A new inequity-in-health index based on Millenium Development Goals: Methodology and validation

Objectives: Developing a new Inequity-in-Health Index (IHI) assuming inequity as ‘‘inequality of health outcomes,’’ based on Millennium
Development Goals (MDG).
Study Design and Setting: Ecological study. Countries from around the world were included from United Nations, the World Bank,
and a nonprofit organization’s databases. The reliability and validity of this bidimensional IHI was tested. Main factor analysis (promax
rotation) and main component analysis were used.
Results: Six variables were used for constructing the IHI: underweight children, child mortality, death from malaria in children aged 0-4, death from malaria at all ages, births attended by skilled health personnel, and immunization against measles. The IHI had high internal consistency (Cronbach’s alpha = 0.8504), was reliable (Spearman=0.9, P =0.0000), and
had 0.3033pi around the world (range: 0 - 0.5984pi). IHI had high correlation with the human development and poverty indexes, health gap indicator, life expectancy at birth, probability of dying before 40 years of age, and Gini coefficients (Spearman=0.7, P= 0.0000). IHI discriminated countries by income, region, indebtedness, and corruption level (Kruskal Wallis, P=0.01). IHI had sensitivity to change (P=0.0000).
Conclusion: IHI is a bidimensional, valid and reliable index to monitor MDG. A new reliable methodology for developing bidimensional
indicators is shown, which could be used for constructing other ones with their corresponding scores and graphs.
Keywords: Inequalities; Health status; Countries; Indicators; Outcome research; Health status indicators