Does Socioeconomic Inequality in Health Persist among Older People Living in Resource-Poor Urban Slums?

Abstract

Using self-reported health that assesses functionality or disability status, this paper investigates whether there are any differences in health status among older people living in a deprived area of Nairobi, Kenya. Data from a cross-sectional survey of 2,037 men and women aged 50 years and older are used to examine the association between socioeconomic position and self-reported health status across 6 health domains. Education, occupation, a wealth index, and main source of livelihood are used to assess the presence of a socioeconomic gradient in health. All the indicators showed the expected negative association with health across some, but not all, of the disability domains. Nonetheless, differences based on occupation, the most commonly used indicators to examine health inequalities, were not statistically significant. Primary level of education was a significant factor for women but not for men; conversely, wealth status was associated with lower disability for both men and women. Older people dependent on their own sources of livelihood were also less likely to report a disability. The results suggest the need for further research to identify an appropriate socioeconomic classification that is sensitive in identifying poverty and deprivation among older people living in slums.

Applying the Consensual Method of Estimating Poverty in a Low Income African Setting

“…The fact that 7 % of households in the top quintile report experiencing 4+ deprivations suggests the wealth index is classifying some deprived responds as relatively wealthy, which we consider problematic. Researchers have questioned the methods used to create the wealth index and its ability to make meaningful or reliable comparisons between countries or over time (Falkingham and Namazie 2002 ; Howe et al 2008 ). Our analysis shows the wealth index may identify as wealthy some very deprived households.…”

Family violence and its ‘adversity package’: a community survey of family violence and adverse mental outcomes among young people

“…Previous studies in developing countries have argued for and used household asset indices as proxies to measure household socio-economic status, rather than monetary measures [21]. …”

Health and ageing in Nairobi’s informal settlements-evidence from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH): a cross sectional study

“…The wealth quintiles report a relative gradient of wealth (or socioeconomic status) with this population. However we acknowledge that in an environment with high levels of deprivation, such as urban slums, it is possible that differences in wealth are marginal in real terms [ 10 , 13 ].…”

“…About one third of the urban population in developing countries live in slums and this proportion is 62 % in SSA [ 11 ]. It is expected that by 2030, more than half of the total population of SSA will live in urban slums [ 12 , 13 ]. Nairobi, the capital of Kenya, will have over two thirds of its inhabitants occupying informal urban settlements [ 14 ].…”