Structural drivers of health inequality in sub-Saharan Africa: evidence and policy implications

Abstract

Health inequalities remain a major challenge in global development, particularly in sub-Saharan Africa (SSA), where disparities are exacerbated by limited access to healthcare and widespread socioeconomic inequities. This study examines health inequality in 10 SSA countries using Body Mass Index as a health outcome. Drawing on data from the Demographic and Health Surveys, we employ conditional inference trees to assess the extent of health disparities by classifying populations into groups based on shared socioeconomic status, demographic characteristics, and lifestyle choices. Our analysis reveals significant health inequality, particularly in Mauritania, Eswatini, and Kenya, while Egypt emerges as the most equal country in terms of health outcomes. Furthermore, our findings show that disparities are largely driven by illegitimate sources of inequality, such as wealth and education, while legitimate factors linked to personal decisions have a minimal impact. Demographic factors, particularly age, are the largest contributors to health disparities in most countries, with gender also standing as a major determinant in many countries. These findings underscore the need for targeted health policies that address the root causes of inequality, such as expanding access to healthcare, implementing social protection programs, and promoting gender equality in health.