Equity and the child health Millennium Development Goal: the role of pro-poor health policies.
BACKGROUND
There are substantial disparities in mortality between rich and poor children in developing countries. As a result, there is a call for explicitly pro-poor health programming in efforts to reach the child health Millennium Development Goals.


OBJECTIVE
To estimate the contribution made by pro-poor health policy to reduction in wealth disparities in under-5 mortality.


METHODS
An ecological, cross-sectional analysis was performed using Demographic and Health Survey data from 47 developing countries. Multivariate analysis was used to estimate the association between government health expenditure, the wealth distribution of two essential child health services (concentration indices of immunisation and treatment for acute respiratory infection) and aggregate under-5 mortality, as well as two measures of poor-rich equity in mortality outcomes-the quintile ratio and the concentration index of under-5 mortality-while confounders were controlled for.


RESULTS
Lower concentration (more pro-poor) indices for immunisation and treatment for acute respiratory infection were found to be associated with a reduction in inequity in under-5 mortality to the benefit of the poor. Government health expenditures were associated with lower overall national mortality reductions but had no effect on equity of mortality outcomes.


CONCLUSIONS
Redistributive health policies that promote pro-poor distribution of health services may reduce the gap in under-5 mortality between rich and poor in low-income and middle-income countries. To ensure that the poor gain from the current efforts to reach the Millennium Development Goals, essential child health services should explicitly target the poor. Failing that, the gains from these services will tend to accrue to the wealthier children in countries, magnifying inequalities in mortality.
Kruk
Margaret E
ME
Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York 10032, USA. mkruk@columbia.edu
Prescott
Marta R
MR
de Pinho
Helen
H
Galea
Sandro
S
D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries; D006291:Health Policy; D006306:Health Surveys; D054625:Healthcare Disparities; D006801:Humans; D015999:Multivariate Analysis; D009937:Organizational Objectives; D012923:Social Class; D014480:United Nations