Vol.2, No.4, 356-365 (2010) Health
doi:10.4236/health.2010.24054
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Health of children less than 5 years old in an upper
middle income country: parents’ views
Paul Andrew Bourne
Department of Community Health and Psychiatry , Faculty of Medical Sciences, Kingston, Jamaica;
Received 25 November 2009; revised 10 December 2009; accepted 16 December 2009.
ABSTRACT
Health literature in the Caribbean, and in par-
ticular Jamaica, has continued to use objective
indices such as mortality and morbidity to ex-
amine children’s health. The current study uses
subjective indices such as parent-reported
health conditions and health status to evaluate
the health of children instead of traditional ob-
jective indices. The study seeks 1) to examine
the health and health care-seeking behaviour of
the sample from the parents’ viewpoints; and 2)
to compute the mean age of the sample with a
particular illness and describe whether there is
an epidemiological shift in these conditions.
Two nationally representative cross-sectional
surveys were used for this study (2002 and
2007). The sample for the current study is 3,062
respondents aged less than 5 years. For 2002,
the study extracted a sample of 2,448 under 5
year olds from the national survey of 25,018
respondents, and 614 under 5 year olds were
extracted from the 2007 survey of 6,728 re-
spondents. Parents-reported information was
used to measure issues on children under 5
years old. In 2007, 43.4% of the sample had very
good health status; 46.7% good health status;
2.5% poor health and 0.3% very poor health
status. Almost 15% of children had illnesses in
2002, and 6% more had illnesses in 2007 over
2002. In 2002, the percentage of the sample with
particular chronic illnesses was: diabetes mel-
litus (0.6%); hypertension (0.3%) and arthritis
(0.3%). However, none was recorded in 2007.
The mean age of children less than 5 years old
with acute health conditions (i.e. diarrhoea,
respiratory diseases and influenza) increased
over 2002. In 2007, 43.4% of children less than 5
years old had very good health status; 46.7%
good health statu s; 7.1% fair health status; 2.5%
poor and 0.3% very poor health status. The as-
sociation between health status and parent-
reported illness was –x2 (df = 4) = 57.494, P<
0.001-with the relationship being a weak one,
correlation coefficient=0.297. A cross-tabulation
between health status and parent-reported di-
agnosed illness found that a significant statis-
tical correlation existed between the two vari-
ables –x2 (df = 16) = 26.621, P < 0.05, cc = 0.422,
– with the association being a moderate one,
correlation coefficient = 0.422. A cross tabula-
tion between health status and health care-
seeking behaviour found a significant statistical
association between the t wo variables –x2 (df = 4)
= 10.513, P < 0.033-with the correlation being a
weak one-correlation coefficient = 0.281. Rural
children had the least health status. The health
disparity that existed between rural and urban
less than 5 year olds showed that this will not
be removed simply because of the abolition of
health care utilization fees.
Keywords: Health Conditions; Acute Condition;
Chronic Conditions; Health Status; Child Health;
Jamaica
1. INTRODUCTION
In many contemporary nations, objective indices such
as life expectancy, mortality and diagnosed morbidity
are still being widely used to measure the health of
people, a society and/or a nation [1-6]. The World
Health Organisation (WHO) in the Preamble to its
Constitution in the 1940s wrote that health is more
important than disease, as it expands to the social,
psychological and physical wellbeing of an individual
[7]; and lately that during the 21st century the emphas is
must be on healthy life expectancy [8,9]. In keeping
with its opined emphasis, the WHO formulated a
mathematical approach that diminished life expectancy
by the length and severity of time spent in illness as
the new thrust in measuring and examining health.
Although healthy life expectancy removes time spent

P. A. Bourne / Health 2 (2010) 356-365
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357
in illness and severity of dysfunctions, it fundamen-
tally rests on mortality. The WHO therefore, instead of
moving forward, has given some scholars, who are
inclined to use objective indices in measuring health, a
guilty feeling about continuing this practice.
