Wang Limin
The World Bank, MC5-208, ENV, 1818 H Street, NW, Washington, DC 20433, USA.
Health Policy. 2003 Sep;65(3):277-99. doi: 10.1016/s0168-8510(03)00039-3.
Empirical studies on child mortality at the disaggregated level-by social-economic group or geographic location-are more informative for designing health polices. Using Demographic and Health Survey data from over 60 low-income countries, this study (1) presents global patterns of the level and inequality in child mortality and (2) investigates the determinants of child mortality, both at the national level and separately for urban and rural areas. The global patterns of health outcomes reveal two interesting observations. First, as child mortality declines, the gap in mortality between the poor and the better-off widens. Second, while child mortality in rural areas is substantially higher than in urban areas, the reduction in child mortality is much slower in rural areas where the poor are concentrated. This suggests that health interventions implemented in the past decade may not have been as effective as intended in reaching the poor. The analysis on mortality determination shows that at the national level access to electricity, incomes, vaccination in the first year of birth, and public health expenditure significantly reduce child mortality. The electricity effect is large and independent of the income effect. While in urban areas, access to electricity is the only significant mortality determinant, in rural areas, vaccination in the first year of birth is the only significant factor.
在社会经济群体或地理位置层面进行的儿童死亡率实证研究,对于制定卫生政策更具参考价值。本研究利用来自60多个低收入国家的人口与健康调查数据,(1)呈现了儿童死亡率水平及不平等程度的全球模式,(2)并在国家层面以及分别针对城市和农村地区,调查了儿童死亡率的决定因素。健康结果的全球模式揭示了两个有趣的现象。首先,随着儿童死亡率下降,贫困群体与富裕群体之间的死亡率差距在扩大。其次,虽然农村地区的儿童死亡率大幅高于城市地区,但在贫困人口集中的农村地区,儿童死亡率的下降速度要慢得多。这表明过去十年实施的卫生干预措施在惠及贫困人口方面可能并未达到预期效果。对死亡率决定因素的分析表明,在国家层面,通电情况、收入、出生第一年的疫苗接种以及公共卫生支出显著降低了儿童死亡率。通电的影响很大且独立于收入影响。在城市地区,通电情况是唯一显著的死亡率决定因素,而在农村地区,出生第一年的疫苗接种是唯一显著的因素。