Health inequities across the socioeconomic gradient in low- and middle-income arab countries: Syria, Lebanon, and OPT

A persistent view in the social determinants of health literature is that social inequities are important determinants of health (SDH) in wealthy countries whereas poverty remains the most important to address in low- and middle-income countries. In this study, we empirically tested the hypothesis that relative position in society and the social gradient are important SDH in low- and middle-income Arab countries. We employed population-based data collected by the Arab league among women of reproductive age in Syria (N=6953), Lebanon (N=3499), and Occupied Palestinian Territory (N=5098); sampling followed a stratified, multi-stage, probability design. In multivariable analyses, we examined the pattern of the relationship between self-rated health status (SRH) and two measures of social position (education and household wealth). Our results show a clear social gradient in SRH inequities. Poverty is not the only determinant of poor SRH. Those who are positioned in the middle of the social hierarchy also report poorer SRH compared to those with higher education (ORs ranged from 1.42 to 1.92 and were all statistically significant) and household wealth (ORs ranged from 1.20 to 2.10; five out of six were statistically significant). Relative position in the social hierarchy is an important determinant of health. In the paper (and presentation) we discuss alternative explanations for the findings and emphasize the importance of addressing social inequities in health within Arab countries, more so now that the whole region is in the throes of major social and political transformations.