UNFPAState of World Population 2002
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State of World Population
Characterizing Poverty
Macro-economics, Poverty, Population and Development
Women and Gender Inequality
Health and Poverty
HIV/AIDS and Poverty
Poverty and Education
Population, Poverty and Global Development Goals: the Way Ahead
Sources for Boxes
Graphs and Tables


Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8


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'Encyclop├ędie 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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