What is the association between economic growth and health equity? : A cross-national study of 83 low- and middle- income countries

Freeman, Toby and Gesesew, H and Bambra, Clare and Brown, Heather and Ullah, S and Popay, Jennie and Baum, Fran (2025) What is the association between economic growth and health equity? : A cross-national study of 83 low- and middle- income countries. International Journal of Social Determinants of Health and Health Services. ISSN 2755-1938 (In Press)

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Abstract

Inequities in infant and child mortality are an urgent public health issue for lower and middle income countries (LMICs). We sought to establish whether gross domestic product (GDP) is associated with the extent of health inequalities within LMICs. We conducted a secondary analysis of publicly available health equity data from the Health Equity Database of LMICs, and GDP data from the World Bank. We used infant and under five mortality rates by socioeconomic quintile. The slope of inequality index and relative index of inequality were calculated for both outcomes for each country (N = 83). Linear regression analysis was used to investigate the relationship with GDP. Higher GDP was associated with only a small decrease in absolute socioeconomic inequities in under five mortality (f2 = 0.10), and was not associated with changes in absolute inequities in infant mortality. Higher GDP was associated with greater relative inequities in infant (f2 = 0.11) and under five mortality (f2 = 0.12). Thus, increasing GDP may do little to redress health inequities in infant and under five mortality. Understanding drivers of the distribution of wealth and income to flatten the socioeconomic gradient in health are crucial to reducing health inequities.