The Impact of Neighborhood Structure on Health Inequalities in Accra, Ghana

John R. Weeks, San Diego State University
Allan G. Hill, Harvard University
Douglas A. Stow, San Diego State University
Arthur Getis, San Diego State University

The literature on health inequalities in Africa and other developing regions of the world has overwhelmingly focused on urban-rural differentials, thus ignoring the tremendous variability (inequality) that almost certainly exists within cities of developing nations. We hypothesize that intra-urban variability is impacted by individual risk factors and by the structure of the neighborhood in which an individual lives. That structure includes the demographic composition of the neighborhood and the environmental context within which people live. We use data from the Women’s Health Survey of Accra in 2003 to provide individual-level data, data from the Ghana census of population and housing in 2000 to provide neighborhood demographic composition and contextual data, and data from a high-resolution satellite image acquired in 2002 to add another component of contextual data, and then test a two-level model to decompose the impact of neighborhood structure on health inequalities in Accra.