The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/0144-3585.htm
JES
42,1
34
Received 11 October 2013
Revised 8 May 2014
Accepted 25 June 2014
Journal of Economic Studies
Vol. 42 No. 1, 2015
pp. 34-53
Emerald Group Publishing Limited
0144-3585
DOI 10.1108/JES-10-2013-0151
SPECIAL ISSUE PAPER
On inequality in health and
pro-poor development: the case
of Southeast Asia
Jacques Silber
Department of Economics, Bar-Ilan University, Ramat-Gan,
Israel and CEPS/INSTEAD, Esch-sur-Alzette, Luxembourg
Abstract
Purpose – The purpose of this paper is to aim at taking a closer look at the decline in the inequality of
the distribution of four health variables, infant and child mortality, child stunting and underweight,
that took place in various Southeast Asian countries during the past 25 years. More specifically its goal
is to check the extent to which this decline in health inequality, as well as the overall reduction in infant
and child mortality, in child stunting and underweight, affected the poorest wealth quintile of the
population of these countries.
Design/methodology/approach – In the first part of the paper the author presents a systematic
comparison of the values taken by various consistent measures of the inequality of health attainments
and shortfalls for several countries in Southeast Asia and for four health indicators: infant mortality,
child mortality, child stunting and underweight. The second part of the paper uses the concept
of Shapley decomposition to determine the respective impacts of the decrease in the average value of
these health variables and in the inequality of their distribution on the reduction observed for each
of these variables in the lowest wealth quintile.
Findings – During the period examined there was an important decline infant and child mortality as well
as in child stunting and underweight in all countries of Southeast Asia for which data were available.
As far as the poorest wealth quintile is concerned this decline was mostly the consequence of the overall
decline in these health variables rather than to the reduction of the inequality of their distribution.
Research limitations/implications – Data were available for only four health variables and for
many countries data were available for only one period.
Practical implications – A decline in health inequality should be considered as an important aspect
of poverty reduction.
Social implications – Development should not be limited to its economic components. A broader
view of development is indispensable.
Originality/value – This study is probably one of the first ones to provide the reader with data on the
reduction in health inequality in Southeast Asia as well as on the impact of this decline on the poorest
wealth quintile.
© Asian Development Bank. The views expressed in this publication are those of the authors and
do not necessarily reflect the views and policies or the Asian Development Bank (ADB) or its Board
of Governors or the governments they represent. ADB does not guarantee the accuracy of the data
included in this publication and accepts no responsibility for any consequence of their use. By
making any designation of or reference to a particular territory or geographic areas, or by using the
term “country” in this document, ADB does not intend to make any judgments as to the legal or
other status of any territory or area.
JEL Classification — D63, I19
This paper is an extension of the first part of a presentation I gave at the ADB workshop on
“Poverty Reduction in Asia: Drivers, Best Practices and Policy Initiatives” held at Sogang University,
Seoul, South Korea, on August 23-24, 2013. The author would like to thank the discussant, Satya
Chakravarty, and other participants to this workshop for their very helpful comments.
 On inequality
Keywords Health, Southeast Asia, Attainment, Child stunting, Infant mortality, Shortfall
Paper type Research paper in health and
1. Introduction
pro-poor
“The poor suffer worse health and die younger. They have higher than average child development
and maternal mortality, higher levels of disease, and more limited access to health care
and social protection. And gender inequality disadvantages further the health of poor 35
women and girls.” This citation is from a report (OECD-WHO, 2003) prepared jointly by
the OECD and the WHO on the link between poverty and health. This report
emphasizes in particular the fact that health should be considered as an asset so that
when poor people are sick, the lost income and the impossibility of affording the cost of
health care are likely to trap the poor in a situation where they become definitively
unable to ever leave the status of poor. This is so because the lack of good health
prevents them from investing in education and thus improving their labor productivity.
It becomes then clear that the goal of poverty reduction cannot be reached if inequality
in health is not reduced.
Policy makers seem in fact to have hesitated between emphasizing the importance of
improving the health of the poor and stressing the need to reduce health inequalities.
As mentioned by Gwatkin (2000), the 1978 Declaration of Alma-Ata on one side
stressed its concern for the unacceptable health conditions found among the hundreds
of millions among the world’s poor, on the other side was also in favor of encouraging
primary health care because of its potential to close the gap between the “haves” and
the “have-nots.” Similarly the World Health Report 1995 (WHO, 1995), while including a
lot of material on the health of the poor, was subtitled “Bridging the gaps.”
It is imperative to understand that such health inequality may already be observed in
the early stages of the life cycle. Minujin and Delamonica (2003), for example, analyzing
the Demographic and Health Surveys (DHS) of 24 developing countries, found that the
under the age of five mortality of the bottom quintile of the distribution of wealth was, on
average, 2.2 times higher than that of the household wealthiest quintile, the range of
variation going from 1.3 to 4.7. The reduction in the average under five mortality rates,
which was observed during the 1980s and 1990s, was hence the consequence of a
reduction of this mortality in the middle and top wealth quintiles. In the study of Minujin
and Delamonica (2003) household wealth was estimated via an “asset index” based on the
presence in the household of certain durable goods (such as a radio, a television or a
bicycle), the quality of the dwelling (e.g. roof and floor materials) and access to different
types of water and sanitation. To construct this index the authors followed the procedure
described in Filmer and Pritchett (1998) and Gwatkin et al. (1999). Such an approach is
quite simple and leads to less measurement errors since the components of such an asset
index are directly observed by the interviewer.
Another important fact is that although there is generally a significant gap between
the levels of health in urban and rural areas, the urban advantage in health, as
emphasized by Fotso (2006), in an analysis of the DHS of 15 countries in sub-Saharan
Africa, masks great disparities between the poor and non-poor within urban areas.
Given these important wealth-related health differences, one may wonder why they
exist and persist and, in particular, why poor children die earlier. Victora et al. (2003)
offer several explanations. Their narrative is as follows: in contrast to children who
grow up in better-off families, children in poor families have a higher risk of being
exposed to diseases because of deficient water and sanitation infrastructure, indoor air
pollution and poor housing conditions. Suffering from malnutrition, these children are
JES also likely to be less resistant to infectious diseases and to have a low weight at birth,
42,1 because of maternal malnutrition, infections during pregnancy and short birth intervals.
Preventive measures such as vaccination, vitamin supplementation and insecticide-treated
mosquito nets rather than being more common are in fact less prevalent among poor
households. Sick, poor children are less likely to be taken care of by health care providers,
and even when they are, the latter are probably less well trained than those attending
36 children of better off families.
The link between income and health status observed among adults has hence
antecedents in childhood, and this is also true in developed countries, as stressed
by Case et al. (2002). It is quite clear that the health of children in families of low
socio-economic status erodes faster with age and that these children start adulthood
with a much poorer health and much lower probability of succeeding financially.
One of the main goals of the present study is indeed to take another look at the
relationship between socio-economic status and child health and this paper makes several
contributions to the literature. First its focus is on the measurement of the inequality of
achievements and shortfalls, that is, of variables that have a lower and an upper bound.
The idea is that when a health variable such as, for example, infant mortality, is
bounded, health inequality may be measured via attainment or shortfalls. Infant mortality,
for example, is a shortfall, since it gives the percentage of children that do not survive
beyond age one. The corresponding attainment would refer to the percentage of children
surviving beyond the age of one. However, traditional measures of inequality, such as the
Gini or Atkinson indices, will generally have different values when the variable under
scrutiny is an attainment or a shortfall. Moreover, when comparing inequality in several
countries, the ranking of these countries may be quite different when the inequality
index is derived from an attainment and a shortfall measure. Several papers have
therefore proposed, in the case of bounded variables, indices that give identical results
for the inequality in attainments and shortfalls or at least guarantee that the order of
the units of observations (e.g. countries) will be identical, whether one works with the
notion of attainment or shortfall. Though not proposing new measures of shortfall or
achievement inequality, the empirical section of the paper makes, however, a systematic
comparison of six different indicators of achievement and shortfall inequality that have
appeared in the literature.
Second only two empirical illustrations appeared hitherto on the topic. Both analyzed
British data: regional British infant mortality rates (IMRs) in the paper by Erreygers (2009)
and a psychological measure of mental stress taken from the British Household Panel
Survey (BHPS) in the recent study of Chakravarty et al. (2013). The present paper on the
contrary examines four child health variables: infant and child mortality, child stunting
and underweight. In addition it concentrates its attention on a geographical area and
period for which studies of the link between wealth and health are rather scarce: Southeast
Asia in the 1990s and the first decade of the twenty-first century.
Third, assuming, for example, that there was, during a given period, a decrease in
the average level of infant mortality and a change in the inequality of its distribution,
this paper, using the concept of Shapley decomposition, estimates the respective
impacts of the overall reduction in infant mortality and of the change in its inequality
on the poorest wealth quintile of the population of various Asian countries. A similar
decomposition is applied to child mortality, child stunting and child underweight.
Such a breakdown has evidently important policy implications. Assuming the welfare
of the poor strata of the population is a concern for policy makers, they may wonder
whether the lot of the poor will not improve automatically when there is an overall
improvement in the health of the country (e.g. decline in average infant mortality or child On inequality
stunting) or whether a prerequisite for an increase in the well-being of the poor is a in health and
reduction in the socio-economic gaps in health.
The paper is therefore organized as follows. Section 2 reviews the literature on the
pro-poor
measurement of the inequality bounded variables and lists the indices which have been development
proposed and give consistent results for the inequality in attainments and shortfalls.
Section 3 then presents estimates of the inequality in health attainments and shortfalls in 37
different countries in Southeast Asia. Using the concept of Shapley decomposition, Section
4 shows how it is possible to determine the respective impacts of the decrease
in the average value of these health variables and of the change in the inequality of their
distribution on the reduction observed for each of these variables in the lowest wealth
quintile. This breakdown is then applied in Section 5 to data covering various Southeast
Asian countries during the past 25 years. Concluding comments are given in Section 6.

