Quantifying environmental health impacts

Poverty: Assessing the distribution of health risks by socioeconomic position at national and local levels

Environmental burden of disease series No. 10

By Tony Blakely, Simon Hales and Alistair Woodward

ebd 10 cover


Socioeconomic status is an important determinant of the likelihood that individuals and populations are exposed to environmental and other risk factors for health. In this guide, we describe a method for measuring the distribution of health risk factors as a function of socioeconomic position. An overview of the method and its requirements are first described, followed by a step-by-step numerical example that uses data for Pakistan. In the numerical example, we focus on income poverty as the measure of socioeconomic position, and we use child malnutrition as the health risk factor. The example uses World Bank estimates of income poverty, individuallevel survey data on the distribution of risk factors by socioeconomic position, and external estimates of the prevalence of the risk factor. From this information, we estimate the risk factor prevalence by category of income poverty, as well as the impact fractions (or attributable risks). Problems in estimating the disease burden of socioeconomic position are also discussed.

We hope the method will be used and further developed by others, so that the contribution of socioeconomic position to the distribution of health risk factors and to the burden of disease will be better understood. A description of how health risk factors are distributed by socioeconomic position will illustrate how poverty contributes to poor health and, hopefully, encourage policy-makers to undertake intersectoral policies to improve population health, as well as public-health policies to reduce or prevent health inequalities.