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

American Journal of Public Health
Cesar G VictoraAluísio J D Barros

Abstract

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. 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. 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. 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.

References

Feb 27, 1971·Lancet·J T Hart
Apr 19, 2003·BMJ : British Medical Journal·Elizabeth Middleton, Deborah Baker
Oct 16, 2004·Journal of Epidemiology and Community Health·Enrique Regidor
Feb 4, 2005·Health Policy and Planning·David BishaiKeith P West
Mar 2, 2005·International Journal of Epidemiology·José Leopoldo Ferreira AntunesCarme Borrell
Sep 22, 2010·PLoS Medicine·Zoë MatthewsWilliam Stones
Jan 5, 2011·Annals of Oncology : Official Journal of the European Society for Medical Oncology·G LyratzopoulosM P Coleman
Jan 29, 2011·Journal of Public Health·Auburn LaroseJohn Lynch
Mar 29, 2011·Journal of Health Economics·Dan AnderbergJonathan Wadsworth
May 13, 2011·Lancet·Cesar G VictoraCelia L Szwarcwald
Sep 25, 2012·Lancet·Mickey ChopraUNKNOWN UNICEF Equity in Child Survival, Health and Nutrition Analysis Team
Jul 11, 2013·International Journal for Equity in Health·Antonia DingleCatherine Goodman
Dec 19, 2013·Bulletin of the World Health Organization·Francesca L CavallaroCarine Ronsmans
Mar 15, 2014·Revista de saúde pública·Marco Aurélio PeresJosé Leopoldo Ferreira Antunes
May 24, 2014·Lancet·Zulfiqar A BhuttaUNKNOWN Lancet Every Newborn Study Group
May 21, 2016·The Lancet Global Health·Luis HuichoUNKNOWN Peru Countdown Country Case Study Working Group
Sep 20, 2016·Lancet·Oona M R CampbellPatricia Bailey

❮ Previous
Next ❯

Citations

Jul 13, 2019·BMJ Global Health·Cesar VictoraAluisio J D Barros
Feb 11, 2020·International Journal of Public Health·Christian Loret de MolaBernardo Lessa Horta
Oct 17, 2019·International Journal for Equity in Health·Maria Del Pilar Flores-QuispeFernando C Wehrmeister
Mar 7, 2019·International Journal for Equity in Health·Mirak Raj AngdembeSumit Karn
Dec 1, 2018·Maternal & Child Nutrition·Phuong Hong NguyenPurnima Menon
Dec 20, 2019·International Journal of Obesity : Journal of the International Association for the Study of Obesity·Ursula Reyes MatosCesar G Victora
Jun 10, 2020·Bulletin of the World Health Organization·Fernando C WehrmeisterUNKNOWN on the behalf of the Countdown to 2030 for Women’s, Children’s and Adolescents’ Health regional collaboration in sub-Saharan
Jun 4, 2019·International Journal for Equity in Health·J Eslava-SchmalbachE V Langlois
Aug 20, 2019·BMJ Paediatrics Open·Nick SpencerGiorgio Tamburlini
Nov 2, 2020·International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases·Shahul H EbrahimZiad A Memish
Jan 27, 2021·Health Sociology Review : the Journal of the Health Section of the Australian Sociological Association·Håvard T Rydland
Mar 1, 2021·Lancet·Richard CooksonFiorella Parra Mujica

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.