Abstract
This paper examines the income gradient in health in the sub-Saharan Africa (SSA) using aggregate data. The paper contributes to previous methods by: (1) measuring health poverty and income poverty across the SSA countries; (2) highlighting dynamics and subgroup composition of health poverty relative to sex and income poverty; (3) testing the extent to which health poverty is related to income poverty. Using data from the World Development Indicators over the period from 1980 to 2017, we apply the Foster-Greer-Thorbecke approach at the national level to calculate health and income poverty indicators across the SSA countries. The Granger panel non-causality model and panel error-correction-based cointegration tests are used to analyse the relationship between gaps in health poverty and income poverty. Our study finds that health poverty chronically and temporally occurs among SSA countries, with the female population worse off overall. In most cases, the Granger model finds that income poverty causes health poverty at the national level. Our most important findings highlight that health poverty and income poverty are dynamically and structurally strongly correlated where causality flows from income poverty to health poverty with no cross-country dependence. Our method’s findings support the income gradient in health which is usually demonstrated using health outcome and income outcome relationships. The results highlight that policies aiming to reduce health poverty may focus on income poverty.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of data and material
Data used in this article are available on http://datacatalog.worldbank.org.
Code availability
Software used for the calculations and the estimations are Excel and Stata. Codes are available on request.
References
Abukari Z, Kuyini AB, Kuyini Mohammed A (2015) Education and health care policies in Ghana: examining the prospects and challenges of recent provisions. SAGE Open 5(4):215824401561145. https://doi.org/10.1177/2158244015611454
Adler NE, Boyce WT, Chesney MA, Folkman S, Syme SL (1993) Socioeconomic inequalities in health: no easy solution. JAMA 269(24):3140–3145. https://doi.org/10.1001/jama.1993.03500240084031
Alkire S, Foster J (2011) Counting and multidimensional poverty measurement. J Public Econ 95(7):476–487. https://doi.org/10.1016/j.jpubeco.2010.11.006
Alkire S, Santos ME (2014) Measuring acute poverty in the developing world: robustness and scope of the multidimensional poverty index. World Dev 59:251–274. https://doi.org/10.1016/j.worlddev.2014.01.026
Allison RA, Foster JE (2004) Measuring health inequality using qualitative data. J Health Econ 23(3):505–524. https://doi.org/10.1016/j.jhealeco.2003.10.006
Banerjee A, Dolado J, Mestre R (1998) Error-correction mechanism tests for cointegration in a single-equation framework. J Time Ser Anal 19(3):267–283. https://doi.org/10.1111/1467-9892.00091
Bennett CJ, Hatzimasoura C (2011) poverty measurement with ordinal data (SSRN Scholarly Paper ID 2093616). Soc Sci Res Netw. https://doi.org/10.2139/ssrn.2093616
Breitung J (2001) The local power of some unit root tests for panel data. In: Baltagi BH, Fomby TB, Carter Hill R (eds) Nonstationary panels, panel cointegration, and dynamic panels. Emerald Group Publishing Limited, Bingley, pp 161–177
Brzezinski M (2015) Accounting for trends in health poverty: a decomposition analysis for Britain, 1991–2008. Eur J Health Econ 16(2):153–159. https://doi.org/10.1007/s10198-014-0561-0
Case A, Lubotsky D, Paxson C (2002) economic status and health in childhood: the origins of the gradient. Am Econ Rev 92(5):1308–1334. https://doi.org/10.1257/000282802762024520
Clarke P, Erreygers G (2020) Defining and measuring health poverty. Soc Sci Med 244:112633. https://doi.org/10.1016/j.socscimed.2019.112633
Collier P, Hoeffler A (1998) On economic causes of civil war. Oxf Econ Pap 50(4):563–573. https://doi.org/10.1093/oep/50.4.563
Collier P, Hoeffler A (2004) Greed and grievance in civil war. Oxf Econ Pap 56(4):563–595. https://doi.org/10.1093/oep/gpf064
Coudouel A, Hentschel J, Wodon Q (2002) Mesure et analyse de la pauvreté [MPRA Paper]. https://mpra.ub.uni-muenchen.de/10490/
Currie J, Stabile M (2003) Socioeconomic status and child health: Why is the relationship stronger for older children? Am Econ Rev 93(5):1813–1823
