four essays on the links between poverty, inequality and health with empirical application to

361 Pages·2017·3.88 MB·English

by  Amadou Bassirou Diallo

FOUR ESSAYS ON THE LINKS BETWEEN
POVERTY, INEQUALITY AND HEALTH WITH
EMPIRICAL APPLICATION TO DEVELOPING
COUNTRIES: AFRICA COMPARED TO THE REST
OF THE WORLD
Amadou Bassirou Diallo
To cite this version:
Amadou Bassirou Diallo. FOUR ESSAYS ON THE LINKS BETWEEN POVERTY, INEQUALITY
AND HEALTH WITH EMPIRICAL APPLICATION TO DEVELOPING COUNTRIES: AFRICA
COMPARED TO THE REST OF THE WORLD. Humanities and Social Sciences. Université
d’Auvergne - Clermont-Ferrand I, 2009. English. ￿NNT: ￿. ￿tel-00356118￿
HAL Id: tel-00356118
https://theses.hal.science/tel-00356118
Submitted on 26 Jan 2009
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Université d’Auvergne - Clermont-Ferrand 1, France
Faculté des Sciences Economiques et de Gestion
Centre d’Etudes et de Recherches sur le Développement International (CERDI)

FOUR ESSAYS ON THE LINKS BETWEEN POVERTY,
INEQUALITY AND HEALTH WITH EMPIRICAL
APPLICATION TO DEVELOPING COUNTRIES:
AFRICA COMPARED TO THE REST OF THE WORLD.

Par
Amadou Bassirou DIALLO

Thèse Nouveau Régime
Présentée et soutenue publiquement le 16 Janvier 2009 pour l’obtention du titre de
Docteur ès Sciences Economiques.

Directeurs:
Dr. Martine AUDIBERT,
Directeur de Recherches, CERDI, Université d’Auvergne et CNRS.
Pr. Jacky MATHONNAT,
Professeur, CERDI, Université d’Auvergne.

Membres du Jury :

Président M. Patrick GUILLAUMONT Professeur Emeritus, CERDI,
Université d’Auvergne.
Rapporteurs Mme Lise ROCHAIX Professeur, Université de la Méditerranée
(Aix-Marseille II) et membre du Collège de
la Haute Autorité de Santé.
M. Mead OVER Senior Researcher, Center for Global
Development, Washington.
Suffragante Mme Cécile CHARASSE-POUELE Maître de Conférences, Université Blaise Pascal.
Directeurs Mme Martine AUDIBERT Directeur de Recherches,
CERDI/CNRS, Université d’Auvergne.
M. Jacky MATHONNAT Professeur, CERDI, Université d’Auvergne.
2
TABLE DES MATIERES

LISTE DES TABLES 6
LISTE DES FIGURES 7
LISTE DES ACRONYMES 8

AVANT-PROPOS 9
REMERCIEMENTS 11

RESUME EXECUTIF 17

GENERAL INTRODUCTION TO AND RATIONALE FOR THE STUDY 27
Introduction. 29
1. The Purpose of the Study. 31
2. Strategy, Methods and Structure. 33
3. Contribution of this Thesis. 38

PART I: ASSET-BASED POVERTY METHODOLOGY. 41

CHAPTER 1: ASSETS-BASED POVERTY. 43
Introduction. 43
I. Poverty: Concept, Definition, Measurement. 43
1.1. Concepts and Definitions. 43
1.2. Schools of Thought. 46
1.3. The Importance of Poverty. 49
1.4. The Renewed Interest on “Poverty” in Economic Analysis. 53
1.5. Anti-Poverty Strategies at the National and International Levels. 54
1.6. Measuring Poverty: The Income-Metric Approach. 56
1.7. Poverty Trends and Comparisons using the Income-Metric Approach. 60
1.8. Limits of the Income-Metric Approach. 62
II. Assets-Based Poverty: Application to DHS Data. 64
2.1. The Assets Methodology. 64
2.2. Limits of the Assets Index. 69
2.3. Does the Choice of the Assets Index as a Measure of Living Standards Matter? 70
2.4. The Data. 71
2.5. Poverty Trends and Comparisons using the Assets-Based Approach. 73
2.6. Comparing What is Comparable: Confronting our Results to Those of Chen and Ravallion. 82
2.7. Trends in Assets-Based Inequality. 86
III. The Impact of Demographic Transition on Growth and Poverty. 92
3.1. The Importance of Demographic Transition. 92
3.2. Growth and Equivalent Income: a Hypothetical Example. 95
3.3. Change in Household Size and Implication for Economic Growth. 98
Conclusion. 104

