Regional inequality in health and its determinants: evidence from China.

Health inequality is a problem with great political importance all over the world. Urban-rural inequality in health has attracted great attentions in recent years in China, but very few researches have been undertaken into regional discrepancies in health. This research aims at measuring the degree of regional health inequality in China and identifying its determinants. Indicators for health, socioeconomic status, health resources and health services delivery were selected through Delphi consultations from 18 experts. With cross-sectional data from 31 provinces, composite health indexes were generated. The regional inequality in health was described by Lorenz curve and measured by Gini coefficient. The determinants of health inequality were identified through canonical correlation analysis. The results showed that there existed distinct regional disparities in health in China, which were mainly reflected in "Maternal & Child Health" and "Infectious Diseases", not in the most commonly used health indicator average life expectancy. The regional health inequality in China was increasing with the rapid economic growth. The regional health inequality was associated with not only the distribution of wealth, but also the distribution of health resources and primary health care services. Policy makers need to be aware of three major challenges when they try to achieve and maintain equality in distribution of health: First, the most commonly used health indicators are not necessarily sensitive enough to detect health inequalities. Second, increase in health inequality is often accompanied with rapid economic growth and increase in life expectancy. Countries in transition are facing the greatest challenge in developing a fair and equitable health care system. Finally, investment in health resources does bring about differences in distribution of health. However, primary health care plays a more important role than hospital services in reducing regional disparities in health.