Measuring socioeconomic status in health research in developing countries: Should we be focusing on households, communities or both? Article DOI:
Cite this article as: Fotso, JC. & Kuate-Defo, B. Soc Indic Res (2005) 72: 189. doi:10.1007/s11205-004-5579-8 Abstract.
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.
Keywords Africa health inequality malnutrition mortality socioeconomic status References Adetunji, J. 2000 ‘Trends in under-5 mortality rates and the HIV/AIDS epidemic’ Bulletin of the World Health Organization 78 1200 1206 PubMed Google Scholar Alder, N., Boyce, W.T., Chesney, M.A., et al. 1993 ‘Socioeconomic differences in health: no easy solution’ Journal of the American Medical Association 269 140 3145 Google Scholar 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 Nutrition 130 1597 1607 PubMed Google Scholar 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 Conference 2 1505 1524 Google Scholar Bicego, G.T., Boerma, J.T. 1991 ‘Maternal education and child survival: a comparative analysis of DHS data’ Demographic and Health Surveys World Conference 1 177 204 Google Scholar Boelhouwer, J., Stoop, I. 1999 ‘Measuring well-being in the Netherlands: The SCP index from 1974 to 1997’ Social Indicators Research 48 51 75 CrossRef Google Scholar 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’ Statistician 46 505 514 Google Scholar Campbell, R.T., Parker, R.N. 1983 ‘Substantive and statistical considerations in the interpretation of multiple measures of SES’ Social Forces 62 450 466 Google Scholar Cebu Study, Team 1991 ‘Underlying and proximate determinants of child health: the Cebu longitudinal health and nutrition survey’ American Journal of Epidemiology 133 185 201 PubMed Google Scholar 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 Medicine 36 1087 1097 CrossRef PubMed Google Scholar Das Gupta, M. 1990 ‘Death clustering, mother’s education and the determinants of child mortality in rural Punjab, India’ Population Studies 44 489 505 CrossRef Google Scholar Desai, S., Alva, S. 1998 ‘Maternal education and child health: Is there a strong causal relationship?’ Demography 35 71 81 PubMed Google Scholar Diez-Roux, A.V. 1998 ‘Bringing context back into epidemiology: variables and fallacies in multi-level analysis’ American Journal of Public Health 88 216 222 PubMed Google Scholar Diez-Roux, A.V. 2000 ‘Multi-level analysis in public health research’ Annual Review of Public Health 21 171 192 CrossRef PubMed Google Scholar Diez-Roux, A.V. 2001 ‘Investigating neighborhood and area effects on health’ American Journal of Public Health 91 1783 1789 PubMed Google Scholar Diez-Roux, A.V. 2002 ‘Invited commentary: places, people and health’ American Journal of Epidemiology 155 516 519 CrossRef PubMed Google Scholar Duncan, C., Jones, K., Moon, G. 1996 ‘Health-related behaviour in context: a multilevel modelling approach’ Social Science and Medicine 42 817 830 CrossRef PubMed Google Scholar Duncan, C., Jones, K., Moon, G. 1998 ‘Context, composition and heterogeneity: using multilevel models in health research’ Social Science and Medicine 46 97 117 CrossRef PubMed Google Scholar Dunteman, G.H. 1989Principal Component Analysis SAGE publication Newbury Park Google Scholar 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 Medicine 38 1289 1297 CrossRef PubMed Google Scholar Feachem, R.G.A. 2000 ‘Poverty and inequity: a proper focus for the new century’ Bulletin of the World Health Organization 78 1 PubMed Google Scholar Fiadzo, E.D., Houston, J.E., Godwin, D.D. 2001 ‘Estimating housing quality for poverty and development policy analysis: CWIQ in Ghana’ Social Indicators Research 53 137 162 CrossRef Google Scholar 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 1994 DC: DECRG Washington, The World Bank Google Scholar Filmer, D., Pritchett, L. 1999 ‘The effect of household wealth on educational attainment: evidence from 35 Countries’ Population and Development Review 25 85 120 CrossRef Google Scholar Gaminirante, K.H.W. 1991 ‘Socio-economic and behavioural determinants of diarrhoeal morbidity among children in Sri Lanka’ Demographic and Health Surveys World Conference 1 757 784 Google Scholar Gwatkin, D.R., Rustein, S., Johnson, K., et al. 2000Socio-Economic Differences in Health, Nutrition, and Population in Cameroon HNP/Poverty Thematic Group The World Bank Google Scholar Hobcraft, J. 1993 ‘Women’s education, child welfare and child survival: a review of the evidence’ Health Transition Review 3 159 175 PubMed Google Scholar Jolliffe, I.T. 1986Principal Component Analysis Springer-Verlag Springer Series in Statistics Google Scholar Kakwani, N., Wagstaff, A., Doorslaer, E. 1997 ‘Socioeconomic inequalities in health: Measurement, computation, and statistical inference’ Journal of Econometrics 77 87 103 CrossRef Google Scholar Kaplan, G.A., Lynch, J.W. 1997 ‘Whiter studies on the socioeconomic foundations of population health’ American Journal of Public Health 87 1409 1411 PubMed Google Scholar Kawachi, I., Subramanian, S.V., Almeida-Filho, N. 2002 ‘A glossary for health inequalities’ Journal of Epidemiology and Community Health 56 647 652 CrossRef PubMed Google Scholar Krieger, N., Willains, D.R., Moss, N.E. 1997 ‘Measuring social class in public health research: Concepts, methodologies, and guidelines’ Annual Review of Public Health 18 341 378 CrossRef PubMed Google Scholar Kuate-Defo, B. 1996 ‘Areal and socioeconomic differentials in infant and child mortality in Cameroon’ Social Science and Medicine 42 399 420 CrossRef PubMed Google Scholar Kuate-Defo, B. 1997 ‘Effects of socioeconomic disadvantage and women’s status on women’s health in Cameroon’ Social Science and Medicine 44 1023 1042 CrossRef PubMed Google Scholar
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.
