I POLICY RESEARCH WORKING PAPER 2795

# Summary findings

Inequalities in health have recently started to receive a good deal of attention in the developing world. But how large are they? And how large are the differences across countries?

Recent data from a 42-country study show large but varying inequalities in health across countries. Wagstaff explores the reasons for these intercountry differences and concludes that large inequalities in health are not apparently associated with large inequalities in income or with small shares of publicly financed health spending. But they are associated with higher per capita incomes.

Evidence from trends in health inequalities-in both the developing and the industrial world-supports the notion that health inequalities rise with rising per capita incomes. The association between health inequalities and per capita incomes is probably due in part to technological change going hand-in-hand with economic growth, coupled with a tendency for the better-off to assimilate new technology ahead of the poor.

average health levels associated with rising incomes are a good thing, Wagstaff outlines a way of quantifying the tradeoff between health inequalities and health levels. He also suggests that successful anti-inequality policies can be devised, but that their success cannot be established simply by looking at "headline" health inequality figures, since these reflect the effects of differences and changes in other variables, including per capita income.

> Wagstaff identifies four approaches that can shed light on the impacts of anti-inequality policies on health inequalities: cross-country comparative studies, countrybased before-and-after studies with controls, benefitincidence analysis, and decomposition analysis. The results of studies based on these four approaches do not give as many clear-cut answers as one might like on how best to swim against the tide of rising per capita incomes and their apparent inequality-increasing effects. But they ought at least to help us build our stock of knowledge on the subject.

Since increased health inequalities associated with rising per capita incomes is a bad thing and increased This paper-a product of Public Services, Development Research Group, and the Health, Nutrition, and Population Team, Human Development Network-is part of a larger effort in the Bank to investigate the links between poverty and health. Copies of the paper are available free from the World Bank, 1818 H Street NW, Washington, DC 20433. Please contact HedySladovich, room MC3-311, telephone 202-473-7698, fax 202-522-1154, email address hsladovich@worldbank.org. Policy Research Working Papers are also posted on the Web at http://econ.worldbank.org. The author may be contacted at awagstaff@worldbank.org. February 2002. (40 pages)

> _The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should he cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the view of the World Bank, its Executive Directors, or the countries they represent._

Produced by the Policy Research Dissemination Center