Social stratification, development and health in Pakistan: an empirical exploration of relationships in population-based national health examination survey data

There is a growing literature on an overall direct relationship between health and social position in developed countries. The relationship, however, is less well documented in developing countries where social hierarchies are changing more rapidly, demographic and health transitions are less advanced, and this topic has received less attention from researchers than in some developed countries. This paper presents an empirical investigation of the relationship between social stratification and social development and population health using data on over 6000 adults from the National Health Survey of Pakistan, a nationally representative health examination survey of people in that country. We analyze four indicators of poor nutrition in adults from this data set. The findings reveal complex relationships among social development, social stratification and the consequences for the health of the people of Pakistan. Underweight is related to economic status, anemia to education and social development, and both severe dental caries and a monotonous diet are related to both development and economic status which interact with each other. These results suggest that continued conceptual refinement and the development of standardized measures of stratification and development would contribute to building cross-nationally comparable data sets addressing issues of the relationship among health and economic development and health transitions. (C) 2003 Elsevier Science Ltd. All rights reserved.