Elsevier

Economics & Human Biology

Volume 8, Issue 3, December 2010, Pages 346-360
Economics & Human Biology

Health and wealth in Uzbekistan and sub-Saharan Africa in comparative perspective

https://doi.org/10.1016/j.ehb.2010.09.002Get rights and content

Abstract

The study investigates the magnitude of differences in child and adult mortality by wealth in Uzbekistan, a former soviet country of Central Asia, and compares it with similar indicators from sub-Saharan Africa. Data were derived from Demographic and Health Surveys. An “Absolute Wealth Index” was built from data on goods owned by households and quality of housing, and scaled from 0 to 12. Wealth was distributed evenly in Uzbekistan, with a symmetric distribution around a mean of 5.5 modern goods. In sub-Saharan Africa, on the contrary, the wealth distribution had a lower mean (2.5) and was highly skewed towards the left, revealing a high proportion of very poor people. Adult and child mortality levels were lower in Uzbekistan. Despite these major differences, the relationships between mortality indicators and the wealth index were similar in the two cases. The magnitude of mortality differentials by wealth was of the same order in both cases, with gradients ranging from 2.5 to 1 for child mortality and 1.5 to 1 for adult mortality (poorest versus richest). However, mortality levels remained lower in Uzbekistan than in sub-Saharan Africa at the same level of wealth for both children and adults. A similar relationship was found between nutritional status and wealth index in both cases. On the contrary, there were no differences by wealth in use of health services and level of education in Uzbekistan, whereas wealth gradients were steep for the same variables in sub-Saharan Africa. The study suggests that mortality differentials were primarily due to nutritional status, and not to access and use of health services or to education. The discussion focuses on health and social policies during the colonial and post-colonial period that have produced these patterns.

Section snippets

Health and wealth in socialist countries

Little is known about income and wealth differentials in mortality and other health outcomes in former communist countries of Asia, since these were not carrying out surveys like in the West during the socialist period. At that time, information on mortality differentials in these countries was limited to classic age and sex patterns, urban versus rural, and regional differences. A few recent articles based on sample surveys provide some information on income differentials. Using data from a

Background on Uzbekistan

Uzbekistan is the most populated country of Central Asia, located at the crossroads of major cultures (Persian, Turk, Mongol, Indian, Russian, Chinese), and was for centuries the main node of the silk routes (Poujol, 2001). Its population history is complex, and the country has a long urban tradition, with major cities such as Samarqand and Bukhara. Central Asia has a rather dry climate, however watered by numerous rivers descending from the south-eastern mountains, part of the Himalaya system.

Data and methods

Data for conducting the empirical analysis on the relationship between wealth and mortality were provided by Demographic and Health Surveys (DHS) (www.measuredhs.com). Uzbekistan conducted two DHS surveys, in 1996 and 2002, the second survey also called UHES (Uzbekistan Health Examination Survey). Both contained information on wealth, nutritional status, child survival and adult survival recorded the same way. Information on wealth came from a series of questions on household goods and

Wealth distribution

The two distributions of the wealth index were remarkably different (Fig. 1). Sub-Saharan African countries exhibited a large proportion of households in extreme poverty, that is with virtually no modern goods: 44.4% of households had a wealth index equal to 0 or 1, whereas only 1.5% of households were in the same situation in Uzbekistan (30 times less). A large majority (83.7%) of Uzbek households had at least four modern goods, whereas only a minority (26.2%) of African households did so. The

Sensitivity analysis

Sub-Saharan African countries selected for this comparison with Uzbekistan were quite heterogeneous with respect to level of development, climate, disease environment and urbanization. We conducted a sensitivity analysis by selecting sub-groups of countries, which had some similarity with Uzbekistan. We first selected seven “Middle Income countries”, which were countries with reasonable educational attainment: Botswana, Comoros, Cote d’Ivoire, Ghana, South Africa and Zimbabwe. We then selected

Discussion

The DHS surveys provide an opportunity to conduct a comparative analysis with the same data on wealth, health and nutritional status in Central Asia and sub-Saharan Africa. This analysis showed the similarities and differences in two areas of the world where populations were colonized for similar duration and benefited from similar health programs, though with different modalities and coverage. One could argue that time since independence differs in the two cases (25–40 years versus 10 years by

Competing interest

None declared.

Author's contributions

S.H. worked for several years in Uzbekistan and was responsible for the analysis of this country. M.G. worked for several years in sub-Saharan Africa, and was responsible for the analysis of sub-Saharan Africa and the re-visiting of Villermé’s study. Both authors share responsibility for the comparative analysis.

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