CHAPTER 2: CONFRONTING ASSETS AND MONETARY POVERTY IN GHANA. 109
Introduction. 109
I. Trends in Asset-Based Poverty and Inequality. 111
1.1. Migration Effects. 116
1.2. Inequality in Ghana. 118
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1.3. Poverty Dynamics. 119
II. Poverty Profile and Correlates of Poverty. 129
2.1. Poverty Profile. 129
2.2. Correlates of Poverty. 131
Conclusion. 134

PART 2 : HEALTH STATUS AND INEQUALITY IN HEALTH. 137

CHAPTER 3: MEASURING OVERALL POPULATION’S HEALTH. 139
Introduction. 139
I. Understanding the Concept of Health. 139
1.1. Why is Health Important? 139
1.1.1. Health and Productivity. 140
1.1.2. Health and the Millennium Development Goals. 141
1.2. What do We Mean by “Health”? 142
1.3. How do We Measure Health? 144
1.4. Child Mortality as a Proxy for Overall Population’s Health. 145
1.5. Measuring Child Mortality. 148
1.6. Literature Review on Child Health and Child Mortality. 151
1.6.1. Macro Determinants. 151
1.6.2. Micro Determinants. 153
1.6.2.1. Morbidity, Illness and Injury. 154
1.6.2.2. Nutrition. 154
1.6.2.3. Children’s Characteristics. 155
1.6.2.4. Mothers’ Characteristics. 155
1.6.2.5. Households’ Characteristics. 157
1.6.2.6. Access to Health Care, Hygiene and Sanitation Services. 158
1.6.2.7. Communities’ Characteristics. 158
1.6.2.8. Other Determinants. 159
1.7. Trends in Child Mortality. 159
II. The Weibull Model and Estimates of Child Mortality. 161
2.1. The Model. 162
2.2. Data. 166
2.3. Results. 167
2.3.1. Non Parametric (Kaplan-Meier) and Fictive Cohort Results. 167
2.3.2. Parametric Results. 175
2.3.3. Oaxaca Decomposition. 188
2.3.4. Explaining Child Mortality Results 189
2.3.4.1. Past Poor Economic Performances and Lack of Economic Development. 194
2.3.4.2. Past Poor Health System Performances. 194
2.3.4.3. Past Wars and Civil Conflicts. 195
2.3.4.4. HIV/AIDS and Tuberculosis. 195
2.3.4.5. Past Morbidity, Nutrition and Mortality Effects. 196
2.3.4.6. Migration effects. 196
2.3.4.7. Brain Drain, Corruption and Absenteeism. 197
2.3.4.8. Poor Sanitation and Environmental Effects. 198
2.3.4.9. Past Economic and Financial Crises. 198
2.3.4.10. Inequality in Health Status, Health Care and Health-Related Services. 201
2.3.4.11. Other Causes. 201
2.3.4. Policy Implications of Poor Health System Performance. 201
2.3.5. Macroeconomic Indicators and Child Mortality. 202
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2.3.6. Child Malnutrition versus Child Mortality. 204
Conclusion. 209

CHAPTER 4: INEQUALITY IN HEALTH AND SANITATION. 213
Introduction. 213
I. Inequality. 214
1.1. The Notion of Inequality and Theories of Social Justice. 214
1.2. The Importance of Accounting for Inequality. 219
1.3. Measuring Inequality in Health. 222
1.3.1. The Concentration Index (Wagstaff et al., 1989). 223
1.3.1.1. Measuring the CI: The Convenient Covariance Method. 225
1.3.1.2. Measuring the CI: The Convenient Regression Method. 226
1.3.2. The Gini Income Elasticity (Lerman et Yitzhaki, 1989). 227
1.2. Determinants of Health Inequality and Trends. 229
II. Estimates of Inequality in Health in SSA and the Rest of the World. 231
2.1. Access Rates. 233
2.1.1. Access Rates to Health Care and Infrastructures Services. 234
2.1.1.1. Access to Health Care Services. 234
2.1.1.2. Access to Health-Related (Sanitation) Services. 237
2.2. Inequality in Health, Health Care and Health-Related Services. 241
Conclusion. 246

