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Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries? A time-series, ecological analysis of 48 countries from 1993 to 2013

Research output: Contribution to journalReview articlepeer-review

Peter Baker, Thomas Hone, Aaron Reeves, Mauricio Avendano, Christopher Millett

Original languageEnglish
Pages (from-to)249-273
Number of pages25
JournalHealth Economics, Policy and Law
Volume14
Issue number2
Early online date27 Jun 2018
DOIs
Accepted/In press8 May 2018
E-pub ahead of print27 Jun 2018
PublishedApr 2019

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Abstract

Inequalities in infant mortality rates (IMRs) are rising in some low- and middle-income countries (LMICs) and decreasing in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMRs. We estimated country-level fixed-effects panel regressions for 48 LMICs (142 country observations). Slope and Relative Indices of Inequality in IMRs (SII and RII) were calculated from Demographic and Health Surveys between 1993 and 2013. RII and SII were regressed on government expenditure (total, health and non-health) and redistribution, controlling for gross domestic product (GDP), private health expenditures, a democracy indicator, country fixed effects and time. Mean SII and RII was 39.12 and 0.69, respectively. In multivariate models, a 1 percentage point increase in total government expenditure (% of GDP) was associated with a decrease in SII of -2.468 [95% confidence intervals (CIs): -4.190, -0.746] and RII of -0.026 (95% CIs: -0.048, -0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were non-significant for GDP, government redistribution, and private health expenditure. Understanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.

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