Reviews

The study investigates the magnitude of mortality differentials by wealth in Uzbekistan and compares it with similar indicators from sub-Saharan Africa, through data derived from Demographic and Health Surveys. An “Absolute Wealth Index” has been built from data on goods owned by households and quality of housing, and scaled from 0 to 12. Mortality differentials have been computed separately for children (survival of children) and for young adults (survival of parents). Death rates and nutritional status have been analysed according to the same absolute measure of wealth (the wealth index) and to relative measures (mortality ratios). Wealth is distributed evenly in Uzbekistan, with a symmetric distribution around a mean of 5.5 modern goods owned. In Africa, on the contrary, the wealth index distribution has a lower mean (2.5), and is highly skewed towards the left, revealing a high proportion of very poor people. Adult and child mortality levels are lower in Uzbekistan. Despite these major differences, the relationships between mortality indicators and the wealth index are similar in both situations. The magnitude of mortality differentials is of the same order in both cases, with gradients ranging from 2.5 to 1 for child mortality, and 1.5 to 1 for adult mortality. However, mortality levels remain lower in Uzbekistan than in Africa at the same level of wealth for both children and adults. A similar relationship has been found between nutritional status and the wealth index in both cases. On the contrary, there is no difference by wealth in use of health services and level of education in Uzbekistan, whereas wealth gradients are steep for the same variables in Africa. The study suggests that mortality differentials are primarily due to nutritional status, and not to access and use of health services or to education. The discussion focuses on health and social policies during the colonial and post-colonial period that have produced these patterns.

The Redaction
CER: II-6.4.G-539