GENERAL CONCLUSION 249

REFERENCES 255
ANNEXES 277
COMPUTER PROGRAMS 343

5
LISTE DES TABLES

Table 1: Decomposing Inequality Trends. P.92
Table 2: Growth and Income per Equivalent Adult: a Hypothetical Example. P.100
Table 3: Population Growth and Average Household Size. P.102
Table 4: Average Value of Required GDP Growth. P.104
Table 5: Asset-Based Poverty, Inequality and Growth, Ghana 1997-2003 (%). P.115
Table 6: Estimates of Some Counterfactuals of Poverty Trends P.117
Table 7: Sectoral Decomposition of Changes in Poverty Over Time, Ghana 1997-2003. P.124
Table 8: Trend in Child Nutritional Indicators by Region, Ghana 1993-2003 (%). P.128
Table 9: Testing for the Appropriate Model to Analyze Child Mortality. P.176
Table 10: Determinants of Child Mortality. P.180
Table 11: Oaxaca Decomposition for Mortality Estimates. P.189
Table 12: Trends in Health Care Services. P.234
Table 13: Trends in Health-Related Services. P.237
Table 14: Trends in Inequality (GIE and CI) P.242
Table A1: Assets Poverty, Inequality and Welfare for Countries in Sample. P.279
Table A2: Relative Risk and Contribution to Overall Assets Poverty. P.284
Table A3: Required GDP Growth Needed. P.289
Table A4: Results of the PCA. P.297
Table A5: Profile of Asset Poverty P.298
Table A6: Correlates of the Logarithm of the Asset Index, Ghana 1997-2003. P.304
Table A7: Predicted Mortality Rates (x 1000). P.311
Table A8: Child Anthropological Status (Underweight) P.314
Table A9: Access to Health Care Services by Areas of Residency and Quintiles. P.320
Table A10: Access to Sanitation Infrastructures by Areas of Residency and Quintiles. P.327
Table A11: Gains in Access to Health and Sanitation Services. P.333
Table A12. Gini Income Elasticity and Concentration Index. P.334
Table A13. Marginal Gini Income Elasticity. P.338

6
LISTE DES FIGURES

Figure 1: Assets Poverty Trends in Various Parts of the World. P.75
Figure 2: Assets Poverty Trends in Central Africa. P.80
Figure 3: Assets Poverty Trends in Eastern Africa. P.80
Figure 4: Assets Poverty Trends in Northern Africa. P.81
Figure 5: Assets Poverty Trends in Southern Africa. P.81
Figure 6: Assets Poverty Trends in Western Africa. P.82
Figure 7: Monetary versus Material Poverty. P.84
Figure 8: Lorenz Curve for the Assets Index. P.89
Figure 9: Trends in Assets Inequality (Gini) in the World: 1990-2005. P.90
Figure 10: Joint Density Estimation for Poverty and Welfare. P.91
Figure 11: Trend in GDP Growth (%) in Ghana (1984-2004). P.111
Figure 12: The Migration Effect. P.118
Figure 13: Growth Incidence Curves for Assets Wellbeing, Ghana 1997-2003. P.121
Figure 14: Relation Between Child Mortality and Age of Mother. World Sample P.172
Figure 15: Non Parametric Survival Curves for SSA versus the Rest of the World. P.172
Figure 16: Health System Performance in SSA for Selected Indicators. P.192
Figure 17: Explaining the Performance of SSA Countries in Child Mortality. P.193
Figure 18: Assets Poverty versus Infant Mortality. P.205
Figure 19: GDP per Capita and GDP Growth versus Infant Mortality. P.205
Figure 20: trends in Malnutrition in SSA and the Rest of the World. P.208
Figure 21: Malnutrition and Infant Mortality Trends. P.210
Figure A1: Assets Poverty Trends in the Rest of the World. P.287
Figure A2: Stochastic Dominance Tests: Changes in Poverty Over Time. P.306
Figure A3: Non Parametric Survival Curves for Various Categories in SSA. P.316
Figure A4: Trends in Infant Mortality Rates (Kaplan-Meier Estimates). P.318
Figure A5: Trends in Under-Five Mortality Rates (Kaplan-Meier Estimates). P.319
Figure A6: Trends in Access to Sanitation Services. P.339