The Caribbean, and in particular Jamaica, continues to
use mortality and morbidity to measure the health of
children or infants [1-6]. The use of mortality, morbidity
and life expectancy is the practice of Caribbean scholars,
and is widely used in Jamaica by the: Ministry of Health
(MOHJ) [10]; Statistical Institute of Jamaica (STATIN)
[11]; Planning Institute of Jamaica (PIOJ) [12]; PIOJ and
STATIN [13] as well as the Pan American Health Or-
ganization (PAHO) [14] in measuring health. In spite of
the conceptual definition opined by the WHO in the
Preamble to its Constitution in 1946, the health of chil-
dren who are less than 5 years old in Jamaica is still
measured primarily by using mortality and morbidity
statistics. Recently a book entitled ‘Health Issues in the
Caribbean’ [15] had a section on Child Health; however
the articles were on 1) nutrition and child health devel-
opment [16] and 2) school achievement and behaviour in
Jamaican children [17], indicating the void in health
literature regarding health cond itions.
An extensive review of health literature in the Carib-
bean region found no study that has used national survey
data to examine the health status of children less than 5
years of age. The current study fills this gap in the lit-
erature by examining the health status of children less
than 5 years of age using cross-sectional survey data
which are based on the views of patients. The objectives
of this study are 1) to examine the health and health
care-seeking behaviour of the sample; and 2) to evaluate
the mean age of the sample with a particular illness and
to describe whether there is an epidemiological shift in
these conditions.
2. MATERIALS AND METHODS
2.1. Sample
The current study used two secondary nationally repre-
sentative cross-sectional surveys (for 2002 and 2007) to
carry out this work. The sub-samples are children less
than 5 years old, and th e only criterion for selection was
being less than 5 years old. The sample in the current
study is 3,062 respondents of ages less than 5 years. For
2002, a sub-sample of 2,448 less than-5 year olds was
extracted from the national survey of 25,018 respondents
in 2002, and information on 614 less than-5 year olds
was extracted from the 2007 survey. The survey (Ja-
maica Survey of Living Conditions) began in 1989 to
collect data from Jamaicans in order to assess govern-
ment policies. Since 1989, the JSLC has added a new
module each year in order to examine that phenomenon,
which is critical within the nation [18,19]. In 2002, the
focus was on 1) social safety nets, and 2) crime and vic-
timization, while for 2007, the re wa s no foc u s.
2.2. Methods
Stratified random sampling technique was used to draw
the sample for the JSLC. This design was a two-stage
stratified random sampling design where there was a
Primary Sampling Unit (PSU) and a selection of dwell-
ings from the primary units. The PSU is an Enumeration
District (ED), which comprises a minimum of 100 resi-
dences in rural areas and 150 in urban areas. An ED is an
independent geographical unit that shares a common
boundary. This means that the country was grouped into
strata of equal size based on dwellings (EDs). Based on
the PSUs, a listing of all the dwellings was made, and
this became the sampling frame from which a Master
Sample of dwellings was compiled, which in turn pro-
vided the sampling frame for the labour force. One third
of the Labour Force Survey (i.e. LFS) was selected for
the JSLC [18,19]. The sample was weighted to reflect
the population of the nation [18-20] .
The JSLC 2007 was conducted in May and Augu st of
that year; while the JSLC 2002 was administered be-
tween July and October of that year. The researchers
chose this survey based on the fact that it is the latest
survey on the national population, and that that it has
data on the self-reported health status of Jamaicans. An
administered questionnaire was used to collect the data
from parents on children less than 5 years old, and the
data were stored, retrieved and analyzed using SPSS for
Windows 16.0 (SPSS Inc; Chicago, IL, USA). The ques-
tionnaire was modelled on the World Bank’s Living
Standards Measurement Study (LSMS) household sur-
vey. There are some modifications to the LSMS, as the
JSLC is more focused on policy impacts. The question-
naire covered areas of socio-demographic variables-such
as education; daily expenses (for the past 7 days); food
and other consumption expenditures; inventory of dura-
ble goods; health variables; crime and victimization;
social safety net and anthropometry. The non-response
rates for the 2002 and 2007 surveys were 26.2% and
27.7% respectively. The non-response includes refusals
and cases rejected in data cleaning.
