Inequalities in health in Latin America and the Caribbean: descriptive and exploratory results for self-reported health problems and health care in twelve countries

Objective: To explore and describe inequalities in health and use of health care as revealed by self-report in 12 countries of Latin America and the Caribbean. Methods: A descriptive and exploratory study was performed based on the responses to questions on health and health care utilization that were included in general purpose household surveys. Inequalities are described by quintile of household expenditures (or income) per capita, sex, age group (children, adults, and older adults), and place of residence (urban vs. rural area). For those who sought health care, median polishing was performed by economic status and sex, for the three age groups. Results: Although the study is exploratory and descriptive, its findings show large economic gradients in health care utilization in these countries, with generally small difference between males and females and higher percentages of women seeking health care than men, although there were some exceptions among the lower economic strata in urban areas. Conclusions: Inequalities in self-reported health problems among the different economic strata were small, and such problems were usually more common among women than men. The presence of small inequalities may be due to cultural and social differences in the perception of health. However, in most countries included in the study, large inequalities were found in the use of health care for the self-reported health problems. It is important to develop regional projects aimed at improving the questions on self-reported health in household interview surveys so that the determinants of the inequalities in health can be studied in depth. The authors conclude that due to the different patterns of economic gradients among different age groups, and among males and females, the practice of standardization used in constructing concentration curves and in computing concentration indices should be avoided. At the end is a set of recommendations on how to improve these sources of data. Despite their shortcomings, household interview surveys are very useful in understanding the dimensions of health inequalities in these countries (AU)

Inequities in access to and use of drinking water services in Latin America and the Caribbean

Objective: To identify and evaluate inequities in access to drinking water services as reflected in household per capita expenditure on water, and to determine what proportion of household expenditures is spent on water in 11 countries of Latin America and the Caribbean. Methods: Using data from multi-purpose household surveys (such as the Living Standards Measurement Survey Study) conducted in 11 countries from 1995 to 1999, the availability of drinking water as well as total and per capita households expenditures on drinking water were analyzed in light of socioeconomic parameters, such as urban vs. rural setting, household income, type and regularity of water supply service, time spent obtaining water in homes not served by running water, and type of water-purifying treatment, if any. Results: Access to drinking water as well as total and per capita household expenditures on drinking water show an association with household income, economic conditions of the household, and location. The access of the rural population to drinking water services is much more restricted than that of the urban population for groups having similar income. The proportion of families having a household water supply system is comparable in the higher-income rural population and the lower-income urban population. Families without a household water supply system spend a considerable amount of time getting water. For poorer families, this implies additional costs. Low-income families that lack a household water supply spend as much money on water as do families with better income. Access to household water disinfection methods is very limited among poor families due to its relatively high cost, which results in poorer drinking water quality in the lower-income population. Conclusions: Multi-purpose household surveys conducted from the consumer's point of view are important tools for research on equity and health, especially when studying unequal access to, use of, and expenditures on drinking water. It is recommended that countries improve their portion of the surveys that deals with water and sanitation in order to facilitate national health assessments and the establishment of more equitable subsidy programs (AU)

Using household surveys and other information sources to study health equity in Latin America and the Caribbean

There are many types of household surveys. The discussion that follows will focus on what is know as "general-purpose household surveys." Such surveys were devised to study household expenditures (and/or income), job and occupational conditions, education of the members of the household (both highest level of attainment and current enrollment), conditions of the dwelling, and access to and utilization of services, including health services. The surveys usually also include a few questions on self-assesment of health status and the presence of health problems. Some of the surveys also include modules for special population groups such as children and women of reproductive age. The modules may cover such topics as immunizations, prevalence of diarrhea, upper respiratory tract illnesses in children, complete birth histories for women, and women's use of contraceptive methods. While they almost never have information on expenditures or income, they do include data about conditions of the dwelling, education, crowding, and other characteristics. These data allow some limited analyses of the relationships that health-seeking behaviors, health outcomes, and access to and utilization of some types of health care services have some aspects of the social and economic determinants of inequalities (AU)