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A new Inequity-in-Health Index based on Millennium Development Goals: methodology and validation.
J Eslava-Schmalbach1, H Alfonso, H Oliveros
1School of Medicine, National University of Colombia, Bogotá, Colombia. jheslavas@unal.edu.co
Journal of Clinical Epidemiology
|January 8, 2008
Summary
A new Inequity-in-Health Index (IHI) was developed to measure health outcome inequalities based on Millennium Development Goals (MDG). This valid and reliable index effectively monitors global health disparities and can be adapted for other indicators.
Area of Science:
- Global Health
- Health Economics
- Biostatistics
Background:
- Health inequities represent a significant global challenge, hindering progress towards sustainable development.
- Existing indicators may not fully capture the multifaceted nature of health outcome inequalities.
Purpose of the Study:
- To develop and validate a new Inequity-in-Health Index (IHI).
- To operationalize health inequity as inequality in health outcomes, aligned with Millennium Development Goals (MDG).
Main Methods:
- An ecological study design was employed, utilizing data from international databases (UN, World Bank).
- The bidimensional IHI was constructed using six key variables: child underweight, child mortality, malaria deaths (0-4 and all ages), skilled birth attendance, and measles immunization.
- Statistical analyses included main factor analysis (promax rotation) and main component analysis to assess reliability and validity.
Main Results:
- The IHI demonstrated high internal consistency (Cronbach's alpha=0.8504) and reliability (Spearman>0.9).
- The global IHI score averaged 0.3033 (range: 0-0.5984) and showed strong correlations with human development, poverty, health gap, life expectancy, and Gini coefficients (Spearman>0.7).
- The IHI effectively discriminated between countries based on income, region, indebtedness, and corruption levels, and was sensitive to change.
Conclusions:
- The Inequity-in-Health Index (IHI) is a valid, reliable, and bidimensional tool for monitoring progress on the Millennium Development Goals (MDG).
- The study presents a novel methodological approach for developing bidimensional indicators, applicable to constructing other relevant health metrics.
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