Health Questionnaire for a Multidimensional Poverty Index

Health is one of the most critical aspects of multidimensional poverty, yet at the same time it is one of the most challenging dimensions  in the measurement of multidimensional poverty.

The relationship between health and monetary poverty has been clearly established in the literature. Indeed, some refer to it as the health–poverty trap, recognising that there is a bidirectional relationship between both conditions.

 

Health and poverty

On the one hand, individuals living in monetary poverty usually have higher financial barriers to accessing healthcare services, including preventive or curative services. They are also more likely to be sick, and their health outcomes are lower. Monetarily poor individuals have a lower life expectancy, a higher prevalence of communicable and non–communicable diseases, and higher mortality rates (Canudas–Romo; Dávila–Cervantes & Agudelo–Botero). On the other hand, ill health is a major cause of monetary poverty. This is due to the high cost that individuals face when seeking health care, including out-of-pocket payments, transportation, and other informal payments to providers.

In the context of multidimensional wellbeing measures, health indicators have been included as a dimension of poverty. The Human Development Index (HDI) includes health as one of its dimensions, and life expectancy is a common indicator used to measure human development. In addition, different indicators have been included to measure the health dimension in multidimensional poverty measures, with child mortality, access to health services, health insurance and health conditions serving as the most used indicators. Empirically, poor health may compound deprivations in other dimensions. For example, evidence suggests there is a relationship between poor health status and school achievement or job performance.

The 2030 Agenda includes a series of indicators related to health, which are mainly listed in Sustainable Development Goals (SDGs) 2 and 3. SDG 3, ‘Health and Wellbeing’, aims to analyse countries’ achievements in areas related to maternal and child health, as well as the prevention of communicable and non-communicable diseases, mortality rates, vaccination, risk behaviours, and coverage of health care services. Although some of these indicators are computed using household surveys, in most cases, the information required to calculate each indicator is based on administrative records, clinical data, or national health information data.

 

What are countries doing to measure health in relation to poverty?

Indicators related to health have also been included in national multidimensional poverty indices (MPIs). To date, more than 40 countries have an official MPI, and all have included the health dimension.

Considering the first 30 national MPIs, the most used indicators are access to health care services (17 countries), followed by nutrition, food security and health insurance. It is important to highlight that countries such as Ecuador and Belize have included access to a clean source of water and improved sanitation as part of the health dimension. The main justification is that those indicators capture some important determinants of health.

Source: Dirksen, J. (2023)

 

Considerations and challenges

It is important to account for the heterogeneity of health outcomes within a household. Health variables to compute indicators for an MPI should therefore be collected for each household member. Depending on the age group, some questions might not apply for some household members.

Measures should also be objective to avoid interpretation issues since frames of reference vary. Hence self-reported health status or self-rated health should be avoided as these questions present problems with reliability, have high levels of measurement error, and cannot be used for comparing across contexts or over time. Subjective questions include satisfaction with health or services, self-rated health status, or self-reported chronic/mental conditions, among others.

Some potential indicators that could be used by countries are related to health risks such as smoking, alcohol consumption or use of illicit drugs, physical activity, cancer screening, even access to health care (preventative and curative), access to health care when living with chronic diseases, and distance to healthcare facilities.

Other indicators such as health insurance, health functioning scales, mental health, or self-reported health status present important methodological problems. These should all be considered carefully before including them in an MPI.

 

Recommendations for accurately measuring health

Where possible, it is recommended that objective measures such as biomarkers are collected. Where this is not possible, questions should capture aspects related to effective and timely access to health services, as well as barriers that individuals face to accessing services, rather than whether an individual has a disease or not.

Finally, the suggested questions are useful if the purpose of the measure is to be comparable across countries, the measure uses household surveys and it aims to capture health indicators that show changes over time.

 

 

This article was published in Dimensions 16