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Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries?: A time-series, ecological analysis of 48 countries from 1993 to 2013

Published online by Cambridge University Press:  27 June 2018

Peter Baker Open the ORCID record for Peter Baker [Opens in a new window] ,
Thomas Hone ,
Aaron Reeves ,
Mauricio Avendano  and
Christopher Millett
Peter Baker
Affiliation:
Public Health Consultant and Honorary Clinical Fellow, The Department of Primary Care & Public Health, Imperial College London, London, UK
Thomas Hone
Affiliation:
Research Fellow, The Department of Primary Care & Public Health, Imperial College London, London, UK
Aaron Reeves
Affiliation:
Associate Professor, Department of Social Policy and Intervention, University of Oxford, Oxford, UKAssociate Professorial Research Fellow, International Inequalities Institute, London School of Economics and Political Science, London, UK
Mauricio Avendano
Affiliation:
Reader in Global Ageing, Department of Social Science, Health and Medicine, King’s College London, London, UK
Christopher Millett
Affiliation:
Professor of Public Health, The Department of Primary Care & Public Health, Imperial College London, London, UK
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Abstract

Inequalities in infant mortality rates (IMRs) are rising in some low- and middle-income countries (LMICs) and decreasing in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMRs. We estimated country-level fixed-effects panel regressions for 48 LMICs (142 country observations). Slope and Relative Indices of Inequality in IMRs (SII and RII) were calculated from Demographic and Health Surveys between 1993 and 2013. RII and SII were regressed on government expenditure (total, health and non-health) and redistribution, controlling for gross domestic product (GDP), private health expenditures, a democracy indicator, country fixed effects and time. Mean SII and RII was 39.12 and 0.69, respectively. In multivariate models, a 1 percentage point increase in total government expenditure (% of GDP) was associated with a decrease in SII of −2.468 [95% confidence intervals (CIs): −4.190, −0.746] and RII of −0.026 (95% CIs: −0.048, −0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were non-significant for GDP, government redistribution, and private health expenditure. Understanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.

Type
Articles
Information
Health Economics, Policy and Law , Volume 14 , Special Issue 2: SPECIAL ISSUE: Frontiers of Health Policy Research , April 2019 , pp. 249 - 273
Copyright
© Cambridge University Press 2018 

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