Currie A, Shields MA, Price SW (2007) The child health/family income gradient: evidence from England. J Health Econ 26(2):213–232
D’Ambrosio C, Deutsch J, Silber J (2011) Multidimensional approaches to poverty measurement: an empirical analysis of poverty in Belgium, France, Germany, Italy and Spain, based on the European panel. Appl Econ 43(8):951–961. https://doi.org/10.1080/00036840802600129
Dumitrescu E-I, Hurlin C (2012) Testing for Granger non-causality in heterogeneous panels. Econ Model 29(4):1450–1460. https://doi.org/10.1016/j.econmod.2012.02.014
Emara N, Mohieldin M (2020) Financial inclusion and extreme poverty in the MENA region: a gap analysis approach. Rev Econ Polit Sci 5(3):207–230. https://doi.org/10.1108/REPS-03-2020-0041
Erreygers G, Clarke P, Zheng Q (2017) On the measurement of socioeconomic inequality of health between countries. J Econ Inequal 15(2):175–193
Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, Weigel JL, Farmer DB, Habinshuti A, Mugeni SD, Karasi J-C, Drobac PC (2013) Reduced premature mortality in Rwanda: lessons from success. BMJ. https://doi.org/10.1136/bmj.f65
Fayissa B, Gutema P (2005) Estimating a health production function for Sub-Saharan Africa (SSA). Appl Econ 37(2):155–164. https://doi.org/10.1080/00036840412331313521
Foster J, Greer J, Thorbecke E (2010) The Foster–Greer–Thorbecke (FGT) poverty measures: 25 years later. J Econ Inequal 8(4):491–524. https://doi.org/10.1007/s10888-010-9136-1
Foster JE, Shorrocks AF (1988) Poverty orderings. Econometrica 56(1):173–177. https://doi.org/10.2307/1911846
Foster J, Greer J, Thorbecke E (1984) A class of decomposable poverty measures. Econometrica 52(3):761–766. https://doi.org/10.2307/1913475
Gluschenko K (2018) Measuring regional inequality: To weight or not to weight? Spat Econ Anal 13(1):36–59. https://doi.org/10.1080/17421772.2017.1343491
Goesling B, Firebaugh G (2004) The trend in international health inequality. Popul Dev Rev 30(1):131–146. https://doi.org/10.1111/j.1728-4457.2004.00006.x
Gravelle H (1998) How much of the relation between population mortality and unequal distribution of income is a statistical artefact? BMJ 316(7128):382–385. https://doi.org/10.1136/bmj.316.7128.382
Harris RDF, Tzavalis E (1999) Inference for unit roots in dynamic panels where the time dimension is fixed. J Econometr 91(2):201–226. https://doi.org/10.1016/S0304-4076(98)00076-1
Kaplan GA, Pamuk ER, Lynch JW, Cohen RD, Balfour JL (1996) Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ 312(7037):999–1003. https://doi.org/10.1136/bmj.312.7037.999
Kennedy BP, Kawachi I, Prothrow-Stith D (1996) Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States. BMJ 312(7037):1004–1007. https://doi.org/10.1136/bmj.312.7037.1004
Kennedy BP, Kawachi I, Glass R, Prothrow-Stith D (1998) Income distribution, socioeconomic status, and self rated health in the United States: multilevel analysis. BMJ 317(7163):917–921. https://doi.org/10.1136/bmj.317.7163.917
Khanam R, Nghiem HS, Connelly LB (2009) Child health and the income gradient: evidence from Australia. J Health Econ 28(4):805–817
Kremers JJM, Ericsson NR, Dolado JJ (1992) The power of cointegration tests. Oxford Bull Econ Stat 54(3):325–348. https://doi.org/10.1111/j.1468-0084.1992.tb00005.x
Lenhart O (2019) The effects of income on health: new evidence from the earned income tax credit. Rev Econ Household 17(2):377–410. https://doi.org/10.1007/s11150-018-9429-x
Lipton M, Ravallion M (1995) Chapter 41 Poverty and policy. In: Handbook of Development Economics Elsevier, vol 3, pp. 2551–2657. https://doi.org/10.1016/S1573-4471(95)30018-X
Madden D (2015) Health and wealth on the roller-coaster: Ireland, 2003–2011. Soc Indic Res 121(2):387–412. https://doi.org/10.1007/s11205-014-0644-4
McIntyre D, Obse AG, Barasa EW, Ataguba JE (2018) Challenges in financing universal health coverage in sub-Saharan Africa. In: McIntyre Diane, Obse AG, Barasa EW, Ataguba JE (eds) Oxford research encyclopedia of economics and finance. Oxford University Press, Oxford
Moyer JD, Hedden S (2020) Are we on the right path to achieve the sustainable development goals? World Dev 127:104749. https://doi.org/10.1016/j.worlddev.2019.104749
