illustration for Domain 1 Life and health

Life and health: Inequality in the capability to be alive and to live a healthy life


Description

The life and health domain covers the capability to be alive, to enjoy longevity and to live a healthy life. Inequality measures pick-up differences in mortality risks which may result from differences in exposure to death, lifestyle factors and differences in medical treatment. Information on some causes of death which involve violations of human rights law are generally not recorded in official statistics, so guidance is given on the use of allegations data. The domain captures key health inequalities across physical and mental health outcomes including objective measures of health and individuals own subjective assessment of their health status.

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In relation to inequality in premature death, this domain covers instances of death from violations and infringements of people’s safety and security by individuals, organisations and the state. It includes death from non-natural causes in institutions (police custody, prisons, care homes, etc.) and as a result of war, conflict and protest. It also includes measures that capture unequal exposure to death as a result of natural disasters, climate change and other environmental factors.

One of the main causes of premature death is disease. Inequalities exist due to differences in exposure, lifestyle factors and differences in medical treatment. Measures are included for communicable and non-communicable disease mortality, with differences in mortality rates computed across population sub-groups.

Forced migration puts some people at much greater risk of mortality during periods of flight and transit. The failure of the state in protecting asylum seekers, refugees and others facing forced migration (due to, for example, flood, famine, conflict or other disasters) can put some individuals at much greater risk of mortality. The international community has a role to play here and many actors have a responsibility for keeping such individuals safe.

Gang-related homicides, deaths resulting from ‘terrorist’ activity and suspected deaths reported as ‘disappearances’ are also included in this domain. Allegations data collected by NGOs can be used to supplement or replace official statistics or estimates survey data where official sources are known to be unreliable.

There are a number of measures designed to pick-up key gender inequalities: maternal mortality, live births, suicide, homicide and domestic homicide. From an inequality perspective there are important factors affecting differences between men and women: “Gender biases in power, resources, entitlements, norms and values, and the way in which organizations are structured and programmes are run damage the health of millions of girls and women. The position of women in society is also associated with child health and survival – of boys and girls.” (WHO, 2008).

The health outcomes included in this domain make reference to key capabilities related to living a long and healthy life. These include overall summary measures of healthy life expectancy, objective and subjective measures of health status. The capability to live a healthy life is affected by biological, physical and mental factors, economic resources and social conditions in the environment, and their interaction (Venkatapuram, 2011). Unequal distributions of these factors play an important role in shaping health inequalities (Marmot, 2016). People need to benefit equally from access to quality health services, medical advances in the treatment of disease, should the need arise, and be protected from communicable diseases. Women need to receive the right treatment and protection during pregnancy, childbirth and in the post-natal period. The treatment and protection of children, particularly during the first five years of life, is a critical element.

Medical advances have made considerable progress in improving health outcomes through the prevention and treatment of diseases and through advances in trauma and neonatal care. This has contributed to increases in average life expectancy in many countries but these additional years of life are not always healthy and inequalities in health outcomes remain high (McKnight and Cowell, 2014). In addition, the cost of medical advances and new treatments and technologies put these out of the reach of many; contributing further to health inequalities. Also, some aspects of health (for example, mental health) have not received the same level of attention or investment and new types of epidemic, such as obesity, are on the rise.

The World Health Organisation (WHO) views health inequities as avoidable inequalities in health between groups of people within and between countries. “These inequities arise from inequalities within and between societies. Social and economic conditions and their effects on people’s lives determine their risk of illness and the actions taken to prevent them becoming ill or treat illness when it occurs.” (WHO, 2008).

