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Statistics, Development and Human Rights

3

17.1

16.3

14.1

11.0

12.5

13.9

7.5

10.2

8.7

8.6

4

17.9

22.1

11.7

10.8

10.4

11.3

10.1

10.6

10.3

8.2

5

17.1

19.8

16.0

11.4

11.3

12.2

10.7

12.2

8.5

9.2

Source: Jamaica Survey of Living Conditions, 1989-1998. Planning Institute of  Jamaica.

Not only is this last bit of information unusual given the  abundance of evidence that a close and inverse relationship between socio-economic status and health is probably universal [Marmot et al 1997; Wilkinson, 1996; Drever & Whitehead 1997; Acheson 1999], but it is also questionable since other available aggregate data from public facilities suggest rising rates for chronic non-communicable diseases, and for communicable diseases such as acute respiratory tract infections, gastroenteritis  and HIV/STDs. The morbidity and mortality rates resulting from violence and injury have also increased exponentially to the point where it is currently the leading cause of reported morbidity [Economic and Social Surveys of Jamaica].

A more likely explanation of the falling illness rates reported may well lie in changing perceptions and definitions of illness. Recent qualitative data [Le Franc and Lalta, in progress] show that straitened economic circumstances among the poor tend to lead to delays in the search for care, and redefinition of the meaning and urgency of “being ill”. Support for this line of argument may be found in the fall-off  (over the 1992-98 period) in the proportion of those seeking primary care: from 70% to 60% in the poorest quintile, as compared with 80% to 73% in the top quintile. In fact, the poor have consistently been less likely to seek care, and have more mean days of illness. Most striking however is that the poor tend to have higher hospitalisation rates, and while those rates have remained fairly constant for the richest group, they have significantly increased among the poor. The data are presented in Table 4.

Table 4 – health seeking behaviours, hospital use and illness burden – 1989 -1998

Year

% Seeking Care

% Seeking Primary care

Hospitalisation Rate (%)a

Mean Days of Illness

Q1

Q5

Q1

Q5

Q1

Q5

Q1

Q5

1992

35

60

70

80

4

4

12

10

1993

39

60

47

70

2

4

12

10

1994

44

63

73

83

13

3

12

9

1995

54

58

72

81

8

4

11

10

1996

53

63

72

84

3

5

10

11

1997

48

65

66

74

9

7

13

8

1998

58

65

60

73

10

6

12

9

a)

Expressed as percentage of those reporting an illness

Source: Jamaica Surveys of Living Conditions. 1992-1998

Theodore [1997] has used the SLC data as well as other hospital data to assist his analysis of the impact of the introduction of user charges, and the increasing use of private health facilities that has followed on  the deterioration of the public ones. He arrived at similar conclusions: “The poor have found it prohibitively difficult  to access health care over the  period….severity of illness has increased, and a disproportionate  share of the increase is borne by persons belonging to the two poorest quintiles…. The highest levels of hospitalisation [also] occurred among persons belonging to the first two quintiles” (p. 21).

7. Improved Consumption Levels and Education

Montreux, 4. – 8. 9. 2000

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