2. On inequality in attainments vs inequality in shortfalls

Many health attainment indicators such as the IMR have bounded values, that is, they
have a minimal value of 0 and a maximal value of 100 or 1,000, for example. Assume
now that we have data on infant mortality for various population subgroups (rural vs
urban areas, educational categories or wealth quintiles) and that we want to measure
the inter-group inequality in mortality. We can first compute an index of the inequality of
“shortfalls,” in our case an index of the inter-group inequality in the IMRs: infant mortality
is indeed a “shortfall” variable since it measures which percent (or per thousand) of
individuals to not survive until the age of one. But we can also measure the inequality
of “attainments,” that is, an index measuring the degree of inequality of the percentage
(or pro mil) of individuals who survive beyond the age of one. It should, however, be clear
that most inequality indices will have a different value in the case where the computation
is based on “shortfalls” and in that where it is derived from “attainments.”
Table I gives a very simple illustration of this issue. Assume that in each of three
countries A, B and C the individuals are classified by increasing socio-economic status
and the population is then divided in three groups of equal size, the groups of low-,
middle- and high-economic status. For each country Table I gives first the IMR, a
shortfall and then the corresponding attainment, that is, the probability (in pro mil) of
surviving until the age of one. A very simple measure of inequality is selected, the ratio
of the highest to the lowest value of the variable (whether shortfall or attainment).
Table I shows then clearly first that the measures of inequality are different when
based on attainments and when derived from shortfalls. Table I also indicates that, if
we classify the countries from the highest to the lowest value of the measure of inequality

Group of low Group of middle Group of high Ratio of the highest to

socio-economic socio-economic socio-economic the lowest value of the
Country Variable status status status variable

A Shortfall 10 20 70 7/1 ¼ 7
A Attainment 990 980 930 990/930 ¼ 1.065 Table I.
B Shortfall 20 50 90 90/20 ¼ 4.5 Inequality in
B Attainment 980 950 910 980/910 ¼ 1.077 attainments vs
C Shortfall 30 50 60 60/30 ¼ 2 inequality in
C Attainment 970 950 940 970/940 ¼ 1.031 shortfalls
JES in shortfalls that has been selected, the order is A, B, C. If, on the contrary, we classify the
42,1 countries by decreasing values of the inequality in attainments, the order is B, A, C.
In other words measuring the inequality in shortfalls gives a ranking which is different
from those obtained when measuring the inequality in attainments.
Various solutions have been proposed in recent years in the literature to overcome
such a difficulty. Erreygers (2009) was probably the first to suggest a solution.
38 He defined two indices, which are extensions of the Gini index and of the coefficient
variation and which will take the same value whether the computations are based on
shortfalls or attainments.
Let Bmax and Bmin be the upper and lower bound of the attainments and Emax and
Emin the upper and lower bounds of the shortfalls. Note that Emin ¼ 0 and Emax ¼
Bmax − Bmin so that Bmax − Bmin ¼ Emax − Emin.
The first index derived by Erreygers, which is derived from the Gini index, is
defined as:
8 X n
F G ðsÞ ¼ 2 v i si (1)
ðn ÞðE max E min Þ i¼1

