A socio-spatial analysis of social exclusion and inequity in health in Mexico

Objective: Determining the relationship between social exclusion and health inequity at state and municipal level in Mexico during recent years. Methods: Adjusted mortality rates were calculated for 2005 (related to transmissible illnesses in childhood, pregnancy, childbirth and being produced by causes considered potentially avoidable); rates were calculated by states, for states grouped in quartiles according to marginalisation level and for municipalities grouped according to degree of marginalisation. Indicators such as rate ratio, Gini coefficient and the inequities in health index (IHI) were used for measuring such inequity, Results: A clear excess of mortality was observed in the states grouped in the 4^th quartile (highest marginalisation) in relationship to the 1^st quartile (lowest marginalisation); conversely, resources and health services in the 1^st quartile were evidently higher than those in the 4^th quartile. The Gini coefficient reached its highest value in the mortality rate for nutritional anaemia (0.44). Excess mortality was evident in those municipalities considered as having very high marginalisation; the highest IHI was observed in the states located in the 4^th quartile (Chiapas, Oaxaca and Guerrero) when analysing mortality related to childhood, pregnancy, childbirth and potentially avoidable mortality. Conclusions: Notorious health inequality exists in Mexico, associated with high prevalent levels of social exclusion in different areas of the country. Deep structural changes are needed to modify this situation, promote social development and lead to reducing the unfair disadvantages to which important population groups are exposed.