What Do Poor Children Die From? Some Evidence From Cebu, The Philippines

Evidence that poor children have a higher risk of dying in childhood than better-off children is accumulating fast. This evidence relates to deaths from all causes. This paper reports evidence showing the socio-economic gradient of child mortality by cause of death. It uses retrospective survey data from Cebu (the Philippines), and measures inequality using an index that is closely related to the index widely used by epidemiologists and others in the measurement of inequalities in health and mortality. The index used here has the advantage of being additively decomposable, so we can make statements to the effect that x% of the inequality in child mortality is accounted for inequality in deaths from just four causes. The index also has the advantage of allowing accurate standard errors to be derived, allowing us to see whether inequalities are statistically significant. Deaths amongst children under five in Cebu over the period 1981-91 were significantly concentrated amongst the poor. Deaths from most causes are concentrated amongst the poor, but not all, and not all concentration indices are significantly different from zero. Mortality from the big killers is more concentrated amongst the poor than mortality from all causes. Four causes— measles, diarrhea, pneumonia, and fever/febrile convulsions—account for a little over 50% of all under-five deaths, but account for nearly 70% of inequality in under-five deaths.