Inequality and Poverty in Africa in an Era of Globalization: Looking Beyond Income to Health and Education

This paper describes changes over the past 15-20 years in non-income measures of wellbeing?education and health?in Africa. We expected to find, as we did in Latin America, that progress in the provision of public services and the focus of public spending in the social sector would contribute to declining poverty and inequality in health and education, even in an environment of stagnant or worsening levels of income poverty. Unfortunately, our results indicate that in the area of health, little progress is being made in terms of reducing pre-school age stunting, a clear manifestation of poor overall health. Likewise, our health inequality measure showed that while there were a few instances of reduced inequality along this dimension, there was, on balance, little evidence of success in improving equality of outcomes. Similar results were found in our examination of underweight women as an indicator of general current health status of adults. With regard to education, the story is somewhat more positive. However, the overall picture gives little cause for complacency or optimism that Africa has reaped, or will soon reap the potential benefits of the process of globalization.health, education, wellbeing, Africa

Expenditure incidence in Africa: microeconomic evidence

In this paper, we examine the progressivity of social sector expenditures in eight sub-Saharan African countries. We employ dominance tests, complemented by extended Gini/concentration coefficients, to determine whether health and education expenditures redistribute resources to the poor. We find that social services are poorly targeted. Among the services examined, primary education tends to be most progressive and university education is least progressive. The benefits associated with hospital care are also less progressive than other health facilities. Our results also show that, while concentration curves are a useful way to summarise information on the distributional benefits of government expenditures, statistical testing of differences in curves is important.

Changes in inequality and poverty in Latin America: Looking beyond income to health and education

This paper uses Demographic and Health Survey data from six Latin American countries to analyze levels and trends of inequality for two important non-income measures of wellbeing, childrenz s stature and adult womenq s educational attainment. Our purpose is to determine whether the worrying trend of increasing income inequality in Latin America is also found in non-income dimensions of well-being. We find that it is not. Almost across the board, health inequality, measured by childreni s stature, and education inequality, measured by young womeni s years of schooling, have fallen in these countries in the late 1980s and 1990s, often dramatically. Further, by decomposing changes in non-income dimensions of poverty into shifts in the mean and changes in the distribution of health and education, we show that reduced inequality has contributed to significant reductions in education poverty, and to a lesser extent, health poverty. This, too, is a very different result from the income inequality literature.inequality, poverty, health, education, Latin America

CONSISTENT ESTIMATION OF LONGITUDINAL CENSORED DEMAND SYSTEMS

In this paper we derive a joint continuous/censored demand system suitable for the analysis of commodity demand relationships using panel data. Unobserved heterogeneity is controlled for using a correlated random effects specification and a Generalized Method of Moments framework used to estimate the model in two stages. While relatively small differences in elasticity estimates are found between a flexible specification and one that restricts the relationship between the random effect and budget shares to be time invariant, larger differences are observed between the most flexible random effects model and a pooled cross sectional estimator. The results suggest the limited ability of such estimators to control for preference heterogeneity and unit value endogeneity leads to parameter bias.Research Methods/ Statistical Methods,

Partial Multidimensional Inequality Orderings

The paper investigates how comparisons of multivariate inequality can be made robust to varying the intensity of focus on the share of the population that are more relatively deprived. It follows the dominance approach to making inequality comparisons, as developed for instance by Atkinson (1970), Foster and Shorrocks (1988) and Formby, Smith, and Zheng (1999) in the unidimensional context, and Atkinson and Bourguignon (1982) in the multidimensional context. By focusing on those below a multidimensional inequality “frontier”, we are able to reconcile the literature on multivariate relative poverty and multivariate inequality. Some existing approaches to multivariate inequality actually reduce the distributional analysis to a univariate problem, either by using a utility function first to aggregate an individual’s multiple dimensions of well-being, or by applying a univariate inequality analysis to each dimension independently. One of our innovations is that unlike previous approaches, the distribution of relative well-being in one dimension is allowed to affect how other dimensions influence overall inequality. We apply our approach to data from India and Mexico using monetary and non-monetary indicators of well-being.Inequality, multidimensional comparisons, stochastic dominance

Validation of test performance characteristics and minimal clinically important difference of the 6-minute walk test in patients with idiopathic pulmonary fibrosis

SummaryBackgroundThe 6-minute walk test distance (6MWD) has been shown to be a valid and responsive outcome measure in patients with idiopathic pulmonary fibrosis (IPF). The analyses were based, however, on a single phase 3 trial and require validation in an independent cohort.ObjectiveTo confirm the performance characteristics and estimates of minimal clinically important difference (MCID) of 6MWD in an independent cohort of patients with IPF.MethodsPatients randomized to placebo in the phase 3 CAPACITY trials who had a baseline 6MWD measurement were included in these analyses. The 6MWD and other functional parameters (lung function, dyspnea, and health-related quality of life) were measured at baseline and 24-week intervals. Validity and responsiveness were examined using Spearman correlation coefficients. The MCID was estimated using distribution- and anchor-based methods.ResultsThe analysis comprised 338 patients. Baseline 6MWD was significantly correlated with lung function measures, patient-reported outcomes, and quality-of-life measures (validity). Compared with baseline 6MWD, change in 6MWD (responsiveness) showed stronger correlations with change in lung function parameters and quality-of-life measures. Dyspnea measured by the University of California San Diego Shortness of Breath Questionnaire showed the strongest correlations with 6MWD (baseline: coefficient −0.35; 48-week change: coefficient −0.37; both p < 0.001). The distribution-based analyses of MCID using standard error of measurement yielded an MCID of 37 m, and distribution-based analyses by effect size resulted in 29.2 m. The MCID by anchor-based analysis using criterion referencing (health events of hospitalization or death) was 21.7 m.ConclusionsThe 6MWD is a valid and responsive clinical endpoint, which provides objective and clinically meaningful information regarding functional status and near-term prognosis. These results confirm previous findings in an independent cohort of patients with IPF

Mitoxantrone pleurodesis to palliate malignant pleural effusion secondary to ovarian cancer

BACKGROUND: Advanced ovarian cancer is the leading non-breast gynaecologic cause of malignant pleural effusion. Aim of this study was to assess the efficacy of mitoxantrone sclerotherapy as a palliative treatment of malignant pleural effusions due to ovarian cancer. METHODS: Sixty women with known ovarian cancer and malignant recurrent symptomatic pleural effusion were treated with chest tube drainage followed by intrapleural mitoxantrone sclerotherapy. Survival, complications and response to pleurodesis were recorded. The data are expressed as the mean ± SEM and the median. RESULTS: The mean age of the entire group was 64 ± 11,24 years. The mean interval between diagnosis of ovarian cancer and presentation of the effusion was 10 ± 2,1 months. Eighteen patients (30%) had pleural effusion as the first evidence of recurrence. The mean volume of effusion drained was 1050 ± 105 ml and chest tube was removed within 4 days in 75% of patients. There were no deaths related to the procedure. Side effects of chemical pleurodesis included fever (37–38,5°C) chest pain, nausea and vomiting. At 30 days among 60 treated effusions, there was an 88% overall response rate, including 41 complete responses and 12 partial responses. At 60 days the overall response was 80% (38 complete responses and 10 partial responses). The mean survival of the entire population was 7,5 ± 1,2 months. CONCLUSIONS: Mitoxantrone is effective in the treatment of malignant pleural effusion secondary to ovarian cancer without causing significant local or systemic toxicity