where si ¼ Bmax − xi is the shortfall of individual i, xi being the attainment of individual

i and vi is defined as:
nþ1
vi ¼  þi (2)
2
where i is the rank of the individual in the attainments, the individuals being classified
by decreasing attainment level.
The second index proposed by Erreygers (2009), which is related to the coefficient of
variation, is defined as:
sffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
Pn 2
2 i¼1 ðsi sÞ
F CV ðsÞ ¼ (3)
ðE max E min Þ n
where s is the average shortfall.
Note that both indices, FG(s) and FCV (s), were derived axiomatically on the basis of a
certain number of desirable properties that such indices should have.
Whereas Erreygers (2009) aimed at deriving measures that would give an identical
level of inequality, whether the variable is measured as attainment or shortfall, Lambert
and Zheng (2010) took, however, a less strict approach to this issue of consistency between
results based on attainments and those derived from shortfalls. They only required that if,
say, country A is found to be less unequal than country B, when working with attainment
data, the same conclusion should be drawn when using shortfall data. But the two
measures of inequality need not be identical. The authors then show that, if consistency is
defined in such a way, no index of intermediate or relative inequality measures attainment
inequality and shortfall inequality consistently. For indices of absolute inequality, the
partial orderings of social states by attainment inequality and by shortfall inequality are,
however, similar. Lambert and Zheng (2010) characterize then two classes of absolute
inequality measures for which attainment and shortfall inequality are measured
consistently: the absolute Gini index and the variance.
Lasso de la Vega and Aristondo (2012) went one step further in that they looked for
inequality indicators that would be bound consistent, that is, would lead to the same
orderings regardless of the bounds. They suggested taking a generalized mean of the On inequality
two indices, that measuring inequality in attainments and that assessing inequality in in health and
shortfalls. Such an indicator turns out to measure equally the attainment and the
shortfall inequality. Moreover some of the properties enjoyed by the original index are
pro-poor
inherited by such a transformation. The authors then derived ratio scale as well as development
translation invariant measures of inequality. They also identified a decomposable
inequality index. Finally they characterized a family of decomposable indices which 39
measures shortfall inequality bound consistently.
The index derived by Lasso de la Vega and Aristondo (2012) is defined as:
 1
I ðxÞr þ I ðBmax 1  xÞr ðrÞ
I r ðx; Bmax Þ ¼ for r a 0 (4)
2

I r ðx; Bmax Þ ¼ ðI ðxÞI ðBmax 1  xÞÞð2Þ

1
for r ¼ 0: (5)
where I(x) is measure of the inequality of attainments, I(Bmax1 − x) being the
corresponding measure of the inequality of shortfalls. In the empirical section we chose
the Gini index as inequality index and a value of r equal to 0.5.
A desirable property of an inequality index (see, Shorrocks, 1980) is that it should be
decomposable into the sum of a between- and a within-group components. The between-
group component is defined as the inequality level of a hypothetical distribution in which
each person’s distribution values are replaced by the mean of their subgroup. The within-
group component is a weighted sum of the subgroup inequality levels. One implication of
this decomposability property is the subgroup consistency property (see, Shorrocks,
1984) which requires that if inequality in one group increases, overall inequality should
also increase. Lasso de la Vega and Aristondo (2012) looked therefore also for indices that
would be both bound consistent and decomposable.
Though emphasizing also the importance of the decomposability property,
Chakravarty et al. (2013) took, however, a different approach because they adopted
Ebert’s (2010) definition of between groups inequality which is depends on pairwise
comparisons of incomes. These authors derived then axiomatically three indices which
each give identical results, whether one looks at the inequality of attainments or at that
of shortfalls. The first one was called by them the Atkinson consistent inequality index,
the second one the Kolm consistent inequality index and the third one the normalized
Theil consistent mean logarithmic deviation index.
The Atkinson consistent inequality index is defined as:
 X !ð1Þ
1 n X n  r r
xi xj 
AðxÞ ¼ (6)
n2 i¼1 j¼1

In the empirical section we assumed that r was equal to 2.

The Kolm consistent inequality index is defined as:
   X !
n X n
1 1 yjxi xj j
K ðxÞ ¼ log e (7)
y n2 i¼1 j¼1

In the empirical section of this paper we assumed that θ was equal to 2.

JES Finally the normalized Theil consistent mean logarithmic deviation index is
42,1 defined as:
 Pn Pn 
T ðxÞ ¼ eð Þ i¼1 j¼1 ð j i j jÞ  1
1=n2 log 1 þ x x
(8)

40
3. An empirical illustration: inequality in attainments and shortfalls for
various indicators of health performance in Southeast Asia
Table II gives an empirical illustration covering the countries from Southeast Asia and
some years for which data were available and shows the values of six consistent
indices of inequality in attainments (shortfalls) derived from data on infant mortality.
Table AI in the Appendix presents similar results for the inequality of the distribution
of child mortality.
It is easy to observe that in those countries for which data were available
for more than one year there was a decrease in both the IMR observed at the
national level and the degree of inequality observed on the basis of data collected
at the level of wealth quintiles. The decrease in national IMRs was particularly
strong in Bangladesh, Cambodia and Nepal whereas the reduction in the wealth-
related inequality in infant mortality was important in Bangladesh, Indonesia
and Nepal.
In Table III we computed the correlation coefficients between the different indices
which consistently measure inequality in infant mortality. These coefficients are
usually very high. The only index which has a much lower correlation coefficient with
other indices is that proposed by Aristondo and Lasso de la Vega (2012).
Table IV gives the values of various indices of inequality of attainments
(shortfalls) as far as child stunting is concerned. The number of countries for which
such data were available for more than one period was quite limited but for those
three countries (Bangladesh, Cambodia and Nepal) for which such data were
available we observe that there was a decrease in the overall (at the national level)
percentage of children less than five years old who are stunted. The picture is,
however, quite different for inequality in child stunting since it barely varied in
Bangladesh but increased in Cambodia and Nepal during the first decade of the
twenty-first century. These results confirm the findings of Ikeda et al. (2013) who
wrote, in their study of child stunting in Cambodia, that “substantial economic
disparity between households was observed: a large fraction of households ranked
low on the nationwide wealth scale. Equitable economic growth is needed to attain
sustained reductions in the prevalence of child stunting in Cambodia.” For Nepal the
explanation may be more complex. Sah (2004) wrote that “under the family
attributes, the ethnicity shows slight effect, the economic status of household no
effect and mother’s education status prominent effects on nutritional status of
children under age three.” Since the socio-economic variable available in the DHS is
a wealth index derived via principal component analysis and not directly related to
income, there is probably no contradiction between Sah’s findings and those of the
present paper.
Table AII shows that the conclusions are the same concerning child underweight
and the inequality of this aspect of malnutrition among wealth quintiles.
The correlation coefficients between the indices measuring inequality in the extent
of child stunting as well as child underweight are usually also quite high[1].
 Erreygers’s Lasso de la Atkinson consistent Kolm consistent
Overall index Vega and inequality index inequality index Normalized Theil consistent
infant Erreygers’s (coefficient of Aristondo (Chakravarty et al., (Chakravarty et al., mean logarithmic deviation
Country Year mortality index (Gini) variation) Index IR 2013) 2013) index (Chakravarty et al., 2013)

