Social Indicators Research

, Volume 72, Issue 2, pp 189–237 | Cite as

Measuring socioeconomic status in health research in developing countries: Should we be focusing on households, communities or both?

  • Jean-Christophe Fotso
  • Barthelemy Kuate-DefoEmail author


Research on the effects of socioeconomic well-being on health is important for policy makers in developing countries, where limited resources make it crucial to use existing health care resources to the best advantage. This paper develops and tests a set of measures of socioeconomic status indicators for predicting health status in developing countries. We construct socioeconomic indexes that capture both household and community attributes so as to allow us to separate the social from the purely economic dimensions of the socioeconomic status within a cross-national perspective, with applications to data from Demographic and Health Surveys (DHS) fielded in five African countries in the 1990s. This study demonstrates the distinctive contributions of socioeconomic indexes measured at the household vs. community level in understanding inequalities in health and survival and underlines the importance of going beyond the purely economic view of socioeconomic status to cover the multidimensional as well as multilevel concept of economic and social inequality.


Africa health inequality malnutrition mortality socioeconomic status 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Adetunji, J. 2000‘Trends in under-5 mortality rates and the HIV/AIDS epidemic’Bulletin of the World Health Organization7812001206PubMedGoogle Scholar
  2. Alder, N., Boyce, W.T., Chesney, M.A.,  et al. 1993‘Socioeconomic differences in health: no easy solution’Journal of the American Medical Association2691403145Google Scholar
  3. Armar-Klemesu, M., Ruel, M.T., Maxwell, D.G., Levin, C.E. 2000‘Poor maternal schooling is the main constraint to good child care practices in Accra’Journal of Nutrition13015971607PubMedGoogle Scholar
  4. Bateman, O.M., Smith, S. 1991‘A comparison of the health effects of water supply and sanitation in urban and rural Guatemala’Demographic and Health Surveys World Conference215051524Google Scholar
  5. Bicego, G.T., Boerma, J.T. 1991‘Maternal education and child survival: a comparative analysis of DHS data’Demographic and Health Surveys World Conference1177204Google Scholar
  6. Boelhouwer, J., Stoop, I. 1999‘Measuring well-being in the Netherlands: The SCP index from 1974 to 1997’Social Indicators Research485175CrossRefGoogle Scholar
  7. Boniface, D.R., Tefft, M.E. 1997‘The application of structural equation modelling to the construction of an index for the measurement of health-related behaviours’Statistician46505514Google Scholar
  8. Campbell, R.T., Parker, R.N. 1983‘Substantive and statistical considerations in the interpretation of multiple measures of SES’Social Forces62450466Google Scholar
  9. Cebu Study, Team 1991‘Underlying and proximate determinants of child health: the Cebu longitudinal health and nutrition survey’American Journal of Epidemiology133185201PubMedGoogle Scholar
  10. Cortinovis, I., Vella, V., Ndiku, J. 1993‘Construction of a socio-economic index to facilitate analysis of health data in developing countries’Social Science and Medicine3610871097CrossRefPubMedGoogle Scholar
  11. Das Gupta, M. 1990‘Death clustering, mother’s education and the determinants of child mortality in rural Punjab, India’Population Studies44489505CrossRefGoogle Scholar
  12. Desai, S., Alva, S. 1998‘Maternal education and child health: Is there a strong causal relationship?’Demography357181PubMedGoogle Scholar
  13. Diez-Roux, A.V. 1998‘Bringing context back into epidemiology: variables and fallacies in multi-level analysis’American Journal of Public Health88216222PubMedGoogle Scholar
  14. Diez-Roux, A.V. 2000‘Multi-level analysis in public health research’Annual Review of Public Health21171192CrossRefPubMedGoogle Scholar
  15. Diez-Roux, A.V. 2001‘Investigating neighborhood and area effects on health’American Journal of Public Health9117831789PubMedGoogle Scholar
  16. Diez-Roux, A.V. 2002‘Invited commentary: places, people and health’American Journal of Epidemiology155516519CrossRefPubMedGoogle Scholar
  17. Duncan, C., Jones, K., Moon, G. 1996‘Health-related behaviour in context: a multilevel modelling approach’Social Science and Medicine42817830CrossRefPubMedGoogle Scholar
  18. Duncan, C., Jones, K., Moon, G. 1998‘Context, composition and heterogeneity: using multilevel models in health research’Social Science and Medicine4697117CrossRefPubMedGoogle Scholar
