The Inverse Equity Hypothesis: Analyses of Institutional Deliveries in 286 National Surveys.

Autor: Victora CG; Cesar Gomes Victora, Gary Joseph, Inacio C. M. Silva, and Aluisio J. D. Barros are with the International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil. Fatima S. Maia is with the Federal University of Rio Grande (FURG), Rio Grande, Brazil. J. Patrick Vaughan is with the Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom. Fernando C. Barros is with Post Graduate Course in Health and Behavior, Catholic University of Pelotas, Pelotas., Joseph G; Cesar Gomes Victora, Gary Joseph, Inacio C. M. Silva, and Aluisio J. D. Barros are with the International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil. Fatima S. Maia is with the Federal University of Rio Grande (FURG), Rio Grande, Brazil. J. Patrick Vaughan is with the Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom. Fernando C. Barros is with Post Graduate Course in Health and Behavior, Catholic University of Pelotas, Pelotas., Silva ICM; Cesar Gomes Victora, Gary Joseph, Inacio C. M. Silva, and Aluisio J. D. Barros are with the International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil. Fatima S. Maia is with the Federal University of Rio Grande (FURG), Rio Grande, Brazil. J. Patrick Vaughan is with the Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom. Fernando C. Barros is with Post Graduate Course in Health and Behavior, Catholic University of Pelotas, Pelotas., Maia FS; Cesar Gomes Victora, Gary Joseph, Inacio C. M. Silva, and Aluisio J. D. Barros are with the International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil. Fatima S. Maia is with the Federal University of Rio Grande (FURG), Rio Grande, Brazil. J. Patrick Vaughan is with the Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom. Fernando C. Barros is with Post Graduate Course in Health and Behavior, Catholic University of Pelotas, Pelotas., Vaughan JP; Cesar Gomes Victora, Gary Joseph, Inacio C. M. Silva, and Aluisio J. D. Barros are with the International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil. Fatima S. Maia is with the Federal University of Rio Grande (FURG), Rio Grande, Brazil. J. Patrick Vaughan is with the Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom. Fernando C. Barros is with Post Graduate Course in Health and Behavior, Catholic University of Pelotas, Pelotas., Barros FC; Cesar Gomes Victora, Gary Joseph, Inacio C. M. Silva, and Aluisio J. D. Barros are with the International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil. Fatima S. Maia is with the Federal University of Rio Grande (FURG), Rio Grande, Brazil. J. Patrick Vaughan is with the Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom. Fernando C. Barros is with Post Graduate Course in Health and Behavior, Catholic University of Pelotas, Pelotas., Barros AJD; Cesar Gomes Victora, Gary Joseph, Inacio C. M. Silva, and Aluisio J. D. Barros are with the International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil. Fatima S. Maia is with the Federal University of Rio Grande (FURG), Rio Grande, Brazil. J. Patrick Vaughan is with the Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom. Fernando C. Barros is with Post Graduate Course in Health and Behavior, Catholic University of Pelotas, Pelotas.
Jazyk: angličtina
Zdroj: American journal of public health [Am J Public Health] 2018 Apr; Vol. 108 (4), pp. 464-471. Date of Electronic Publication: 2018 Feb 22.
DOI: 10.2105/AJPH.2017.304277
Abstrakt: Objectives: To test the inverse equity hypothesis, which postulates that new health interventions are initially adopted by the wealthy and thus increase inequalities-as population coverage increases, only the poorest will lag behind all other groups.
Methods: We analyzed the proportion of births occurring in a health facility by wealth quintile in 286 surveys from 89 low- and middle-income countries (1993-2015) and developed an inequality pattern index. Positive values indicate that inequality is driven by early adoption by the wealthy (top inequality), whereas negative values signal bottom inequality.
Results: Absolute inequalities were widest when national coverage was around 50%. At low national coverage levels, top inequality was evident with coverage in the wealthiest quintile taking off rapidly; at 60% or higher national coverage, bottom inequality became the predominant pattern, with the poorest quintile lagging behind.
Conclusions: Policies need to be tailored to inequality patterns. When top inequalities are present, barriers that limit uptake by most of the population must be identified and addressed. When bottom inequalities exist, interventions must be targeted at specific subgroups that are left behind.
Databáze: MEDLINE
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