2014年-世界发展银行全球_Progress_on_Global_Health_Goals___Are_the_Poor_Being_Left_Behind__26页_1mb

Summary of "Progress on Global Health Goals: Are the Poor Being Left Behind?"

Core Content

This paper analyzes the differential progress on health-related Millennium Development Goals (MDGs) between the poor and the better-off within 64 developing countries from 1990 to 2011. The authors examine five health status indicators and seven intervention indicators across four MDGs, using data from 235 Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS).

Main Findings

• Overall Progress: The developing world has made progress toward most health MDGs, with the exception of HIV prevalence, where progress has been pro-rich. For most indicators, the majority of countries have seen improvements.

• Relative Inequality:

  • On intervention indicators, progress has been pro-poor in most countries. The poorest 40% have made faster progress than the richest 60% in these areas.
  • On outcome indicators, relative inequality has been growing in nearly half of the countries, with the poorest still facing higher risks of malnutrition and child mortality.
  • In about one-quarter of countries, the poorest 40% have seen absolute declines in both health outcomes and interventions.

• Inequality Trends:

  • The concentration index (CI), a measure of relative inequality, has remained stable or decreased for most intervention indicators.
  • However, for outcome indicators, the CI has not significantly decreased, indicating that inequality in health status persists.

Key Indicators and Their Progress

Key Observations

• Pro-poor Progress on Interventions: Most health interventions have shown faster progress among the poor, with the exception of HIV prevalence, which has seen pro-rich progress.

• Persistent Inequalities in Outcomes: Despite improvements in interventions, inequalities in health outcomes (such as child mortality and malnutrition) have not been significantly reduced, and in some cases have increased.

• Geographic Variations:

  • In Asia, progress on underweight has been pro-rich.
  • In Africa, inequalities in under-five mortality have been growing.

• Data and Methodology:

  • The study uses a larger number of countries, more recent data, and more indicators than previous research.
  • It stratifies households by the wealth index, developed by Filmer and Pritchett (2001), to assess differential progress.
  • The concentration index (CI) is used to measure relative inequality, with a focus on how it has changed over time.

Implications

• The findings suggest that while overall progress toward health MDGs has been made, the poor are still facing higher health risks and lower access to key interventions.
• The study highlights the need to focus on monitoring and incentivizing interventions that disproportionately benefit the poor.
• It also raises questions about the effectiveness of current strategies in reducing health inequalities and the importance of considering both absolute and relative progress in future health policies.

Comparison with Previous Studies

• Previous studies (Moser et al. 2005; Suzuki et al. 2012; Victora et al. 2012) found mixed results, with some showing pro-poor progress and others indicating pro-rich trends.
• This study provides a more comprehensive analysis by using a larger dataset and more indicators, offering clearer insights into the pro-poor or pro-rich nature of progress across different health outcomes and interventions.

Conclusion

While the developing world has made significant strides in achieving health MDGs, the poorest populations continue to face higher risks of poor health outcomes and lower access to essential health interventions. The study underscores the importance of addressing health inequalities and ensuring that progress is inclusive and benefits all segments of the population, particularly the most vulnerable.