Bangladesh 1993 97.46 0.0375 0.0344 0.0424 24.33 45.84 9.217

2007 55.54 0.0264 0.0248 0.0459 17.54 30.01 6.745
Cambodia 2000 89.04 0.0449 0.0434 0.0543 30.66 58.61 9.289
2010 53.78 0.0449 0.0406 0.0801 28.73 52.94 11.85
India 1998 69.4 0.0454 0.0408 0.0663 28.85 57.04 12
2005 61.36 0.0377 0.0339 0.0605 23.94 46.54 10.52
Indonesia 1997 49.82 0.0406 0.0364 0.0770 25.75 53.44 11.23
2007 38.02 0.0249 0.0229 0.0589 16.2 28.64 6.993
Maldives 2009 22.34 0.0089 0.0080 0.0330 5.638 10.24 3.09
Nepal 1996 90.56 0.0337 0.0311 0.0403 22.02 41.54 9.09
2011 51.52 0.0188 0.0199 0.0347 14.03 27.04 4.352
Pakistan 2006 74.9 0.0330 0.0294 0.0454 20.79 39.94 9.47
Philippines 1998 33.32 0.0225 0.0201 0.0594 14.2 26.44 6.861
2008 26.26 0.0184 0.0168 0.0593 11.89 24.14 5.499
Timor
Leste 2009 55.98 0.0212 0.0203 0.0365 14.32 28.54 5.975
Vietnam 1997 33.18 0.0218 0.0200 0.0577 14.11 25.09 6.013
2002 23.2 0.0204 0.0190 0.0733 13.45 24.36 5.832
Notes: aInfant mortality refers to mortality before the age of one, that is, to the probability of dying between birth and the age of 1 per 1,000 live births.
The various inequality indices are defined in Section 2
Source: WHO Health Equity Monitor
development
On inequality

pro-poor

quintiles inequality
mortality and
in health and

41

between wealth
Overall infant
Table II.

in infant mortalitya
 42
JES
42,1

Table III.

infant mortality
the inequality of
Correlation matrix
between measures of
Erreygers’s Lasso de la Atkinson consistent Kolm consistent
index Vega and inequality index inequality index Normalized Theil consistent
Erreygers’s (coefficient of Aristondo (Chakravarty et al., (Chakravarty et al., mean logarithmic deviation
index (Gini) variation) Index IR 2013) 2013) index (Chakravarty et al., 2013)

Erreygers’s index (Gini) 1 0.9952 0.4674 0.9953 0.9893 0.9606

Erreygers’s index (coefficient
of variation) 0.9952 1 0.4283 1 0.9921 0.9314
Lasso de la Vega and
Aristondo index IR 0.4674 0.4283 1 0.4293 0.4315 0.5504
Atkinson consistent inequality
index (Chakravarty et al., 2013) 0.9953 1 0.4293 1 0.9921 0.9318
Kolm consistent inequality
index (Chakravarty et al., 2013) 0.9893 0.9921 0.4315 0.9921 1 0.9354
Normalized Theil consistent
mean logarithmic deviation
index (Chakravarty et al., 2013) 0.9606 0.9314 0.5504 0.9318 0.9354 1
 Percentage of Erreygers’s Lasso de la Atkinson consistent Kolm consistent Normalized Theil consistent
children who are index Vega and inequality index inequality index mean logarithmic deviation
stunted at the Erreygers’s (coefficient of Aristondo (Chakravarty et al., (Chakravarty et al., index (Chakravarty et al.,
Country Year national level index (Gini) variation Index IR 2013) 2013) 2013)

Bangladesh 1996 58.98 0.2045 0.2003 0.1048 14.17 27.04 5.527

2007 42.2 0.2128 0.1924 0.1084 13.61 26.14 6.408
Cambodia 2000 47.8 0.1866 0.1777 0.0934 12.57 25.04 5.328
2010 37.64 0.2077 0.1874 0.1089 13.25 26.14 6.404
India 2005 45.9 0.2630 0.2391 0.1322 16.91 33.04 7.713
Laos
(LPDR) 2006 43.8 0.2582 0.2362 0.1306 16.7 33.54 7.553
Maldives 2009 17.94 0.0666 0.0617 0.0499 4.359 6.547 2.247
Nepal 2001 55.66 0.1882 0.1707 0.0950 12.07 24.24 5.584
2011 38.28 0.2493 0.2243 0.130 15.86 30.04 7.426
Thailand 2005 15.24 0.0938 0.0844 0.0780 5.966 10.64 3.21
Timor
Leste 2009 57.56 0.1354 0.1258 0.0689 8.895 16.07 4.222
Notes: aThe variable “stunting” gives the percentage of children less than five years old who are stunted. The various inequality indices are defined in Section 2.
N.B. Child stunting refers to the percentage of stunting (height-for-age less than minus two SDs of the WHO Child Growth Standards median) among children
aged five years or younger
Source: WHO Health Equity Monitor
development
On inequality

pro-poor

quintiles inequality
are stunted and the
in health and

Overall percentage of
43

between wealth
five years old who
children less than
Table IV.

of these percentagesa
JES 4. Determining the contribution of changes in the average value of a health
42,1 indicator and of its inequality to the value of this health indicator in the
poorest quintile
Let xt be the average value of a health indicator at time t and I(xt) be a measure of the
inequality of this indicator at time t. This index of inequality will be assumed to be an
absolute index since, as stressed in Section 2, this is a pre-condition for deriving
44 “consistent” values for the inequality in attainments and shortfalls will be the same
(see, Lambert and Zheng, 2010). Finally let xtP be the value of such a health indicator in
the poorest quintile in the population. The changes in xt , I(xt) and xtP between, say,
times 0 and 1 will be written as Dx, DI and DxP, respectively.
Adapting the approach of Deutsch and Silber (2011) we can write that xtP ¼
f ½x t ; I ðxt Þ so that DxP ¼ g ðDx; DI Þ.
Using the concept of Shapley decomposition (see, Chantreuil and Trannoy, 2013;
Shorrocks, 2013) we can, respectively, express the contributions C Dx and C DI of the
changes in the average value of the indicator and of its inequality, to the change in
the value of the health indicator in the poorest quintile as:
 
