What is the Association Between Economic Growth and Health Equity? A Cross-National Study of 83 Low- and Middle-income Countries.

Abstract

Inequities in infant and child mortality are an urgent public health issue for lower- and middle-income countries (LMICs). We sought to establish whether gross domestic product (GDP) is associated with the extent of health inequalities within LMICs. We conducted a secondary analysis of publicly available health equity data from the Health Equity Database of LMICs and GDP data from the World Bank. We used infant and under-five mortality rates by socioeconomic quintile. The slope of inequality index and relative index of inequality were calculated for both outcomes for each country (n = 83). Mixed effect linear regression analysis was used to investigate the relationship with GDP. Higher GDP was associated with a significant decrease in absolute socioeconomic inequities in both infant (f² = 0.26) and under-five mortality (f² = 0.33). Higher GDP was also associated with relative inequities in infant (f² = 0.08) and under-five mortality (f² = 0.07). Thus, increasing GDP may help reduce absolute inequities in infant and under-five mortality, but may increase relative inequities. Understanding drivers of the distribution of wealth and income to flatten the socioeconomic gradient in health are crucial to reducing health inequities.