Health inequality in the tropics and its costs: a Sustainable Development Goals alert

Callander, Emily J., and Topp, Stephanie M. (2020) Health inequality in the tropics and its costs: a Sustainable Development Goals alert. International Health, 12 (5). pp. 395-410.

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Background: It is known that health impacts economic performance. This article aims to assess the current state of health inequality in the tropics, defined as the countries located between the Tropic of Cancer and the Tropic of Capricorn, and estimate the impact of this inequality on gross domestic product (GDP).

Methods: We constructed a series of concentration indices showing between-country inequalities in disability-adjusted life years (DALYs), taken from the Global Burden of Disease Study. We then utilized a non-linear least squares model to estimate the influence of health on GDP and counterfactual analysis to assess the GDP for each country had there been no between-country inequality.

Results: The poorest 25% of the tropical population had 68% of the all-cause DALYs burden in 2015; 82% of the communicable, maternal, neonatal and nutritional DALYs burden; 55% of the non-communicable disease DALYs burden and 61% of the injury DALYs burden. An increase in the all-cause DALYs rate of 1/1000 resulted in a 0.05% decrease in GDP. If there were no inequality between countries in all-cause DALY rates, most high-income countries would see a modest increase in GDP, with low- and middle-income countries estimated to see larger increases.

Conclusions: There are large and growing inequalities in health in the tropics and this has significant economic cost for lower-income countries.

Item ID: 61476
Item Type: Article (Research - C1)
ISSN: 1876-3405
Copyright Information: © The Author(s) 2020. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work isproperly cited. For commercial re-use, please contact
Funders: National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC APP1159536
Date Deposited: 21 Jan 2020 23:47
FoR Codes: 38 ECONOMICS > 3801 Applied economics > 380108 Health economics @ 40%
44 HUMAN SOCIETY > 4407 Policy and administration > 440706 Health policy @ 30%
42 HEALTH SCIENCES > 4206 Public health > 420602 Health equity @ 30%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920408 Health Status (e.g. Indicators of Well-Being) @ 40%
92 HEALTH > 9202 Health and Support Services > 920206 Health Policy Economic Outcomes @ 60%
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