TY - JOUR

T1 - Beyond access to basic services

T2 - perspectives on social health determinants of Mozambique

AU - Llop-Girones, Alba

AU - Jones, Sam

PY - 2021

Y1 - 2021

N2 - A wide range of evidence shows systematic differences in health status among social groups, which are associated with unequal exposure to and distribution of the social determinants of health (SDH). However, the role of these SDH has not been studied extensively in low-income countries, where most studies focus on access to medical care. In this paper, we undertake a retrospective cross-sectional analysis of the SDH in Mozambique for the period 2002-2014 based on a set of household budget surveys, covering 152,259 observations. We run logistic regression models, comparing various sets of determinants of health status proxied by two measures: self-assessed overall health and number of days ill. The results, which include models stratified by sex, age and year, consistently show that neither better access to healthcare nor material conditions are related to better health. Rather, macro factors, proxied by place of residence, are the dominant predictor of health inequalities. In the stratified models, women and elders appear more vulnerable to poor health. The policy implication is that a narrow focus of health policy on selected services ignores the underlying economic and social context and their role in producing well-being or poor health. More integrated approaches are required to address the health equity gap in low-income countries.

AB - A wide range of evidence shows systematic differences in health status among social groups, which are associated with unequal exposure to and distribution of the social determinants of health (SDH). However, the role of these SDH has not been studied extensively in low-income countries, where most studies focus on access to medical care. In this paper, we undertake a retrospective cross-sectional analysis of the SDH in Mozambique for the period 2002-2014 based on a set of household budget surveys, covering 152,259 observations. We run logistic regression models, comparing various sets of determinants of health status proxied by two measures: self-assessed overall health and number of days ill. The results, which include models stratified by sex, age and year, consistently show that neither better access to healthcare nor material conditions are related to better health. Rather, macro factors, proxied by place of residence, are the dominant predictor of health inequalities. In the stratified models, women and elders appear more vulnerable to poor health. The policy implication is that a narrow focus of health policy on selected services ignores the underlying economic and social context and their role in producing well-being or poor health. More integrated approaches are required to address the health equity gap in low-income countries.

KW - Social determinants of health

KW - self-assessed health

KW - health equity

KW - Mozambique

KW - SOCIOECONOMIC-STATUS

KW - MORTALITY

KW - INEQUALITIES

KW - AFRICA

KW - WATER

KW - POOR

U2 - 10.1080/09581596.2020.1769838

DO - 10.1080/09581596.2020.1769838

M3 - Journal article

JO - Critical Public Health

JF - Critical Public Health

SN - 0958-1596

ER -