Wealth Inequality, Conflict and Population Health in Sudan

Abstract

Background: Researchers have demonstrated an association between income inequality and poor health outcomes over recent decades. We sought to understand the effects on health of both inequality and political armed conflict in Sudan, a northeast African country with seven international borders. Sudan's 31 million people represent diverse cultures, both Arabic and African. Sudan is a poor country, with a Human Development index of 0.41, ranking 171st of 187 countries. The country has suffered political instability since independence from Britain in 1956, with two revolutions and a 40-year civil war. Armed conflict in western Sudan and states bordering South Sudan are ongoing. Methods: Data on 13,282 under five children were derived from the Sudan household survey round 2 (SHHS2), conducted between March and May 2010. The household assets index from that study was used as the indicator of living standards inequality. We also used data from the Sudan census conducted in 2008. We evaluated the role of both asset distribution and armed conflict in six health-related outcomes: life expectancy, infant mortality, teenage birth, height for age (stunting), vaccination coverage for children aged 12 to 23 months, and adequacy of food consumption. Results: For four of our six measures of health in Sudan (food consumption, life expectancy, teen births and infant mortality), outcomes were significantly worse in the states with more skewness of wealth distribution, with correlation coefficients above .70 in all cases. For the two remaining health indicators, (height-for-age z scores or stunting, and vaccination coverage), we found weaker correlations with wealth skewness until we removed the conflict-affected states from the analysis. After removing those three states, the correlation coefficients on the stunting was significantly high again of .82 however there was no big difference for vaccination. Conclusion: Wealth inequality and armed conflict are associated with poor population health in Sudan. Policies and public health strategies are required to address the distribution of resources and associated health problems. Wealth redistribution in the more unequal states, as well as a political resolution of conflict, may improve population health.