Kuate-Defo, B., Diallo, K. 2002 ‘Geography of child mortality clustering within African families’ Health and Place 8 93 117 CrossRef PubMed Google Scholar Lai, D. 2000 ‘Temporal analysis of human development indicators: principal component approach’ Social Indicators Research 51 331 366 CrossRef Google Scholar Lai, D. 2003 ‘Principal component analysis on human development indicators of China’ Social Indicators Research 61 319 330 CrossRef Google Scholar 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 Medicine 46 403 414 CrossRef PubMed Google Scholar
Lynch J.W., Kaplan G.A. 2000. ‘Socioeconomic position’. In: Berkman L.F., Kawachi I. (eds), Social Epidemiology. Oxford University Press 2000, 13–35.
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.
Macintyre, S., Maciver, S., Sooman, A. 1993 ‘Area, class and health: should we be focusing on places or people?’ Journal of Social Policy 22 213 234 Google Scholar Macintyre, S., Ellaway, A., Cummins, S. 2002 ‘Place effects on health: how can we conceptualise, operationalise and measure them’ Social Science and Medicine 55 125 39 CrossRef PubMed Google Scholar Montgomery, M.R., Gragnolati, M., Burke, K.A., Paredes, E. 2000 ‘Measuring living standards with proxy variables’ Demography 37 155 174 PubMed Google Scholar Morris, R., Castairs, V. 1991 ‘Which deprivation? A comparison of selected deprivation indices’ Journal of Public Health Medicine 13 318 326 PubMed Google Scholar Mosley, W.H., Chen, L.C. 1984 ‘An analytic framework for the study of child survival in developing countries’ Population and Development Review 10 25 45 Google Scholar 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 Medicine 56 769 784 CrossRef PubMed Google Scholar Quadrado, L., Heijman, W., Folmer, H. 2001 ‘Multidimensional analysis of regional inequality: the case of Hungary’ Social Indicators Research 56 21 42 CrossRef Google Scholar 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 Health 56 442 443 CrossRef PubMed Google Scholar 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 Epidemiology 25 585 592 PubMed Google Scholar Ricci, J.A., Becker, S. 1996 ‘Risk factors for wasting and stunting among children in Metro Cebu, Philippines’ American Journal of Clinical Nutrition 63 966 975 PubMed Google Scholar Robert, S. 1999 ‘Socioeconomic position and health: the independent contribution of community socioeconomic context’ Annual Review of Sociology 25 489 516 CrossRef Google Scholar 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 Epidemiology 135 904 914 PubMed Google Scholar 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 Development 27 1993 2009 CrossRef Google Scholar Rutstein, S.O. 2000 ‘Factors associated with trends in infant and child mortality in developing countries during the 1990s’ Bulletin of the World Health Organization 78 1256 1270 PubMed Google Scholar Sastry, N. 1996 ‘Community characteristics, individual and household␣attributes, and child survival in Brazil’ Demography 33 211 229 PubMed Google Scholar Sommerfelt, A.E. 1991 ‘Comparative analysis of the determinants of children’s nutritional status’ Demographic and Health Surveys World Conference 2 981 998 Google Scholar 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 Medicine 55 2083 2092 CrossRef PubMed Google Scholar UNDP 2002Human Development Report 2002: Deepening Democracy in a Fragmented World UNDP New York Google Scholar UNICEF 1990Strategy for Improved Nutrition for Women and Children in Developing Countries UNICEF New York Google Scholar 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 Medicine 34 899 905 CrossRef PubMed Google Scholar Wagstaff, A. 2000 ‘Socioeconomic inequalities in child mortality: comparisons across nine developing countries’ Bulletin of the World Health Organization 78 19 29 PubMed Google Scholar Wagstaff, A. 2002 ‘Inequality aversion, health inequalities and health achievement’ Journal of Health Economics 21 627 641 CrossRef PubMed Google Scholar Wagstaff, A., Watanabe, N. 2000Socioeconomic inequalities in child malnutrition in the developing world Policy Research Working Paper # 2434 The World Bank) Google Scholar Wagstaff, A., Paci, P., Doorslaer, E. 1991 ‘On the measurement of inequalities in health’ Social Science and Medicine 33 545 557 CrossRef PubMed Google Scholar 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 # 2713 The World Bank Google Scholar World, Bank 2002African Development Indicators 2002 The World Bank. Washington DC Google Scholar