Socioeconomic inequalities and mortality trends in BRICS, 1990–2010
Bulletin of the World Health Organization
Number 6, June 2014, 385-464
Oscar J Mújica, Enrique Vázquez, Elisabeth C Duarte, Juan J Cortez-Escalante, Joaquin Molina & Jarbas Barbosa da Silva
Objective
To explore the presence and magnitude of – and change in – socioeconomic and health inequalities between and within Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – between 1990 and 2010.
Methods
Comparable data on socioeconomic and health indicators, at both country and primary subnational levels, were obtained from publicly available sources. Health inequalities between and within countries were identified and summarized by using standard gap and gradient metrics.
Findings
Four of the BRICS countries showed increases in both income level and income inequality between 1990 and 2010. The exception was Brazil, where income inequality decreased over the same period. Between-country inequalities in level of education and access to sanitation remained mostly unchanged but the largest between-country difference in mean life expectancy increased, from 9 years in 1990 to 20 years in 2010. Throughout the study period, there was disproportionality in the burden of disease between BRICS. However, the national infant mortality rate fell substantially over the study period in all five countries. In Brazil and China, the magnitude of subnational income-related inequalities in infant mortality, both absolute and relative, also decreased substantially.
Conclusion
Despite the economic prosperity and general improvements in health seen since 1990, profound inequalities in health persist both within and between BRICS. However, the substantial reductions observed – within Brazil and China – in the inequalities in income-related levels of infant mortality are encouraging.
Relative health performance in BRICS over the past 20 years: the winners and losers
Dennis Petrie & Kam Ki Tang
Bulletin of the World Health Organization
Number 6, June 2014, 385-464
Objective
To determine whether the health performance of Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – has kept in step with their economic development.
Methods
Reductions in age- and sex-specific mortality seen in each BRICS country between 1990 and 2011 were measured. These results were compared with those of the best-performing countries in the world and the best-performing countries with similar income levels. We estimated each country’s progress in reducing mortality and compared changes in that country’s mortality rates against other countries with similar mean incomes to examine changes in avoidable mortality.
Findings
The relative health performance of the five study countries differed markedly over the study period. Brazil demonstrated fairly even improvement in relative health performance across the different age and sex subgroups that we assessed. India’s improvement was more modest and more varied across the subgroups. South Africa and the Russian Federation exhibited large declines in health performance as well as large sex-specific inequalities in health. Although China’s levels of avoidable mortality decreased in absolute terms, the level of improvement appeared low in the context of China’s economic growth.
Conclusion
When evaluating a country’s health performance in terms of avoidable mortality, it is useful to compare that performance against the performance of other countries. Such comparison allows any country-specific improvements to be distinguished from general global improvements.