Social Indicators

Health status and health care services for the poor

Children born into poor families have a higher chance of dying before their 5th birthday than children born into better-off families—but the differences varies greatly across countries:

• in Ghana and Pakistan, the under-5 mortality rate for the poorest 20 percent of children is only 1.1-1.2 times the rate for the richest 20 percent. In South Africa, it is twice as high;
• but in NE and SE Brazil the under-5 mortality rate for the poorest 20 percent of children is over 10 times that of the richest 20 percent of children;
• Inequalities matter but so too do averages: Brazil's poorest children fare much worse in terms of their chances of surviving to their 5th birthday than their rich counterparts, but they fare far better, on average, than the richest 20 percent of children in the other three countries; likewise, it is small consolation to poor Pakistani children that their survival chances are not dissimilar from those of the richest 20 percent of children, given that the latter have a risk of dying before their 5th birthday of 145/1000 (Table 12).

The poor are less likely to obtain health care than are the rich:

• Between 1992 and 1997, in ten developing countries, only 22 percent of births among the bottom twenty percent of the population were attended by medically trained health staff, compared with 76 percent for those in the top twenty percent.
• In the same period, only 41 percent of the poor suffering from acute respiratory infections were treated in a health facility, compared to 59 percent of the non-poor.
• In Peru in 1990 only 20 percent of the rural poor and 35 percent of the urban poor sought treatment when ill, compared with 39 percent and 57 percent of the rural and urban rich (see Table 13).

The poor are much more affected by communicable diseases than the rich:

• In 1990, 59 percent of all deaths among the poorest 20 percent of the world population were caused by communicable diseases, against 8 percent for the rich.

Table 12. Under-5 Mortality rate inequalities (per 1,000)

Source: Wagstaff (1999) Inequalities in Child Mortality in the Developing World.

Table 13. Percentage of the Rural and Urban Ill Population Seeking Treatment

Source: Baker, Judy and Jacques van der Gaag (1993), "Equity in Health Care and Health Care Financing: Evidence from Five Developing Countries."

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