt Associates.
50. Begum, S. 1997. Health and Poverty in the
Context of Country Development Strategy: A
Case Study on Bangladesh. Macroeconomics
Health and Development Series. No. 26.
Geneva: WHO. Cited in: "Bangladesh:
An Intervention Study of Factors Underlying
Increasing Equity in Child Survival," by A.
Bhuiya, et al. 2000. Ch. 16 in: Challenging
Inequities in Health from Ethics to Action,
edited by T. Evans, et al. 2000. London:
Oxford University Press.
51. WHO. 2000. World Health Report 2000:
Health Systems: Improving Performance.
Geneva: WHO.
52. Filmer, D., J. Hammer, and L. Pritchett. 1998.
"Health Policy in Poor Countries: Weak Links
in the Chain." Policy Research Working Paper.
No. 1874. Washington, D.C.: The World Bank.
53. Murray, C., Director, Global Programme
on Evidence for Health Policy, WHO. 2000.
Quoted in: UNFPA. 2000. "Who Rates
Health Systems." Populi. 27(2): 5-7.
54. Broadly speaking, health care financing
covers how funds are mobilized (general
revenue/earmarked taxes, social insurance
contributions, private insurance premiums,
community financing and direct out-ofpocket
payment), how funds are allocated
(geographically or by population groups and
for what types of health care), and the mechanisms
for paying for health care. All three
aspects are important for equity and quality.
55. Hsiao, W. C., and Y. Liu. 2001. "Health Care
Financing: Assessing Its Relationship to
Health Equity." Ch. 18 in: Evans, et al. 2000.
56. Litvak, J. L., and C. Bodart. 1993. "User Fees
Plus Quality Equals Improved Access to
Health Care: Results from a Field Experiment
in Cameroon." Social Science and Medicine
37(3): 369-383.
57. Alderman, H., and V. Lavy. 1996. "Household
Response to Public Health Services: Cost
and Quality Tradeoffs." World Bank Research
Observer 11: 3-22; Akin, J. S., D. K. Guilkey,
and E. H. Denton. 1995. "Quality of Services
and Demand for Health Care in Nigeria:
A Multinomial Probit Estimation." Social
Science and Medicine 40(11): 1527-1537;
Shaw, R., and C. C. Griffin. 1995. Financing
Health Care in Sub-Saharan Africa through
Fees and Insurance. Washington, D.C.: The
World Bank; and Hotchkiss, D., et al. 1998.
"Household Expenditures in Nepal: Implications
for Health Care Financing Reform." Health
Policy and Planning 13(4): 371-383.
58. Sadasivam, B. 1999. Risks, Rights and
Reforms: A 50 Country Survey Assessing
Government Actions Five Years after the
International Conference on Population
and Development. New York: Women's
Environment and Development Organization;
Kutzin, J. 1995. Experience with
Organizational and Financing Reform of
the Health Sector. Current Concerns:
Strengthening Health Services Paper. No. 8
(WHO/SHS/CC/94.3). Geneva: WHO; and
Standing, H. 1997. "Gender and Equity in
Health Sector Reform Programmes: A Review."
Health Policy and Planning 12(1): 1-18.
59. Wilkinson, D., et al. 2001. "Effect of
Removing User Fees on Attendance for
Curative and Preventive Primary Care
Services in Rural South Africa," pp. 667-668.
Bulletin of the World Health Organization
79(7): 665-671.
60. McPake, B., et al. 1999. "Informal Economic
Activities of Public Health Workers
in Uganda: Implications for Quality and
Accessibility of Care." Social Science and
Medicine 49(7): 849-865.
61. Hsiao and Liu 2001.
62. Ibid
63. Shehu, D., A. T. Ikeh, and M. J. Kuna.
1997. "Mobilizing Transport for Obstetric
Emergencies in Northwestern Nigeria."
International Journal of Gynecology and
Obstetrics 59 (Supplement 2): S173-180.
64. Behrman, J. R., and J. C. Knowles. 1998.
"Population and Reproductive Health: An
Economic Framework for Policy Evaluation."
Population and Development Review
24(4): 697-737.
65. Isaacs, Stephen, and G. Solimano. (No date.).
"Health Reform and Civil Society in Latin
America." L'Encyclopédie de L'Agora. Web
site: http://agora.qc.ca. Accessed on 13
March 2002.
66. The World Bank 2001.
67. Birdsall, N., and A. de la Torre. 2001.
Washington Contentious: Economic Policies
for Social Equity in Latin America. Findings
of the Commission on Economic Reform in
Unequal Latin American Societies. Washington,
D.C.: Carnegie Endowment for International
Peace and the Inter-American Dialogue.
68. Wagstaff, A. 2002. "Inequalities in Health
in Developing Countries: Swimming
Against the Tide?" Health and Population
Working Paper. No. 2795. Washington, D.C.:
The World Bank.
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