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LISTE DES ACRONYMES
CI Concentration Index
CWIQ Core Welfare Indicators Questionnaire
DALY Disability Adjusted Life Year
DHS Demographic and Health Survey
EDE Equally Distributed Equivalent
FA Factor Analysis
FGT Foster-Greer-Thorbecke
GDP Gross Domestic Product
GE General Entropy (inequality measure)
GLSS Ghana Living Standard Surveys
GIE Gini Income Elasticity
HDI Human Development Index
HDR Human Development Report (UND)
HIV/AIDS Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome
HR Hazard Ratio
KMO Kaiser-Meyer-Olkin
KM Kaplan and Meier
LAC Latin America Countries
MENA Middle East and North Africa
MDGs Millennium Development Goals
MGIE Marginal Gini Income Elasticity
MICS Multiple Indicators Core Surveys
NGO Non Governmental Organization
OLS Ordinary Least Squares
PCA Principal Components Analysis
PG Poverty Gap
PPP Purchase Parity Power
PRS Poverty Reduction Strategy
QALY Quality-Adjusted Life Year
RoW Rest of the World
SA South Asia
SSA Sub-Saharan Africa
SUREG Seemingly Unrelated Test
UN United Nations
UNCTAD United Nations Conference on Trade and Development
UNDP United Nations Development Programme
UNFPA United Nations Population Fund
UNICEF United Nations Children's Emergency Fund
USAID United States Agency for International Development
WDI World Development Indicators (World Bank)
WDR World Development Report (World Bank)
WFS World Fertility Surveys
WHO World Health Organization

8
AVANT-PROPOS

Disons-le tout de suite. Cette thèse fut l’une des aventures les plus pénibles mais aussi la plus
exaltante de ma vie. Mais elle m’a appris à me connaître, à connaître mes limites et les dépasser,
mes forces et faiblesses. Comme beaucoup de thèses, le début fut chaotique, plein de
changements, d’interrogations, de doutes, de questionnements, d’excitation, mais aussi de
découragement et d’abattement. Le chemin fut plein d’embûches et de sacrifices voire de
renonciations, tant au niveau personnel, professionnel et familial, que sur le plan du travail de
recherches en vue d’aboutir à sa finalisation.

Le choix sur la santé et la pauvreté en Afrique tient du fait que ce sont des problèmes cruciaux
sur le continent. Nulle part ailleurs on a vu une pauvreté aussi massive ni un état de santé aussi
dégradé. Le fait que l’économie de la santé posât conceptuellement d’énormes problèmes
constituait aussi un défi que j’ai voulu relever. Enfin, la disponibilité de nos directeurs de thèse
ainsi que l’existence au Cerdi d’une école de pensée sur l’économie de la santé furent les facteurs
qui me poussèrent dans cette étude.

Comme tout travail de recherches, elle n’est pas parfaite et les questions effleurées dans cet essai
demandent dans le futur une investigation beaucoup plus poussée. Mais elle m’a aussi permis de
mieux comprendre les questions explorées et de mesurer le chemin accompli en Afrique au Sud
du Sahara en matière de développement socio-économique, et les défis qui se posent pour
accélérer et rendre soutenable ce développement. Ces défis restent immenses, mais l’espoir est
grand de voir le sous-continent rejoindre le train du développement à l’instar des autres parties
du monde. Il en a les moyens, les ressources et les talents nécessaires.

Les résultats et recommandations de politique économique contenus dans cette thèse ne reflètent
pas nécessairement la position du Cerdi et de l’Université d’Auvergne, son administration ou son
personnel enseignant. Toute erreur contenue dans cette thèse reste évidemment l’entière
responsabilité de l’auteur.

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