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Inequalities in Access to Health Care in Brazil and India
Closing the Gap for the Poorest-poor
Sabu Padmadas ([email protected])
4th ESRC Research Methods Festival, St. Catherine’s College, University of Oxford, 5-8 July, 2010
ESRC Collaborative Analysis of Micro Data Resources: BRAZIL-INDIA PATHFINDER Research Project
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life expectancy at birth, 1950-2050
Source of data: calculated from the UN World Population Prospects, 2008 revision (http://esa.un.org/unpp/)
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Source: Marmot Review (2010) Fair Society, Healthy Lives http://www.ucl.ac.uk/gheg/marmotreview/Documents/finalreport
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Source: Marmot Review (2010) Fair Society, Healthy Lives http://www.ucl.ac.uk/gheg/marmotreview/Documents/finalreport
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objectives of the project Facilitate international research partnerships and networking of social scientists from Brazil, India and the UK
Analyse large-scale national survey data to address policy-oriented research problems in the area related to social inequalities and population health
Share research experiences and build capacity in quantitative analysis of health and demographic data from household surveys
Produce joint academic research outputs and disseminate findings at international conferences
Identify priority research areas and strengthen the research consortium by developing joint research proposals.
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research Team: UK partners
Sabu Padmadas, Andrew Channon, Fiifi Amoako Johnson, Zoe Matthews, Maria Evandrou, Jane Falkingham
Saseendran Pallikadavath Tiziana Leone
Expertise: Reproductive and child health, Family planning, Health care systems, Health inequalities, Epidemiology, Poverty, Ageing, Spatial analysis, Survey data analysis, Demographic & Health Surveys
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research Team: Brazil
André Junqueira Caetano, Eduardo L.G. Rios-Neto, Carla Jorge Machado, Ernesto F. L. Amaral, Monica Viegas & Kenya Noronha
Expertise: Reproductive and child Health, Family planning, Economic demography, Health Economics, Epidemiology, Policy evaluation, Health care systems, Health inequalities Infectious diseases, Poverty, Ageing, Demographic & Health Surveys
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research Team: India
KS James, Lekha Subaiya
Dilip TR (currently based in Abhishek Singh Family Health International-New
Delhi), US Mishra
Expertise: Reproductive and child Health, Health inequalities, Economic demography, Health care systems, Health inequalities, Morbidity, Poverty, Ageing, Demographic & Health Surveys, National Sample Surveys
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Brazil-India: the case for comparison
steady economic growth, increase in per-capita income working age population and demographic dividend extreme inequalities (wealth, health, education) growing urban poverty, rich-poor gap widening rise of middle-class (crushed in-between rich-poor) increased desire for small families and FP use patterns differential health systems & policies, common health
goals
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research questions (1) What are the assessment criteria to measure and quantify inequalities in health care access in Brazil and India?
What is the extent of inequalities in access to health care and how do these vary over time and within (intra) and across (inter) wealth and expenditure classes and by geographical location of residence?
What are the individual, household and community barriers to health care access and how these differ between Brazil and India?
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research questions (2) How do individual, household and community attributes interact and mediate the relationship between household wealth and health care access?
What is the extent of heterogeneity in health care access at the community level?
To what extent do differences in inequalities in access to health care between Brazil and India reflect differences in health care system functioning and policies and whether they have narrowed or widened the gap between the rich and the poor?
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conceptual framework
Life course component of health care, focusing on three population sub-groupsChildren below 5 years, women in the reproductive age range (15-49) and older women aged 60+
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Timeline & Outputs
12 months (April 2010 – March 2011)
Three sets of research workshops with specific research agenda incl academic papers (under progress), research proposals and capacity building activities: June 2010 (Belo Horizonte), Jan 2011 (Bangalore) & Mar 2011 (Southampton).
Dissemination: national and international conferences, project website, fact sheets, peer-reviewed joint publications
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Brazil workshop, 28 June – 2 July, 2010
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PAPER 1 (Leone et al)
Health systems and inequalities in India and Brazil: How do they cope?
PAPER 2 (Caetano et al)
Social inequality, health care delivery system and family planning in Brazil and India: drugstore, hospital or public policy (an APC-hierarchical approach)?
PAPER 3 (Amaral et al)
Quantifying child health care inequalities in poor settings: the case of India and Brazil
Identified 6 key comparative analyses
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PAPER 4 (Channon et al)
Use of inpatient health care for the elderly in Brazil and India
PAPER 5 (Padmadas et al)
Inequalities in access to modern contraception in India and Brazil
PAPER 6 (Pallikadavath et al)
Access to reproductive health care services among the poorest-poor in India- a multilevel modelling in India and Brazil
+ stand alone country specific papers
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Micro data resources used BrazilPesquisa Nacional de Demografia e Saúde (PNDS), 1986, 1991, 1996National Household Sample Survey (PNAD), 1998, 2003, 2008Avaliação de Impacto do Programa Bolsa Família (AIBF), 2005Pesquisa de Orçamentos Familiares (POF), 2002-03, 2007-08Sistema de Informações sobre Mortalidade (SIM), several, ongoingSistema de Informações de Nascimentos (SINASC), several, ongoingSistema de Informações Hospitalares (SIH), several, ongoingSistema de Informações do Atendimento Básico (SIAB), several, ongoing
IndiaNational Family Health Survey (NFHS), 1992-93, 1998-99, 2005-06
National Sample Survey Organization (NSSO), 1986-87, 1995-96, 2004-05
Reproductive and Child Health Surveys (DLHS), 1998-99, 2002-04, 2006-07
WHO Study on Global Ageing and Adult Health (SAGE), 2003, 2007
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Administrative units (spatial level)
Brazil Índia
5507 Municipalities Village/Ward/Town
558 Micro regions 640 Districts
137 Meso regions
27 States 31 States
5 Major regions 6 Major Regions
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Analysis of the 2005/06 National Family Health Surveys, India (analyses under progress, Padmadas et al.)
ratio (richest-fifth over poorest-fifth)Current contraceptive use among women aged 25 years or above who have 2 or more children
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Analysis of the 2007/08 District Level Household Survey (analyses under progress, Pallikadavath et al.)
odds ratio of antenatal care uptake
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Analysis of the 2005/06 National Family Health Surveys, India
social ladder and targeted interventionsDistribution of women by caste and household wealth in India
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acknowledgments
ESRC/Pathfinder Scheme (Grant Reference: RES-238-25-0009) Project team members from Brazil, India & the UK
Thank you very much