Social Capital and Health Inequalities in Developing Countries: A Case Study for Indonesia

Florence Jusot and Marta Menéndez develop and apply methods to measure the role of opportunities versus effort in creating inequalities in health.

Florence Jusot[1] and Marta Menéndez[2]

These authors develop and apply methods to measure the role of opportunities versus effort in creating inequalities in health. These extend from and go beyond previous studies of European countries (Jusot et al, 2013; Bricard et al, 2013) revised to work with the situations in developing countries, in this application, Indonesia. To achieve this, Jusot and Menéndez: 1. Devise a reasonably objective health measure based on locally available data that includes biomarkers as well as self-reported information; 2. Measure the extent to which health inequalities derive from things the individual has no control over, the “circumstances” such as parent health and education, as well as social capital; and 3. Decompose the variance in health into three related parts, each being the covariance of health with circumstances, demographics (age and gender), and residual unmeasured factors, such as “effort” chance and luck. This permits the calculation of the portion due to circumstances and of its parts, including the social capital. These would capture the inequitable parts.

The health of each Indonesian is found by econometrics from the predicting factors for the probability of him describing himself as very healthy. The groups of predictors used are: biomarker measures and a variety of “quasi-objective” self-descriptions capturing, among other things, difficulties in daily activities, body pains and other symptoms. Results show that, if unsurprisingly health inequalities are difficult to explain, the portion of health inequalities due to circumstances, though small in absolute numbers (about 10%), is reported as large in Indonesia compared to more developed countries (and this, having a smaller set of explanatory circumstance variables available in the data). With a contribution of over 50 to 60%, parental health (and specially maternal health) is the circumstance variable found to have the greatest impact on inequality of opportunities in health in Indonesia, while the leading circumstance in European countries is parental education. Demographic factors (accounting for over 20% of total variation), also play a greater role in Indonesia, and the portion due to social capital, though of second order importance, is not negligible (about 4%). The question of focus becomes “how social capital is measured”? There are two available indicators: Speaks Indonesian in the home, and the degree to which they are Christian and thus don’t share the share the dominant Indonesian religion, Islam. The first contributes positively to one’s perception of belonging to the community social life, the second does the opposite.

Conclusions:

These two authors introduce innovative methods into the studies of health inequalities in the developing world. They warn that much of this being new to these studies, results may differ from further work with similar focus. Fully comparable studies as well as contrasting methods and measures are needed. They point out the need to go beyond levels of health and focus on health inequalities in this area of research. Complete references can be found in the chapter.

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[1] Florence Jusot is Professor of Economics at PSL – Paris-Dauphine University and Associate Researcher at Leda-Legos, France.

[2] Marta Menéndez is Associate Professor of Economics at PSL – Dauphine University and Associate Researcher at Leda-DIAL, France.

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