Visualizing Health Disparities: Data Insights
Part 5 of the Speak Out Series: A Visual Journey into Health Disparities in LMICs and Under-5 Mortality
Table of contents
∘ Introduction: The Importance of Healthcare Access and Wealth Disparities
∘ Unraveling the Impact: Wealth Disparities Explored
∘ Beyond Price Tags: Exploring Spending and Mortality Rates
∘ Delving Deeper: Uncovering Patterns and Exceptions
∘ Out-of-Pocket Expenditure: A Critical Factor
∘ Assessing Universal Health Coverage
∘ Lessons from Bangladesh: A Success Story
∘ Debunking the Myth: The Role of Money in Healthcare
∘ Empowering Change: The Path to Equitable Care
∘ Tableau Interactive Dashboard
∘ Data Sources and MethodologyIntroduction: The Importance of Healthcare Access and Wealth Disparities
Access to healthcare is a significant issue in many developing countries, where most healthcare facilities are privately run and out-of-pocket spending is the norm. Wealth disparity exacerbates this problem, with a common belief that more expensive private care equals better quality healthcare. I, too, held this assumption until I encountered a thought-provoking chart presented by Sir Michael Marmot during the launch of the “Build Back Fairer: Achieving Health Equity in the Eastern Mediterranean Region” (2021) report by the WHO EMRO Commission on the Social Determinants of Health, an initiative I was closely involved with during my tenure at EMRO.
The chart (below) suggested that wealth quintiles significantly impact under-5 mortality rates within a country, with the under-5 mortality rate (per 1000 live births) often used as an indicator of accessibility and quality of health services. This section of the report, under “Inequities in Life Expectancy and Health Within Countries,” highlighted that the wealthiest quintile typically has the lowest infant mortality rate, except in Jordan and Pakistan. Furthermore, the chart underscored that disparities exist not only within countries but also between them.
Unraveling the Impact: Wealth Disparities Explored
I approached the report’s chart with initial skepticism, given that the countries compared had little in common other than their location in the Eastern Mediterranean Region. To ensure a more meaningful comparison, I decided to conduct further investigation. I focused on five lower-middle-income countries (LMICs) with comparable population sizes and economic growth: Bangladesh, Egypt, Indonesia, Nigeria, and Pakistan. Recreating the chart with the same indicator, I meticulously collected and interpreted the data using my data analysis and visualization skills in Tableau.
This recreated chart echoed the original, revealing significant wealth disparities within each country. However, what intrigued me most was the astonishing effects of wealth disparities on under-5 mortality rates among these five countries. For instance, the poorest quintile in Egypt exhibited lower mortality rates than the richest quintile in Pakistan. This suggests that even affluent individuals in Pakistan receive subpar services despite their ability to afford substantial healthcare spending. Can money alone not guarantee the best care?
Beyond Price Tags: Exploring Spending and Mortality Rates
To explore further, I investigated the countries’ health expenditures per capita. Perhaps countries that allocate more resources to healthcare achieve better outcomes. Here is what I found:
It is logical to observe that Egypt, which spends significantly more than Pakistan, has a relatively lower under-5 mortality rate. However, upon closer examination, I discovered that Bangladesh, despite its lower spending, managed to maintain lower mortality rates compared to Nigeria and Pakistan. How? I should explore other factors that might contribute to these differences.
Delving Deeper: Uncovering Patterns and Exceptions
Diving deeper, I explored the Gross National Income (GNI) per capita (PPP) as a possible explanation for these discrepancies. This measure takes into account the differences in purchasing power across countries, allowing for a more accurate comparison of income levels between countries. Using a bubble chart, I correlated GNI per capita with population size and under-5 mortality rate (represented by bubble size).
While I understand that correlation does not imply causation, one cannot overlook the tendency for countries with higher GNI per capita to allocate more resources and capacity towards healthcare, leading to higher levels of health expenditure per capita. In this context, both Egypt and Indonesia, despite varying population sizes, exhibited the highest health expenditure per capita and lower under-5 mortality rates. But Bangladesh, again, emerged as an exception to this trend.
Out-of-Pocket Expenditure: A Critical Factor
It is also well-known that out-of-pocket expenditure per capita remains considerably high in LMICs. To investigate this further, I analyzed the trend in out-of-pocket expenditure per capita across the five countries over ten years. Interestingly, except for Indonesia (31% in 2020), all countries demonstrated high out-of-pocket spending (ranging from 55%-75% of current health expenditure) in the same year.
Assessing Universal Health Coverage
This leads us to question why these countries, despite relying on out-of-pocket spending, exhibit drastic variations in under-5 mortality rates across different wealth quintiles. Does this reflect disparities in the quality of care provided, or does it stem from differences in health service coverage? While I cannot give a definitive answer regarding care quality due to data limitations, I explored the Universal Health Coverage (UHC) service coverage index and each country’s progress over time (highlighting their lowest and highest %). This index primarily measures the extent to which essential health services are covered and accessed by the population, including both public and private sectors.
These charts show that even though Egypt has impressively performed well compared to others, it is Bangladesh that has made the most progress in providing essential care to its population over the last 21 years.
Lessons from Bangladesh: A Success Story
This brings us back to the dual-axis chart showing that even though Bangladesh spent way less as compared to Egypt and Indonesia on health, it has succeeded in maintaining lower under-5 mortality rates. The country’s success can be attributed to its proactive implementation of evidence-based interventions and effective strategies. Bangladesh serves as a valuable model for other countries striving to achieve similar achievements in reducing under-five mortality rates.
Debunking the Myth: The Role of Money in Healthcare
This analysis effectively dispels the myth that money alone guarantees access to better healthcare. The pursuit of Universal Health Coverage goes beyond enabling access for the poor; it is about achieving health equity that benefits everyone. It is high time for individuals, irrespective of their income status, to rally together and advocate for equitable and accessible healthcare for all within their respective countries.
Empowering Change: The Path to Equitable Care
In conclusion, the data presented suggests that while LMICs face significant challenges in providing adequate healthcare to their populations, there are lessons to be learned from countries such as Indonesia and Bangladesh. By reducing out-of-pocket expenses and prioritizing universal health coverage, LMICs can make significant progress in improving healthcare access and reducing under-5 mortality rates. Let’s hope that other countries will follow their lead and prioritize accessible and equitable healthcare for all.
Tableau Interactive Dashboard
I have compiled all this information into an interactive dashboard on Tableau. Feel free to delve deeper into the data: Uncovering Health Disparities and Progress: LMICs Comparative Dashboard.
Data Sources and Methodology
Data Sources:
- Under-5 mortality rate*: WHO Health Equity Assessment Toolkit (HEAT).
- Population, GNI per capita (PPP), Current health expenditure per capita, OOP expenditure per capita: World Bank Open Data
- Universal health coverage (UHC) service coverage index: UN SDG Indicators Database
*It’s important to note that the overall U5MR values, used as the setting average, and those for wealth quintiles were derived from the same source, ensuring consistency in the dataset. This approach allows for a comprehensive examination of health inequalities based on economic status.
The under-5 mortality rate refers to the probability a newborn would die before reaching exactly 5 years of age, expressed per 1,000 live births. Apart from being a child survival indicator, it also reflects the social, economic, and environmental conditions in which children (and others in society) live, including their healthcare.
Reason for Choosing PPP (Intl$): Purchasing Power Parity (PPP) is used to compare economic productivity and standards of living between countries. It accounts for the relative cost of living and inflation rates, allowing for a more accurate comparison of income and expenditure levels across different countries.