1 
C Dx ¼ ½g ðDx a 0; DI a 0Þ  ½g ðDx ¼ 0; DI a 0Þ
2
 
1 
þ ½g ðDx a 0; DI ¼ 0Þ  ½g ðDx ¼ 0; DI ¼ 0Þ
2
and:
 
1 
C DI ¼ ½g ðDx a 0; DI a 0Þ ½g ðDx a 0; DI ¼ 0Þ
2
 
1 
þ ½g ðDx ¼ 0; DI a 0Þ  ½g ðDx ¼ 0; DI ¼ 0Þ
2
It is then easy to observe that:
DxP ¼ C Dx þ C DI
since:
DxP ¼ g ðDx a 0; DI a 0Þ
and:
g ðDx ¼ 0; DI ¼ 0Þ ¼ 0
Let us take as illustration the case of infant mortality in Bangladesh in 1993 (time 0)
and 2007 (time 1). Table V gives the IMRs (a shortfall measure labeled x) by wealth
quintile in this country.

Year Poorest quintile Second quintile Third quintile Fourth quintile Highest quintile
Table V.
Infant mortality
in Bangladesh by 1993 114.6 117.4 93.3 91.7 70.3
wealth quintile 2007 66.2 67.1 62.4 46.1 35.9
Note that x0 ¼ 114:6 þ 117:4 þ 93:3 þ 91:7 þ 70:30=5 ¼ 97:46. One can derive similarly On inequality
that x1 ¼ 55:54. Therefore Dx ¼ ðx1 x0 Þ ¼ 55:54  97:46 ¼ 41:92. in health and
It is also easy to see that x0P ¼ 114.6 and x1P ¼ 66.2, so that x1P − x0P ¼ 66.2 −
114.6 ¼ −48.4.
pro-poor
It is clear that the value of the shortfall of the lowest wealth quintile that would be development
observed when there is a change in both average wealth and in inequality, that is, when
we have (Dx a 0, DI ≠ 0), is the actual value of the shortfall of the lowest wealth quintile 45
at time 1, x1P ¼ 66.2.
The value x01P of the shortfall of the lowest wealth quintile that would have been
observed, had there been only a change in the average shortfall, that is, when (Dx a 0,
DI = 0), would be:

x01P ¼ x0P þ ðx1  x0 Þ ¼ 114:6  41:92 ¼ 72:68

The value x001P of the shortfall of the lowest wealth quintile that would have been
observed, had there been only a change in inequality, that is, when (Dx ¼ 0, DI ≠ 0),
would be:

x001P ¼ x1P  ðx1  x0 Þ ¼ 66:2  ð  41:92Þ ¼ 108:12

Finally the value x000

1P of the shortfall of the lowest wealth quintile that would have been
observed, had there been no change in the average shortfall and no change in the
shortfall inequality (Dx ¼ 0, DI ¼ 0), would obviously be the original value x0P ¼ 114.6
of the shortfall of the lowest wealth quintile.
Using the breakdown mentioned previously, the contribution of the change in the
average shortfall to the change in the shortfall of the lowest wealth quintile will then be
expressed as:
 
1
C Dx ¼ ½ð66:2  108:12Þ þ ð72:68  114:6Þ ¼ 41:92
2

Similarly the contribution of the change in inequality to the change in the shortfall of
the lowest wealth quintile will be expressed as:
 
1
C DI ¼ ½ð66:2  72:68Þþ ð108:12  114:6Þ ¼ 6:48
2

As expected, the sum of these two contributions is –(41.92 + 6.48) ¼ −48.4 which is the
actual change (x1P − x0P) observed in the shortfall of the lowest wealth quintile.
In accordance with what was stressed in Sections 2 and 3, it is desirable that the
same breakdown holds when working with attainments rather than shortfalls.
Table VI shows the attainments for Bangladesh by wealth quintile, where the
attainment refers to the number of children, out of 1,000, surviving until age one.

Table VI.
Year Poorest quintile Second quintile Third quintile Fourth quintile Highest quintile Survival attainment
at age one in
1993 885.4 882.6 906.7 908.3 Bangladesh by
2007 933.8 932.9 937.6 953.9 964.1 wealth quintile
JES Call a0k and a1k the attainments of wealth quintile k in 1993 and 2007. The average
42,1 attainments a0 and a1 in 1993 and 2007 will then be a0 ¼ 902.54 and a1 ¼ 944.46 so
that the change in average attainments is Da ¼ 944.46 − 902.54 ¼ 41.92.
The change in the average attainments of the poorest quintile is Da0P ¼ 933.8 −
885.4 ¼ 48.4.
The value of the attainment of lowest wealth quintile that would be observed if there
46 were a change in both the average wealth and the inequality, that is, when we have
(Da ≠ 0, DI ≠ 0), is the actual value of the attainment of the lowest wealth quintile at
time 1, namely a1P ¼ 933.8.
The value a01P of the attainment of the lowest wealth quintile that would have been
observed, had there been only a change in the average wealth, that is, when (Da ≠ 0,
DI ¼ 0), would be:
a01P ¼ a0P þ ða1  a0 Þ ¼ 885:4 þ 41:92 ¼ 927:32
The value a001P of the attainment of the lowest wealth quintile that would have been
observed, had there been only a change in inequality, that is, when (Da ¼ 0, DI ≠ 0),
would be:
a001P ¼ a1P  ða1  a0 Þ ¼ 933:8  41:92 ¼ 891:88
Finally the value a000
1P of the attainment of the lowest wealth quintile that would have
been observed, had there been no change in the average wealth and no change in
inequality (Da ¼ 0, DI ¼ 0), would obviously be the original value a0P ¼ 885.4 of the
attainment of the lowest wealth quintile.
Using the breakdown mentioned previously, the contribution of the change in the
average attainment to the change in the attainment of the lowest wealth quintile will
then be expressed as:
 
1
C Da ¼ ½ð933:8  891:88Þþ ð927:32  885:4Þ ¼ 41:92
2
. imilarly the contribution of the change in inequality to the change in the attainment of
S
the lowest wealth quintile will then be expressed as:
 
1
C DI ¼ ½ð933:8  927:32Þ þ ð891:88  885:40Þ ¼ 6:48
2
As expected, the sum of these two contributions is (41.92 + 6.48) ¼ −48.4, which is the
actual change (a1P − a0P) observed in the attainment of the lowest wealth quintile. We
also observe that the contributions (to the change in the attainment of the lowest wealth
quintile) of the change in the average attainment and that of the change in inequality
are identical (in absolute value) to the contributions of the changes in average shortfall
and inequality in shortfalls derived previously.

