Measuring Urban Health Differentials: Conceptual and Analytical Challenges Illustrated from a Study of Accra, Ghana

Samuel Agyei-Mensah, University of Ghana
Allan G. Hill, Harvard University
John K. Anarfi, University of Ghana
Rosemary Duda, Harvard Medical School

Assessments of population health draw on data from diverse sources. Most demographic and health data can be located in space, even in low-income countries. We have already shown how an understanding of the interaction of individual and community-level factors at different levels can provide new insights into the fertility transitions. From this new study of the health of women in Accra, we report on measuring and accounting for intra-urban health differentials. The structure of the survey instruments required re-thinking of the domains of health that can be reliably assessed from self-report studies. To standardize for social class variations in health status reporting was tested using "anchoring vignettes". The study included home interviews and objective evaluations of the health of 3200 women aged 18 and over by physicians. This analysis revealed the need for a clear specification of the models needed to explain both differentials and changes in population health.