Van de Poel Ellen, O'Donnell Owen, Van Doorslaer Eddy
Erasmus University Rotterdam, Rotterdam, The Netherlands.
Soc Sci Med. 2007 Nov;65(10):1986-2003. doi: 10.1016/j.socscimed.2007.06.032. Epub 2007 Aug 14.
On average, child health outcomes are better in urban than in rural areas of developing countries. Understanding the nature and the causes of this rural-urban disparity is essential in contemplating the health consequences of the rapid urbanization taking place throughout the developing world and in targeting resources appropriately to raise population health. Using micro-data on child health taken from the most recent Demographic and Health Surveys for 47 developing countries, the purpose of this paper is threefold. First, we document the magnitude of rural-urban disparities in child nutritional status and under-5 mortality across all 47 developing countries. Second, we adjust these disparities for differences in population characteristics across urban and rural settings. Third, we examine rural-urban differences in the degree of socioeconomic inequality in these health outcomes. The results demonstrate that there are considerable rural-urban differences in mean child health outcomes in the entire developing world. The rural-urban gap in stunting does not entirely mirror the gap in under-5 mortality. The most striking difference between the two is in the Latin American and Caribbean region, where the gap in growth stunting is more than 1.5 times higher than that in mortality. On average, the rural-urban risk ratios of stunting and under-5 mortality fall by, respectively, 53% and 59% after controlling for household wealth. Controlling thereafter for socio-demographic factors reduces the risk ratios by another 22% and 25%. We confirm earlier findings of higher socioeconomic inequality in stunting in urban areas and demonstrate that this also holds for under-5 mortality. In a considerable number of countries, the urban poor actually have higher rates of stunting and mortality than their rural counterparts. The findings imply that there is a need for programs that target the urban poor, and that this is becoming more necessary as the size of the urban population grows.
平均而言，在发展中国家，城市地区的儿童健康状况优于农村地区。了解这种城乡差距的性质和原因，对于思考发展中世界正在发生的快速城市化对健康的影响，以及合理分配资源以提高人口健康水平至关重要。本文利用从47个发展中国家最新的人口与健康调查中获取的儿童健康微观数据，目的有三个。第一，我们记录了所有47个发展中国家城乡儿童营养状况和五岁以下儿童死亡率的差距程度。第二，我们针对城乡人口特征的差异对这些差距进行调整。第三，我们研究这些健康结果在社会经济不平等程度方面的城乡差异。结果表明，在整个发展中世界，城乡儿童健康平均水平存在相当大的差异。发育迟缓方面的城乡差距并不完全反映五岁以下儿童死亡率的差距。两者最显著的差异出现在拉丁美洲和加勒比地区，那里发育迟缓的差距比死亡率差距高出1.5倍以上。平均而言，在控制家庭财富后，发育迟缓和五岁以下儿童死亡率的城乡风险比分别下降了53%和59%。此后再控制社会人口因素，风险比又分别降低了22%和25%。我们证实了早期关于城市地区发育迟缓方面社会经济不平等程度更高的研究结果，并表明五岁以下儿童死亡率也是如此。在相当多的国家，城市贫困人口的发育迟缓和死亡率实际上高于农村贫困人口。研究结果表明，需要针对城市贫困人口制定相关项目，而且随着城市人口规模的扩大，这一点变得越发必要。