5. A Shapley decomposition of the change in various health and access to

health indicators in Southeast Asia
This Shapley decomposition technique has been applied to the four health indicators
mentioned previously: infant and child mortality, child stunting and underweight, for
various countries and years in Southeast Asia. Table VII gives the results of this
decomposition as far as infant mortality is concerned. It appears that for Bangladesh,
Cambodia, Nepal and the Philippines most of the decline in the infant mortality On inequality
observed in the poorest wealth quintile was a consequence of the overall decline in in health and
infant mortality in these countries. But for India and Indonesia the decline in the
between wealth quintiles inequality in infant mortality played also an important role.
pro-poor
Finally note that in Cambodia, Nepal and Vietnam the overall decline in infant development
mortality would per se have considerably reduced infant mortality in the poorest
wealth quintile but the change (see, Table VII) in the between wealth quintiles 47
inequality in infant mortality would per se have led to a rise in infant mortality among
households belonging to the poorest wealth quintile.
To understand such a result let us take a look at the infant mortality data for
Cambodia, as they are provided by wealth quintile in World Health Organization
(2013). A quick calculation shows that the decline in IMR between 2000 and 2010 was
equal to −32.7 for the lowest quintile but on average to −35.9 for the four other
quintiles. The poorest quintile progressed hence less than the other quintiles and this is
why the change in inequality per se would have led, other things constant, to a higher
IMR in 2010 than in 2000, for the poorest wealth quintile. In a recent paper on child
deprivation in Cambodia Acharya and Mishra (2012) confirmed these findings since
they wrote that “in Cambodia the record of reducing the IMR from 65 (per 1,000 live
births) to 45 between 2005 and 2010 has been commendable. However, the inequality
component is stark.” The IMR for the wealthiest quintile is around 23, three times lower
than that of the poorest quintile. Acharya and Mishra (2012) emphasize also the fact
that wealth inequality can manifest itself via more than one dimension and note that
the IMR is much higher among people with a low level of education and in rural areas.
Analogous explanations may be given for the a priori strange impact of inequality
on the reduction in infant mortality in the poorest quintile in Nepal and Vietnam.
A similar decomposition concerning child mortality is presented in Table VIII. In all
countries, but Indonesia, the overall decline in child mortality in the poorest wealth
quintile is a consequence of the overall decline in child mortality, the change in the
between wealth quintiles inequality in child mortality playing a much less important
role except in Indonesia. Here again if we take a look at child mortality rates by wealth
quintiles (see, World Health Organization, 2013), we will observe that between 1997 and
2007 the child mortality rate in the four highest wealth quintiles decreased on average
by 14.2 while for the poorest wealth quintile it decreased by 31.7. This explains why for
Indonesia we have such an important contribution of inequality to the reduction in
child mortality in the poorest wealth quintile. Note also that in Vietnam the change
in the between wealth quintiles inequality in child mortality would per se, like in the

Total Contribution of change in Contribution of change

Years change average health attainments in health inequality
Table VII.
Bangladesh 1993 and 2007 −48.4 −41.92 −6.48 Contributions of the
Cambodia 2000 and 2010 −32.7 −35.26 2.56 change in average
India 1998 and 2005 −14.4 −8.04 −6.36 infant mortality
Indonesia 1997 and 2007 −22.5 −11.8 −10.7 and its inequality
Nepal 1996 and 2011 −35.3 −39.04 3.74 to the change in
Philippines 1998 and 2008 −8.2 −7.06 −1.14 infant mortality
Vietnam 1997 and 2002 −3.5 −9.98 6.48 in the poorest wealth
Source: WHO Health Equity Monitor quintile
JES case of infant mortality, have led to an increase in child mortality for the poorest
42,1 wealth quintile.
In Table IX the Shapley decomposition is applied to data concerning child
malnutrition, more precisely child stunting. Unfortunately data were available for more
than one period for only three countries: Bangladesh, Cambodia and Nepal. In all three
cases it appears that the decrease in child stunting among households belonging to the
48 poorest wealth quintile was mostly due to the decrease in the overall (country as a
whole) percentage of children suffering from stunting. Note, however, that for all
three countries the overall change in the between wealth quintiles inequality in child
stunting would per se have led to an increase in child stunting in the poorest wealth
quintile. The explanation for such opposing effects is evidently similar to that given
previously in the case of infant and child mortality.
The results of the Shapley decomposition for child underweight, another aspect of
child malnutrition, are very similar to those observed for child stunting, as can be seen
in Table X.
One may wonder whether the Shapley decomposition undertaken previously should
take into account the time span which ranges to 14 years for Bangladesh to five years for

Total Contribution of change in Contribution of change

Years change average health attainments in health inequality

Table VIII.
Contributions of the Bangladesh 1993 and 2007 −99.2 −72.26 −26.94
change in average Cambodia 2000 and 2010 −64.1 −52.64 −11.46
child mortality and India 1998 and 2005 −24.3 −15.7 −8.6
its inequality to the Indonesia 1997 and 2007 −31.7 −17.7 −14
change in child Nepal 1996 and 2011 −81 −74.28 −6.72
mortality in the Philippines 1998 and 2008 −20.1 −15.36 −4.74
poorest wealth Vietnam 1997 and 2002 −10.9 −13.6 2.7
quintile Source: WHO Health Equity Monitor

Table IX. Total Contribution of change in Contribution of change

Contributions of Years change average health attainments in health inequality
change in child
stunting and its
inequality to the Bangladesh 1996 and 2007 −11.2 −16.78 5.58
change in child Cambodia 2000 and 2010 −8.5 −10.16 1.66
stunting in the Nepal 2001 and 2011 −11.5 −17.38 5.88
poorest quintile Source: WHO Health Equity Monitor

Table X. Total Contribution of change in Contribution of change

Contributions of Years change average health attainments in health inequality
change in child
underweight and its
inequality to the Bangladesh 1996 and 2007 −9.4 −11.04 1.64
change in child Cambodia 2000 and 2010 −9.8 −10.66 0.86
underweight in the Nepal 2001 and 2011 −11.4 −14.84 3.44
poorest quintile Source: WHO Health Equity Monitor
Vietnam or whether this type of analysis should take into consideration the countries’ On inequality
initial conditions in terms of overall mortality (or malnutrition) as well as achievement in health and
inequality[2]. The previous analysis, however, did not really attempt to make inter-country
comparisons. Needless to say, an attempt to contrast the variation over time in the
pro-poor
achievements of various countries should not ignore differences in the time span for which development
observations are available and should refer to the initial conditions. Improvements over
time in infant or child mortality as well as in child stunting or underweight are very likely 49
not to be linear and one may expect that a given improvement would be easier to achieve
when starting from high levels of mortality or malnutrition than when relatively good
levels have already been reached.