  19. Dunteman, G.H. 1989Principal Component AnalysisSAGE publicationNewbury ParkGoogle Scholar
  20. Durkin, M.S., Islam, S., Hasan, Z.M., Zaman, S.S. 1994‘Measures of socioeconomic status for child health research: comparative results from Bangladesh and Pakistan’Social Science and Medicine3812891297CrossRefPubMedGoogle Scholar
  21. Feachem, R.G.A. 2000‘Poverty and inequity: a proper focus for the new century’Bulletin of the World Health Organization781PubMedGoogle Scholar
  22. Fiadzo, E.D., Houston, J.E., Godwin, D.D. 2001‘Estimating housing quality for poverty and development policy analysis: CWIQ in Ghana’Social Indicators Research53137162CrossRefGoogle Scholar
  23. Filmer, D., Pritchett, L. 1998Estimating Wealth Effects Without Expenditure Data – or Tears: An Application to Educational Enrolments in States of India (World Bank Policy Research working Paper No 1994DC: DECRGWashington, The World BankGoogle Scholar
  24. Filmer, D., Pritchett, L. 1999‘The effect of household wealth on educational attainment: evidence from 35 Countries’Population and Development Review2585120CrossRefGoogle Scholar
  25. Gaminirante, K.H.W. 1991‘Socio-economic and behavioural determinants of diarrhoeal morbidity among children in Sri Lanka’Demographic and Health Surveys World Conference1757784Google Scholar
  26. Gwatkin, D.R., Rustein, S., Johnson, K.,  et al. 2000Socio-Economic Differences in Health, Nutrition, and Population in CameroonHNP/Poverty Thematic GroupThe World BankGoogle Scholar
  27. Hobcraft, J. 1993‘Women’s education, child welfare and child survival: a review of the evidence’Health Transition Review3159175PubMedGoogle Scholar
  28. Jolliffe, I.T. 1986Principal Component AnalysisSpringer-VerlagSpringer Series in StatisticsGoogle Scholar
  29. Kakwani, N., Wagstaff, A., Doorslaer, E. 1997‘Socioeconomic inequalities in health: Measurement, computation, and statistical inference’Journal of Econometrics7787103CrossRefGoogle Scholar
  30. Kaplan, G.A., Lynch, J.W. 1997‘Whiter studies on the socioeconomic foundations of population health’American Journal of Public Health8714091411PubMedGoogle Scholar
  31. Kawachi, I., Subramanian, S.V., Almeida-Filho, N. 2002‘A glossary for health inequalities’Journal of Epidemiology and Community Health56647652CrossRefPubMedGoogle Scholar
  32. Krieger, N., Willains, D.R., Moss, N.E. 1997‘Measuring social class in public health research: Concepts, methodologies, and guidelines’Annual Review of Public Health18341378CrossRefPubMedGoogle Scholar
  33. Kuate-Defo, B. 1996‘Areal and socioeconomic differentials in infant and child mortality in Cameroon’Social Science and Medicine42399420CrossRefPubMedGoogle Scholar
  34. Kuate-Defo, B. 1997‘Effects of socioeconomic disadvantage and women’s status on women’s health in Cameroon’Social Science and Medicine4410231042CrossRefPubMedGoogle Scholar
  35. Kuate-Defo B., 2001. ‘Nutritional status, health and survival of Cameroonian children: the state of knowledge’. In: Kuate-Defo B. (eds). Nutrition and Child Health in Cameroon Price-Patterson Ltd, Canada Publishers, 3–52.Google Scholar
  36. Kuate-Defo, B., Diallo, K. 2002‘Geography of child mortality clustering within African families’Health and Place893117CrossRefPubMedGoogle Scholar
  37. Lai, D. 2000‘Temporal analysis of human development indicators: principal component approach’Social Indicators Research51331366CrossRefGoogle Scholar
  38. Lai, D. 2003‘Principal component analysis on human development indicators of China’Social Indicators Research61319330CrossRefGoogle Scholar
  39. Lamontagne, J.F., Engle, P.L., Zeitlin, M.F. 1998‘Maternal employment, child care, and nutritional status of 12–18-month-old children in Managua, Nicaragua’Social Science and Medicine46403414CrossRefPubMedGoogle Scholar
  40. Lynch J.W., Kaplan G.A. 2000. ‘Socioeconomic position’. In: Berkman L.F., Kawachi I. (eds), Social Epidemiology. Oxford University Press 2000, 13–35.Google Scholar
  41. Macintyre S., Ellaway A. 2000. ‘Ecological approaches: rediscovering the role of physical and social environment’. In: Berkman L.F., Kawachi I. (eds), Social Epidemiology. Oxford University Press 2000: 322–348.Google Scholar
  42. Macintyre, S., Maciver, S., Sooman, A. 1993‘Area, class and health: should we be focusing on places or people?’Journal of Social Policy22213234Google Scholar
  43. Macintyre, S., Ellaway, A., Cummins, S. 2002‘Place effects on health: how can we conceptualise, operationalise and measure them’Social Science and Medicine5512539CrossRefPubMedGoogle Scholar
