Missing the Unhealthy? Examining Empirical Validity of Material Deprivation Indices (MDIs) Using a Partial Criterion Variable

Abstract

This study investigates the empirical validity of the material deprivation indices (MDIs) using a partial criterion variable, namely UHCNIR (unmet health care need due to inadequate resources). This alternative approach helps to assess absolute validity (Type I and II errors) and sources of error in the measurement of poverty for a specific aspect of poverty (in this case inability to receive adequate health care due to affordability problems). A simple mismatch analysis identifies a sizable group, around 1% of the adult EU population, missed by MDIs despite being in UHCNIR. A majority of this 1% experiences not only UHCNIR but also multiple other deprivations, commonly reports having some difficulties making ends meet, and prevalently has a disability or a chronic health problem. The analysis reveals that MDIs miss specifically those “unhealthy poor” since these measures do not include a relevant item, and thus cannot adjust for different needs and costs in health care and account for the distinct poverty experiences of these people. Therefore, the main methodological assumption of MDIs, identifying the people in poverty with only a limited set of key deprivation indicators is not supported by this empirical analysis.

Are there socioeconomic disparities in geographic accessibility to community first responders to out-of-hospital cardiac arrest in Ireland?

“…The validity and reliability of both the deprivation and social fragmentation measures is open to debate. Establishing the validity of a deprivation index is challenging ( Beduk, 2018 ). Both indices are limited to a small number of variables with a direct link to the concept being quantified.…”

Realising poverty in all its dimensions: A six-country participatory study

“…While poverty may perhaps always have been conceptualised as multidimensional, it has very often been measured by 'deficiency in income' alone (Bedük, 2019). The World Bank's measure of poverty, introduced in 1990 and now based on the average poverty thresholds of the 15 poorest countries, is still the dominant measure used in development.…”

“…The studies cited above are either axiomatic, stemming from prior assumptions about the nature of poverty, or non-axiomatic, derived empirically from data (Dotter and Klasen, 2017;Grynspan and López-Calva, 2011). Unfortunately, theory is too weak and contested to generate satisfactory axioms, while data-driven analyses are constrained by inadequate data deriving from multipurpose surveys or weak axioms (Bedük, 2019). A potential resolution of this conundrum is provided by Wresinski (1989) who argued both that extreme poverty is a violation of human rights and that only people enduring poverty know what it means to live in poverty.…”

Identifying People in Poverty: A Multidimensional Deprivation Measure for the EU

“…As a result, people who experience poverty related to missing dimensions are not captured unless they are also deprived in existing dimensions. Beduk (2017;2018a) show that existing deprivation scales particularly fail to identify people in poverty with needs in health care, child care, social care and education. In order to address these conceptual problems, the aim here is to construct a deprivation measure of poverty which is i) concept-led where the identification of dimensions, and the specification of overall design are primarily determined from the theoretical definition of poverty; ii) multidimensional where each dimension is evaluated separately with a relevant scale before reaching an overall evaluation of poverty; and iii) more comprehensive including aspects of poverty that are missing in existing deprivation scales such as needs for education and health.…”