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This is the first study to our knowledge to estimate the effect of country-specific health expenditures on life expectancies of men and women. Future work understanding the determinants of these differences has the potential to improve the overall efficiency and equity of national health systems.

Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The 2030 agenda for sustainable development. For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi’s equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda. In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi’s previous approach to measuring equity was the difference in vaccination coverage between a country’s richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time. Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool – the equity dashboard – to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d’Ivoire and Haiti.

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The impact of legislated minimum wages on the early-life health of children living in low and middle-income countries has not been examined. For our analyses, we used data from the Demographic and Household Surveys (DHS) from 57 countries conducted between 1999 and 2013. Our analyses focus on height-for-age z scores (HAZ) for children under 5 years of age who were surveyed as part of the DHS. To identify the causal effect of minimum wages, we utilized plausibly exogenous variation in the legislated minimum wages during each child's year of birth, the identifying assumption being that mothers do not time their births around changes in the minimum wage. As a sensitivity exercise, we also made within family comparisons (mother fixed effect models). Our final analysis on 49 countries reveal that a 1% increase in minimum wages was associated with 0.1% (95% CI = -0.2, 0) decrease in HAZ scores. Adverse effects of an increase in the minimum wage were observed among girls and for children of fathers who were less than 35 years old, mothers aged 20-29, parents who were married, parents who were less educated, and parents involved in manual work. We also explored heterogeneity by region and GDP per capita at baseline (1999). Adverse effects were concentrated in lower-income countries and were most pronounced in South Asia. By contrast, increases in the minimum wage improved children's HAZ in Latin America, and among children of parents working in a skilled sector. Our findings are inconsistent with the hypothesis that increases in the minimum wage unconditionally improve child health in lower-income countries, and highlight heterogeneity in the impact of minimum wages around the globe. Future work should involve country and occupation specific studies which can explore not only different outcomes such as infant mortality rates, but also explore the role of parental investments in shaping these effects.

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Background: In low and middle income countries, diarrheal disease and associated malnutrition remain leading causes of preventable morbidity and mortality among children under 5 years. In Peru, these conditions are more prevalent in children in rural areas, such as the Ancash region. For instance, while the number of years of life lost due to diarrheal diseases decreased significantly in Peru from 1990 to 2010, the prevalence of diarrhea in children under 5 years old in Ancash increased from 2009 (11%) to 2012 (14.2%). Additionally, 24.5% of children under 5 years of age in this region currently suffer from chronic malnutrition. We hypothesize that various observable elements related to food preparation and access, sanitation, and water in the home contribute to diarrheal episodes and associated malnutrition in children in the Ancash region.Methods: To explore this further, we conducted an observational convenience survey of 28 households in three small towns in Ancash, Peru. Visits were made to kitchen areas, animal housing areas, and bathrooms; cooking practices were directly observed; and a questionnaire was administered by a native Spanish speaker. Qualitative and quantitative data were obtained; quantitative data were analyzed using SPSS software. Findings:The results revealed a number of observable risk factors for fecal-oral contamination, including untreated water, periods of no access to water, animals near food preparation areas, and limited access to sewage collection and disposal systems.Interpretation: The information gathered from this survey will inform future efforts for designing public health interventions to prevent diarrheal disease and malnutrition in this area.