2.3. Measures
Social class: This variable was measured based on the
income quintiles: The upper classes were those in the
wealthy quintiles (quintiles 4 and 5); the middle class
was quintile 3 and the poor were the lower quintiles
(quintiles 1 and 2).
Age is a continuous variable in years.
Health conditions (i.e. parent-reported illness or par-
ent-reported dysfunction): The question was asked: “Is
this a diagnosed recurring illness?” The answering options
are: Yes, Cold; Yes, Diarrhoea; Yes, Asthma; Yes, Diabe-
tes; Yes, Hypertension; Yes, Arthritis; Yes, Other; and No.

P. A. Bourne / Health 2 (2010) 356-365
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358
Self-rated health status: “How is your health in gen-
eral?” And the options were: Very Good; Good; Fair;
Poor and Very Poor.
Medical care-seeking behaviour was taken from the
question ‘Has a health care practitioner, healer or phar-
macist been visited in the last 4 weeks? ’ with there being
two options: Yes or No.
Parent-reported illness status. The question is ‘Have
you had any illness other than due to injury (for example
a cold, diarrhoea, asthma, hypertension, diabetes or any
other illness) in the past four weeks? Here the options
were Ye s or No.
2.4. Statistical Analysis
Descriptive statistics, such as mean, standard deviation
(SD), frequency and percentage were used to analyze
the socio-demographic characteristics of the sample.
Chi-square was used to examine the association be-
tween non-metric variables, and Analysis of Variance
(ANOVA) was used to test the relationships between
metric and non-dichotomous categorical variables,
whereas an independent sample t-test was used to ex-
amine the statistical correlation between a metric vari-
able and a dichotomous categorical variable. The level
of significance used in this research was 5% (i.e. 95%
confid enc e inte rval ).
3. RESULTS
3.1. Demographic Characteristic of Sample
In 2002, the sex ratio was 98.8 males (less than 5 years
old) to 100 females (less than 5 years old), which shifted
to 116.2 less than-5 year old males to 100 less than-5
year old females. The sample over the 6 year period
(2002 to 2007) revealed internal migrations to urban
zones (Ta bl e 1 ): In 2002, 59.6% of respondents resided
with their parents and/or guardians in rural areas, which
declined to 5.07%. The percentage of children less than
5 years of age whose parents were in the poorest 20%
fell to 25.4% in 2007 over 29.6% in 2002. In 2007 over
2002, 1.7 times less children less than 5 years of age
were taken to public hospitals, compared to 1.2 times
less taken to private hospitals (Tab le 1 ). Approximately
6% more children less than 5 years were ill in 2007 over
2002. Based on Tabl e 1, less than-5 year olds with par-
ticular chronic illnesses had: diabetes mellitus (0.6%);
hypertension (0.3%) and arthritis (0.3%). Howev er, none
was recorded in 2007.
There were some occasions on which the response
rates were less than 50%: In 2002, health care-seeking
behaviour was 14.3%; parent-reported diagnosed health
conditions, 14.2%; and visits to health care institutions,
8.9% (Table 1). For 2007, the response rate for health
care-seeking behaviour was 20.2%; parent-reported di-
agnosed health condition s, 20.2%, and less than 11% for
cost of medical care.
3.2. Health Conditions
Based on Ta b l e 1 , the percentage of less than-5 year olds
with particular acute conditions saw a decline in colds and
asthmatic cases, as well as chronic conditions. Figure 1
revealed that in 2007 the mean age of children less than 5
years old with acut e health conditions (i. e. diarrhoea, respi-
ratory diseases and influenza) increased ov er 2002. On the
other hand, the mean age of those with unspecified illnesses
declined from 1.76 years (SD = 1.36 years) to 1.64 years
(SD = 1.36 years). Concomitantly, the greatest mean age of
the sample was 2.71 years (SD = 1.21 years) for asthmatics
in 2007 and 2.59 years (1.24 years) in 2002. It should be
noted here that the me an age of a child less than 5 years of
age in 2002 with diabetes mellitus was 1.50 years (2.12
years).