6. Conclusions
This paper aimed first at providing estimates of the degree of inequality in health
attainments and access to health services in various countries in Southeast Asia during
the past 20 years. Particular attention was given to the fact that, when working with
bounded variables, indices measuring inequality in health attainments may be quite
different from inequality in health shortfalls so that we selected only indices which
have been proposed recently in the literature and give identical results for the
inequality of shortfalls and that of attainments. These indices were then computed for
four health variables: infant and child mortality, child stunting and underweight. In all
cases it appears that both the average value of these variables and the inequality of
their distribution between wealth quintiles declined over time.
In the second part of the paper we implemented the so-called Shapley decomposition
in order to find out whether the decline observed generally in the value taken by these
health variables among the poorest wealth quintile was mainly a consequence of
the overall decline (country as a whole) in the value of these variables or whether the
change in the between wealth quintiles inequality in the values taken by these health
variables played also a role. It then appeared that generally the overall decline in infant
and child mortality as well as in child stunting and underweight played the main role.
The decomposition approach selected was also shown to give identical results, whether
one works with shortfalls or attainments.
The breakdown proposed here has important policy implications because one can
think of two scenarios leading to an improvement of the well-being of the poor. A first
case is that where the well-being of the poor improves because the average well-being
in society increases. This would correspond to what is usually called “trickle down.”
Another possibility is that the well-being of the poor improves although no major
increase occurred in society as a whole. This would be the case if specific measures
aimed at the poor are taken to improve their lot. The empirical illustration given in this
paper for the very few countries for which data on mortality and malnutrition were
available for at least two periods has shown that most of the improvement was a
consequence of a general improvement in society. Since in the second period for which
data were available, the gap between the richest and poorest wealth quintiles was still
important (e.g. in Indonesia in 2007 infant mortality for the poorest wealth quintile was
55.7, that is, twice as high as the infant mortality of the richest wealth quintile which
was 25.8), there is no doubt that improving the lot of the poor requires specific
measures aimed at the poor.
In a recent article Nguyen (2013) argues that “isolated successes in parts of Asia
suggest that it is possible to reduce infant and child mortality rates quickly even
without high rates of economic growth […] At that stage, the focus needs to shift to
JES improving the quality of education, healthcare and childcare […].” Implementing such
42,1 policies clearly requires focussing on the poor strata of the population, that is, those
who have a low level of education and little access to health and child care.

Notes
1. These coefficients are available upon request from the author.
50
2. I thank an anonymous referee for drawing my attention to these important issues.

References
Acharya, S. and Mishra, U. (2012), “Findings from three surveys: CSES 2010, CDHS 2010 and
CBD 2010. An Analysis of child deprivation and inequality in Cambodia”, working paper,
UNICEF, Cambodia.
Case, A., Lubotsky, D. and Paxson, C. (2002), “Economic status and health in childhood: the
origins of the gradient”, American Economic Review, Vol. 92 No. 5, pp. 1308-1344.
Chakravarty, S., D’Ambrosio, C. and Chattopadhyay, N. (2013), “On a family of achievement and
shortfall inequality indices”, Working Paper No. 300, ECINEQ.
Chantreuil, F. and Trannoy, A. (2013), “Inequality decomposition values: the trade-off between
marginality and efficiency”, Journal of Economic Inequality, Vol. 11 No. 1, pp. 83-98.
Deutsch, J. and Silber, J. (2011), “On various ways of measuring pro-poor growth”, The Open-Access,
Open-Assessment E-Journal, Vol. 5 No. 13, pp. 1-57.
Ebert, U. (2010), “The decomposition of inequality reconsidered: weakly decomposable
measures”, Mathematical Social Sciences, Vol. 60 No. 2, pp. 94-103.
Erreygers, G. (2009), “Can a single indicator measure both attainment and shortfall inequality?”,
Journal of Health Economics, Vol. 28, pp. 885-893.
Filmer, D. and Pritchett, L. (1998), “Education attainment of the poor (and rich): DHS evidence
from around the globe”, working paper, World Bank, Washington, DC.
Fotso, J. (2006), “Child health inequalities in developing countries: differences across urban and
rural areas”, International Journal for Equity in Health, Vol. 5 No. 9, pp. 1-10.
Gwatkin, D.R. (2000), “Health inequalities and the health of the poor: what do we know? What can
we do?”, Bulletin of the World Health Organization, Vol. 78 No. 1, pp. 3-18.
Gwatkin, D.R., Rutstein, S., Johnson, K., Pande, R. and Wagstaff, A. (1999), Socio-Economic
Differences in Health, Nutrition, and Population, Country Reports on HNP (Health,
Nutrition and Population) and Poverty, The World Bank, Washington, DC.
Ikeda, N., Irie, Y. and Shibuya, K. (2013), “Determinants of reduced child stunting in Cambodia:
analysis of pooled data from three demographic health surveys”, Bulletin of the World
Health Organization, Vol. 91 No. 5, pp. 341-349.
Lambert, P. and Zheng, B. (2010), “On the consistent measurement of achievement and shortfall
inequality”, Working Paper No. 10-01, Department of Economics, University of Colorado
Denver, CO.
Lasso de la Vega, C. and Aristondo, O. (2012), “Proposing indicators to measure achievement and
shortfall inequality consistently”, Journal of Health Economics, Vol. 31 No. 4, pp. 578-583.
Minujin, A. and Delamonica, E. (2003), “Mind the gap! Widening child mortality disparities”,
Journal of Human Development, Vol. 4 No. 3, pp. 397-418.
Nguyen, V.D. (2013), “Child mortality declines in Asia – just not quickly enough”, East Asia
Forum Economics, Politics and Public Policy in East Asia and the Pacific, May 9, pp. 1-4,
available at: www.eastasiaforum.org
Organization of Economic Cooperation and Development (OECD) and World Health Organization On inequality
(WHO) (2003), “Poverty and Health”.
in health and
Sah, N. (2004), “Determinants of child malnutrition in Nepal: a case analysis from
Dhanusha, Central Terai of Nepal”, Journal of Nepal Health Research Council, Vol. 2
pro-poor
No. 2, pp. 50-54. development
Shorrocks, A.F. (1980), “The class of additively decomposable inequality measures”,
Econometrica, Vol. 48 No. 3, pp. 613-625. 51
Shorrocks, A.F. (1984), “Inequality decomposition by population subgroups”, Econometrica,
Vol. 52 No. 6, pp. 1369-1385.
Shorrocks, A.F. (2013), “Decomposition procedures for distributional analysis: a unified
framework based on the shapley value”, Journal of Economic Inequality, Vol. 11 No. 1,
pp. 99-126.
Victora, C.G., Wagstaff, A. and Schellenberg, J.A. (2003), “Applying an equity lens to child health
and mortality: more of the same is not enough”, The Lancet, Vol. 362 No. 9379, pp. 233-241.
World Health Organization (1995), The World Health Report 1995: Bridging the Gaps, World
Health Oranginization, Geneva.
World Health Organization (2013), “WHO Health Equity Monitor”, available at: http://apps.who.
int/gho/data/node.main.HE-1540