Pascual-Sáez M, Cantarero-Prieto D, Lanza-León P (2019) The dynamics of health poverty in Spain during the economic crisis (2008–2016). Health Policy 123(10):1011–1018. https://doi.org/10.1016/j.healthpol.2019.06.009
Persyn D, Westerlund J (2008) Error-correction–based cointegration tests for panel data. Stata J Promot Commun Statist Stata 8(2):232–241. https://doi.org/10.1177/1536867X0800800205
Phaladze N, Tlou S (2006) Gender and HIV/AIDS in Botswana: a focus on inequalities and discrimination. Gend Dev 14(1):23–35. https://doi.org/10.1080/13552070500518095
Preston SH (1975) The changing relation between mortality and level of economic development. Popul Stud 29(2):231–248. https://doi.org/10.1080/00324728.1975.10410201
Pritchett L, Summers LH (1996) Wealthier is Healthier. J Hum Resour 31(4):841–868. https://doi.org/10.2307/146149
Propper C, Rigg J, Burgess S (2007) Child health : Evidence on the roles of family income and maternal mental health from a UK birth cohort. Health Econ 16(11):1245–1269
Rajan K, Kennedy J, King L (2013) Is wealthier always healthier in poor countries? The health implications of income, inequality, poverty, and literacy in India. Soc Sci Med 88:98–107. https://doi.org/10.1016/j.socscimed.2013.04.004
Ravallion M (2001) Growth, inequality and poverty: looking beyond averages. World Dev 29(11):1803–1815. https://doi.org/10.1016/S0305-750X(01)00072-9
Ravallion M (2011) On multidimensional indices of poverty. J Econ Inequal 9(2):235–248. https://doi.org/10.1007/s10888-011-9173-4
Ravallion M, Datt G, van de Walle D (1991) Quantifying absolute poverty in the developing world. Rev Income Wealth 37(4):345–361. https://doi.org/10.1111/j.1475-4991.1991.tb00378.x
Reinhold S, Jürges H (2012) Parental income and child health in Germany. Health Econ 21(5):562–579
Santos ME, Villatoro P (2018) A multidimensional poverty index for Latin America. Rev Income Wealth 64(1):52–82. https://doi.org/10.1111/roiw.12275
Simões N, Crespo N, Moreira SB, Varum CA (2016) Measurement and determinants of health poverty and richness: evidence from Portugal. Emp Econ 50(4):1331–1358. https://doi.org/10.1007/s00181-015-0967-2
Snyder FG (1974) Health policy and the law in Senegal (1967). Soc Sci Med 8(1):11–28. https://doi.org/10.1016/0037-7856(74)90004-3
Traoré O (2021) Methods for testing the income-health relative hypothesis that the distribution of income in a society affects the distribution of health. MethodsX 8:101410
Waldmann RJ (1992) Income distribution and infant mortality. Q J Econ 107(4):1283–1302. https://doi.org/10.2307/2118389
Weiser S, Wolfe W, Bangsberg D, Thior I, Gilbert P, Makhema J, Kebaabetswe P, Dickenson D, Mompati K, Essex M, Marlink R (2003) Barriers to Antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. JAIDS J Acquir Immune Defic Syndr 34(3):281–288. https://doi.org/10.1097/00126334-200311010-00004
Westerlund J (2007) Testing for error correction in panel data*. Oxford Bull Econ Stat 69(6):709–748. https://doi.org/10.1111/j.1468-0084.2007.00477.x
Wilkinson RG (1992) Income distribution and life expectancy. BMJ: Br Med J 304(6820):165–168
Wilkinson RG (1997) Socioeconomic determinants of health: Health inequalities: relative or absolute material standards? BMJ 314(7080):591. https://repository.library.georgetown.edu/handle/10822/901831
Wilkinson RG (2002) Unhealthy societies: the afflictions of inequality. Routledge, UK
World Development Indicators | DataBank. (s. d.). Consulté 16 mai 2020, à l’adresse https://databank.worldbank.org/source/world-development-indicators
Acknowledgements
I would like to thank Idrissa M. Ouédraogo and Yaya Ky at the Université Thomas Sankara, for some helpful discussions.
Funding
Not applicable.
Author information
Authors and Affiliations
Contributions
This article is written with the contribution of its corresponding author alone.
Corresponding author
Ethics declarations
Conflict of interest
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendix
Appendix
See Appendix Tables
6,
7,
8,
9.
Rights and permissions
About this article
Cite this article
Traoré, O. The effect of income on health: evidence from the poverty gaps analysis method in the sub-Saharan Africa. Int Rev Econ 69, 401–432 (2022). https://doi.org/10.1007/s12232-022-00397-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12232-022-00397-1