References and selected readings

Bartley, M. (2016). Health Inequality: An Introduction to Concepts, Theories and Methods, Polity Press

Marmot, M. (2016). The Health Gap: The Challenge of an Unequal World, Bloomsbury

McKnight, A. and F. Cowell (2014) ‘Social Impacts: Health, Housing and Intergenerational Mobility’ in Salverda, W., Nolan, B., Checchi, D., Marx, I., McKnight, A., Tóth, I. G., and H. G. van de Werfhorst (eds) (2014) Changing Inequalities and Societal Impacts in Rich Countries: Analytical and Comparative Perspectives, Oxford: Oxford University Press

Spinakis, A., Anastasiou, G., Panousis, V., Spiliopoulos, K., Palaiologou, S., and Yfantopoulos, J., 2011. Expert Review and Proposals for Measurement of Health Inequalities in the European Union – Full Report. Luxembourg: European Commission Directorate General for Health and Consumers

Venkatapuram, S. (2011) Health Justice: An Argument from the Capabilities Approach, Polity Press

WHO (2013). Handbook on Health Inequality Monitoring with a special focus on low- and middle-income countries. Luxembourg


Measurement considerations

Many of the inequality measures in this domain compare incidence rates between population sub-groups. For example, live births by gender, homicide rates by age group, prevalence of key diseases (such as malaria) by sex and age, rates of obesity by socio-economic group. Some measure ordinal inequality such as inequality in self-reported current health status, and some measure inequality in continuous variables such as inequality in mental health score and inequality in life expectancy.

There is generally good quality data available for the measures included in this domain. This is helped through an overlap with indicators that form part of SDG monitoring. The work of the WHO has also helped to facilitate access to good quality data on health and life inequalities.

 

Click on the button beside each sub-domain to see related indicators, inequality measures and references to any relevant UN Sustainable Development Goal (SDG) indicators. You may click on the Expand All button to view all inequality indicators, their measures and SDG indicators within each of the sub-domains.

 

Sub-domains:
Avoid premature mortality through disease, neglect, injury or suicide
Indicator: Inequality in life expectancy
Measures:
Live births by gender
Perinatal, infant and under 5 mortality rates
Reference: UN SDG:
3.2.1

Under-5 mortality rate

3.2.2

Neonatal mortality rate

Inequality in age-mortality rates
Period life expectancy at birth, and ages 20, 65 & 80

Indicator: Specific-cause mortality rates
Measures:
Mortality rates due to the top 5 communicable diseases (country specific - eg influenza, HIV, malaria, tuberculosis, hepatitis)
Mortality rates due to the top 5 non-communicable diseases (country specific - eg cardiovascular disease, cancer, diabetes, chronic respiratory disease, hypertension, disease related to diet and nutrition)
Reference: UN SDG:
3.4.1

Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease

Maternal mortality ratio - the number of maternal deaths during a year per 100,000 live births
Reference: UN SDG:
3.1.1

Maternal mortality ratio

Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene
Reference: UN SDG:
3.9.2

Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene (exposure to unsafe Water, Sanitation and Hygiene for All (WASH) services)

Age-standardized death rate attributable to air pollution (per 100,000)
Reference: UN SDG:
3.9.1

Mortality rate attributed to household and ambient air pollution

Death rate due to (a) road traffic accident injuries; (b) other unintentional injuries
Reference: UN SDG:
3.6.1

Death rate due to road traffic injuries

8.8.1

Frequency rates of fatal and non-fatal occupational injuries, by sex and migrant status

Suicide mortality rate
Reference: UN SDG:
3.4.2

Suicide mortality rate


Be protected from being killed or murdered
Indicator: Homicide
Measures:
Homicide rate
Reference: UN SDG:
16.1.1

Number of victims of intentional homicide per 100,000 population, by sex and age

Domestic homicide rate (with separate reporting of relationship of victim to principal suspect, including partner homicide)
Racially motivated, religiously motivated and homophobic homicide

Be protected from natural and non-natural causes of mortality
Indicator: Death from natural disasters
Measures:
Deaths from natural disasters - earthquakes; volcanic eruptions; flood; fire; famine; draught; hurricane (typhoon/cyclone)
Reference: UN SDG:
1.5.1

Number of deaths, missing persons and directly affected persons attributed to disasters per 100,000 population

11.5.1

Number of deaths, missing persons and directly affected persons attributed to disasters per 100,000 population

