Use of self-rated health in monitoring health inequities internationally: Lessons from a Lebanese population-based study

Monitoring health inequities in developing countries is an international health priority. In countries lacking in database infrastructure, self-rated health (SRH) is employed in population-based surveys to compare health between population groups. Recent epidemiologic evidence from developed countries has raised concerns about the appropriateness of subjective measures in monitoring inequities in health and argued that SRH underestimates the magnitude of these inequities. Yet, the use of SRH is expected to increase in developing countries where reliable morbidity and mortality data are lacking. This is the case in countries of the Arab region. We employed data from the Lebanese PapFam-Women (2004) to examine whether SRH is a reliable predictor of physician-diagnosed chronic illness across income and education groups in Lebanon. The PapFam-Women is a population-based probability sample survey (N = 3365) of 15-54 year-old ever-married Lebanese women. We carried out multivariate analyses to test for differences in the association between SRH and chronic illness across socioeconomic groups, controlling for age and other demographic variables. Our findings revealed that the associations between SRH and chronic illness did not differ in magnitude or direction across income and education categories. We conclude that SRH is a reliable predictor of objective health outcomes and an appropriate measure to use in the context of Lebanon to compare the health between income and education groups. Concerned researchers in countries with limited database infrastructures can employ SRH in research while advocating for better reporting of objective morbidity and mortality data.