Further reading
Deaton, A. (2001), “Health, inequality, and economic development”, Working Paper No. 8318,
National Bureau of Economic Research.
Filmer, D. and Pritchett, L. (2001), “Estimating wealth effects without expenditure data – or tears:
an application to educational enrollments in states of India”, Demography, Vol. 38 No. 1,
pp. 115-132.
O’Hare, B., Makuta, I., Chiwaula, L. and Bar-Zeev, N. (2013), “Income and child mortality in
developing countries: a systematic review and meta-analysis”, Journal of the Royal Society
of Medicine, Vol. 106 No. 10, pp. 408-414.
Silber, J. (1989), “Factors components, population subgroups and the computation of the gini
index of inequality”, The Review of Economics and Statistics, Vol. LXXI No. 1, pp. 107-115.

Corresponding author
Professor Jacques Silber can be contacted at: jsilber_2000@yahoo.com

(The appendix follows overleaf.)

 52
JES
42,1

Table AI.
Overall child
mortality and
between wealth

in child mortalitya
quintiles inequality
Appendix

Atkinson
Erreygers’s Erreygers’s Index IR consistent Kolm consistent Normalized Theil
Overall index index adjusting proposed by inequality index inequality index consistent mean
child adjusting the coefficient of Lasso de la Vega (Chakravarty et al., (Chakravarty logarithmic deviation index
Country Year mortality Gini index variation and Aristondo 2013) et al., 2013) (Chakravarty et al., 2013)

Bangladesh 1993 143.5 0.0697 0.0626 0.0603 44.28 86.04 16.87

2007 71.26 0.0337 0.0330 0.0482 23.35 40.87 6.84
Cambodia 2000 116.3 0.0666 0.0621 0.0665 43.89 90.94 14
2010 63.64 0.0497 0.0443 0.0776 31.36 59.14 13.27
India 1998 94.76 0.0764 0.0678 0.0883 47.93 94.24 19.14
2005 79.06 0.0612 0.0542 0.0809 38.31 76.04 16.1
Indonesia 1997 67.1 0.0589 0.0530 0.0883 25.75 53.44 11.23
2007 49.4 0.0373 0.0339 0.0711 23.93 45.44 10.17
Maldives 2009 26.3 0.0129 0.0117 0.0414 8.27 13.46 4.092
Nepal 1996 134.2 0.0642 0.0609 0.0581 43.07 79.94 13.7
2011 59.9 0.0272 0.0266 0.0446 18.77 37.94 7.096
Pakistan 2006 90.36 0.0463 0.0411 0.0554 29.09 59.44 12.74
Philippines 1998 49.8 0.0406 0.0367 0.0770 25.95 48.14 10.65
2008 34.44 0.0301 0.0277 0.0772 19.62 40.24 8.457
Timor Leste 2009 79.98 0.0294 0.0295 0.0385 20.88 40.44 7.055
Vietnam 1997 43.8 0.0303 0.0272 0.0637 19.26 39.84 8.671
2002 30.2 0.0293 0.0273 0.0841 19.28 36.44 7.667
Notes: aThe variable “Child mortality” refers to mortality before the age of five. The various inequality indices are defined in Section 2. N.B. Child
mortality refers to the probability of dying by age five per 1,000 live births
Source: WHO Health Equity Monitor
 Percentage of Erreygers’s Lasso de la Atkinson consistent Kolm consistent Normalized Theil consistent
children who are index Vega and inequality index inequality index mean logarithmic deviation
underweight (at Erreygers’s (coefficient of Aristondo (Chakravarty et al., (Chakravarty et al., index (Chakravarty et al.,
Country national level) index (Gini) variation Index IR 2013) 2013) 2013)

Bangladesh 51.2 0.2058 0.2006 0.1029 14.18 25.87 5.393

40.16 0.1827 0.1668 0.0941 11.8 23.24 5.659
Cambodia 37.42 0.1091 0.0972 0.0573 6.87 12.94 3.763
26.76 0.1536 0.1393 0.0924 9.85 17.79 4.793
India 40.18 0.2874 0.2565 0.1480 18.14 35.74 8.52
Laos
(LPDR) 29.02 0.1862 0.1704 0.1078 12.05 23.64 5.707
Maldives 16.82 0.1098 0.0993 0.0857 7.021 13.04 3.543
Nepal 41.36 0.1962 0.1819 0.1003 12.86 25.14 5.819
26.52 0.2275 0.2047 0.1374 14.47 29.24 6.908
Thailand 6.72 0.0563 0.0504 0.0843 3.564 6.064 2.108
Timor
Leste 44.12 0.1133 0.1057 0.0572 7.477 12.78 3.531
Notes: aThe variable “underweight” gives the percentage of children less than five years old who are underweight. The various inequality indices are defined
in Section 2. N.B. The variable analyzed in this table refers to the percentage of underweight (weight-for-age less than minus two SDs from the WHO Child
Growth Standards median) among children aged five years or younger
Source: WHO Health Equity Monitor
development
On inequality

pro-poor

Table AII.

quintiles inequality
are underweight and
in health and

Overall percentage of
53

the between wealth

five years old who
children less than

of these percentagesa