13.1.1

Number of deaths, missing persons and directly affected persons attributed to disasters per 100,000 population


Indicator: Death rates from non-natural causes
Measures:
Deaths from non-natural causes during or following police custody
Deaths in prisons: (a) from non-natural causes; (b) self-inflicted
Deaths from non-natural causes for people resident in health or social care establishments
Deaths from torture and political oppression (Guidance - ok to use allegations data collected by NGOs)
Reference: UN SDG:
16.10.1

Number of verified cases of killing, kidnapping, enforced disappearance, arbitrary detention and torture of journalists, associated media personnel, trade unionists and human rights advocates in the previous 12 months

Civilian deaths as a result of war, conflict, unrest and protest (Guidance - includes disappearances - ok to use allegations data collected by NGOs)
Reference: UN SDG:
16.1.2

Conflict-related deaths per 100,000 population, by sex, age and cause

16.10.1

Number of verified cases of killing, kidnapping, enforced disappearance, arbitrary detention and torture of journalists, associated media personnel, trade unionists and human rights advocates in the previous 12 months


Achieve the highest possible standard of general health
Indicator: Subjective evaluation of current health status and treatment
Measures:
Percentage who report poor current health status
Inequality in self-reported current health status
Percentage who are treated with dignity and respect in health treatment

Indicator: Prevalence of key diseases associated with deprivation and low income
Measures:
Prevalence of new infections per 1,000 or per 100,000 uninfected population, by sex, age and key populations: (a) Number of new HIV infections per 1,000 uninfected population; (b) Tuberculosis incidence per 100,000 population; (c) Malaria incidence per 1,000 population; (d) Hepatitis B incidence per 100,000 population
Reference: UN SDG:
3.3.1

Number of new HIV infections per 1,000 uninfected population, by sex, age and key populations

3.3.2

Tuberculosis incidence per 100,000 population

3.3.3

Malaria incidence per 1,000 population

3.3.4

Hepatitis B incidence per 100,000 population

Percentage requiring interventions against neglected tropical diseases
Reference: UN SDG:
3.3.5

Number of people requiring interventions against neglected tropical diseases


Indicator: Healthy life
Measures:
Inequality in healthy life expectancy
Prevalence of: (a) Stunting in young children; (b) undernourishment
Reference: UN SDG:
2.2.1

Prevalence of stunting (height for age <-2 standard deviation from the median of the World Health Organization (WHO) Child Growth Standards) among children under 5 years of age

2.2.2

Prevalence of malnutrition (weight for height >+2 or <-2 standard deviation from the median of the WHO Child Growth Standards) among children under 5 years of age, by type (wasting and overweight)

Rates of obesity/Prevalence of Type II diabetes
Percentage diagnosed with eating disorders
Rates of: (a) alcoholism; (b) drug addiction; (c) tobacco use
Reference: UN SDG:
3.5.2

Harmful use of alcohol, defined according to the national context as alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol

3.A.1

Age-standardized prevalence of current tobacco use among persons aged 15 years and older

Prevalence of asthma
Percentage who report participation in sport/physical activity on regular basis

Indicator: Limiting illness and disability
Measures:
Percentage who report a long-standing health problem or disability that substantially limits their ability to carry out normal day-to-day activities

Enjoy good mental health
Indicator: Mental health
Measures:
Percentage who report poor mental health and well-being
Inequality in mental health score

Have good sexual and reproductive health
Indicator: Sexual and reproductive health
Measures:
Rates of sexually transmitted infections
Percentage of women with unmet need for family planning
Reference: UN SDG:
3.7.1

Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods

Percentage of women who have given birth in the last five years having delivery attended by a qualified health professional
Reference: UN SDG:
3.1.2

Proportion of births attended by skilled health personnel

Percentage of women who have given birth in the last five years who were given the choice of where to give birth and birthing method
Percentage of women in the last five years who have undergone an unofficial, unregulated abortion (age standardised rate per 1,000 women aged 15-44)