Inequalities in health and health-related indicators: a spatial geographic analysis of Pakistan
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RESEARCH ARTICLE
Open Access
Inequalities in health and health-related indicators: a spatial geographic analysis of Pakistan Sami Ullah Khan*
and Ijaz Hussain
Abstract Background: In developing countries, Pakistan is one of the countries where access to health and health-related indicators is a major concern. Their improvement would reduce inequalities among various Communities/Districts or groups of Communities. A Community health index (CHI) in this regard is estimated to explore inequality ratio, inequality slope, and spatial analysis of inequalities among all Communities at regional and geographical levels. Methods: Data from Pakistan Social and Living Standard Measurement (PSLM) survey, Round-VI, 2014–15 were used to construct CHI. The index was constructed in two steps. In the first step, the study indicators were standardized while in the second step, the standardized indicators were aggregated into a single metric by applying non-linear Geometric Mean formula. Results: The inequality ratio of 16.59 estimated for Pakistan was found to be higher than the ratio of Atlanta city, GA (5.92), whereas, a lower slope coefficient was estimated for Pakistan than Atlanta city, GA (0.38 < 0.54). This ratio of disparity was also found to be lower for urban regions as compared to rural (7.78 < 17.54). While the slope coefficient was slightly higher for urban regions (0.45 > 0.43). The results of the spatial analysis revealed different patterns of inequalities. A cluster of healthy districts was found in Punjab province, whereas districts from Baluchistan had made a bunch of deprived/unhealthy districts in terms of CHI scores. Besides, separate maps for all provinces showed that capital districts of all provinces were relatively well-off/developed. Conclusion: The instant results concluded that inequalities in access to health and health-related indicators exist across countries as well as across geographical regions. To reduce or eradicate these inequalities, government and public health workers are recommended to set priorities based on access to composite index. Keywords: Community health, Human development index, Disparities, Socioeconomic indicators, Spatial analysis, Pakistan
Background Improvement towards equitable access to health and health-related determinants is a global concern and fundamental to the advancement of Sustainable Development Goals (SDGs) [1]. Access to health-related social indicators is one of the major subjects playing a pivotal role in the determination of economic growth [2, 3]. On * Correspondence: [email protected] Department of Economics, Gomal University, Dera Ismail Khan, Pakistan
the other hand, rapid urbanization and a growing population have threatened people’s accessibility to health and the environment. About 400 million people have no access to basic health facilities and nearly 7 million people die each year due to air pollution mostly in low and middle-income countries [4, 5]. Likewise, more than 15 million people living with HIV have no access to treatment, and it is e
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