  44. Montgomery, M.R., Gragnolati, M., Burke, K.A., Paredes, E. 2000‘Measuring living standards with proxy variables’Demography37155174PubMedGoogle Scholar
  45. Morris, R., Castairs, V. 1991‘Which deprivation? A comparison of selected deprivation indices’Journal of Public Health Medicine13318326PubMedGoogle Scholar
  46. Mosley, W.H., Chen, L.C. 1984‘An analytic framework for the study of child survival in developing countries’Population and Development Review102545(suppl)Google Scholar
  47. Oakes, J.M., Rossi, P.H. 2003‘The measurement of SES in health research: current practice and steps toward a new approach’Social Science and Medicine56769784CrossRefPubMedGoogle Scholar
  48. Quadrado, L., Heijman, W., Folmer, H. 2001‘Multidimensional analysis of regional inequality: the case of Hungary’Social Indicators Research562142CrossRefGoogle Scholar
  49. Rahkonen, O., Lahelma, E., Martikainen, P., Silventoinen, P. 2002‘Determinants of health inequalities by income from the 1980s to the 1990s in Finland’Journal of Epidemiology and Community Health56442443CrossRefPubMedGoogle Scholar
  50. Reed, B.A., Habicht, J.P., Niameogo, C. 1996‘The effects of maternal education on child nutritional status depend on socio-environmental conditions’International Journal of Epidemiology25585592PubMedGoogle Scholar
  51. Ricci, J.A., Becker, S. 1996‘Risk factors for wasting and stunting among children in Metro Cebu, Philippines’American Journal of Clinical Nutrition63966975PubMedGoogle Scholar
  52. Robert, S. 1999‘Socioeconomic position and health: the independent contribution of community socioeconomic context’Annual Review of Sociology25489516CrossRefGoogle Scholar
  53. Ruel, M.T., Habicht, J.P., Pinstrup-Anderson, P., Gröhn, Y. 1992‘The mediating effect of maternal nutrition knowledge on the association between maternal schooling and child nutritional status in Lesotho’American Journal of Epidemiology135904914PubMedGoogle Scholar
  54. Ruel, M.T., Levin, C.E., Armar-Klemesu, M.,  et al. 1999‘Good care practices can mitigate the negative effects of poverty and low maternal schooling on children’s nutritional status: Evidence from Accra’World Development2719932009CrossRefGoogle Scholar
  55. Rutstein, S.O. 2000‘Factors associated with trends in infant and child mortality in developing countries during the 1990s’Bulletin of the World Health Organization7812561270PubMedGoogle Scholar
  56. Sastry, N. 1996‘Community characteristics, individual and household␣attributes, and child survival in Brazil’Demography33211229PubMedGoogle Scholar
  57. Sommerfelt, A.E. 1991‘Comparative analysis of the determinants of children’s nutritional status’Demographic and Health Surveys World Conference2981998Google Scholar
  58. Szwarcwald, C.L., Andrade, C.L.T., Bastos, F.I. 2002‘Income inequality, residential poverty and infant mortality: a study in Rio de Janeiro, Brazil’Social Science and Medicine5520832092CrossRefPubMedGoogle Scholar
  59. UNDP2002Human Development Report 2002: Deepening Democracy in a Fragmented WorldUNDPNew YorkGoogle Scholar
  60. UNICEF1990Strategy for Improved Nutrition for Women and Children in Developing CountriesUNICEFNew YorkGoogle Scholar
  61. Victoria, C.G., Huttly, S.R.A., Barros, F.C.,  et al. 1992‘Maternal education in relation to early and late child health outcomes: findings from a Brazilian cohort study’Social Science and Medicine34899905CrossRefPubMedGoogle Scholar
  62. Wagstaff, A. 2000‘Socioeconomic inequalities in child mortality: comparisons across nine developing countries’Bulletin of the World Health Organization781929PubMedGoogle Scholar
  63. Wagstaff, A. 2002‘Inequality aversion, health inequalities and health achievement’Journal of Health Economics21627641CrossRefPubMedGoogle Scholar
  64. Wagstaff, A., Watanabe, N. 2000Socioeconomic inequalities in child malnutrition in the developing worldPolicy Research Working Paper # 2434The World Bank)Google Scholar
  65. Wagstaff, A., Paci, P., Doorslaer, E. 1991‘On the measurement of inequalities in health’Social Science and Medicine33545557CrossRefPubMedGoogle Scholar
  66. Wagstaff, A., Paci, P., Joshi, H. 2001Causes of Inequalities in health: Who you are? Where you live? Or who your parents were?Policy Research Working Paper # 2713The World BankGoogle Scholar
  67. World, Bank 2002African Development Indicators 2002The World Bank. WashingtonDCGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  1. 1.PRONUSTIC Research LaboratoryUniversity of MontrealMontrealCanada

Personalised recommendations