3.3. Health Status
In 2002, the JSLC did not collect data on the general
health status of Jamaicans, although this was done in
2007. Therefore, no figures were available for health
status for 2002. In 2007, 43.4% of children less than 5
years old had very good health status; 46.7% good health
status; 7.1% fair health status; 2.5% poor and 0.3% very
poor health status. The response rate for the h ealth status
question was 96.9%.
Ninety-seven percent of the sample wa s used to exa mine
the association between health status and parent- reported
illness –x2 (df = 4) = 57.494, P < 0.001-with the rela ti o ns hi p
being a weak one, correlation coefficient = 0.297. Tab le 2
revealed that 24.2% of children less than 5 years of age
who reported an illness had very good health status, com-
pared t o 2 times more of th ose wh o did no t repo rt an ill ness.
One percent of parents ind icated that their children (of le ss
than 5 years) who had no illness had poor health status,
compared to 5.6 times more of those with illness who had
poor health status.
3.4. Health Conditions, Health Status and
Medical Care-Seeking Behaviour
A cross-tabulation between health status and parent-
reported diagnosed illness found that a significant statis-
tical correlation existed between the two variables –x2
(df =16)=26.621, P < 0.05, cc=0.422, -with the associa-
tion being a moderate one, correlation coefficient=0.422
(Ta b l e 3 ). Based on Ta b l e 3 , children less than 5 years
old with asthma were less likely to report very good
health status (5.9%), compared to those with colds
(30.5%); diarrhoea (22.2%); and unspecified health con-
ditions (22.7%).
When health status by parent-reported illness (in %)
was examined by gender, a significant statistical rela-
tionship was found, P < 0.001: males –x2 (df = 4)

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Table 1. Socio-demographic characteristic of sample, 2002 and 2007.
2002 2007
Variable n % n %
Sex
Male 1216 49.7 330 53.7
Female 1231 50.3 284 46.7
Income quintile
Poorest 20% 725 29.6 156 25.4
Poor 554 22.6 140 22.8
Middle 474 19.4 126 20.5
Wealthy 402 16.4 117 19.1
Wealthiest 20% 293 12.0 75 12.2
Self-reported illness
Yes 345 14.9 125 20.8
No 1969 85.0 475 79.2
Visits to health care facilities (hospitals)
Private, yes 17 7.8 5 6.7
Public, yes 100 46.3 20 26.7
Area of residence
Rural 1460 59.6 311 50.7
Semi-urban 682 27.9 125 20.4
Urban 306 12.5 178 29.0
Health (or, medical) care-seeking behaviour
Yes 221 63.3 76 61.3
No 128 36.7 48 38.7
Health insurance coverage
Yes, privat e 211 9.0 66 11.1
Yes, public * * 33 5.5
No 2123 91.0 496 83.4
Self-reported diagnosed health conditions
Acute
Cold 185 53.3 60 48.4
Diarrhoea 20 5.8 9 7.3
Asthma 46 13.3 17 13.7
Chronic
Diabetes mellitus 2 0.6 0 0
Hypertension 1 0.3 0 0
Arthritis 1 0.3 0 0
Other (unspecified) 54 15.6 22 17.7
Not diagnosed 38 11.0 16 12.9
Number of visits to health care institutions 1.53 (SD = 0.927 ) 1.43 (SD = 0.989 )
Duration of illness Mean (SD) 8.51 days (6.952 days) 8.07 days (7.058 d ays)
Cost of medical care
Public facilities Median (Range) in USD 2.36 (157.26)1 0.00 (64.62)2
Private facilities Median (Range) in USD 13.76 (117.95)1 10.56 (49.71)2
1USD1.00 = Ja. $50.87; 2USD1.00 = Ja. $80.47
*In 2002, all health insurance coverage was private and this was change in 2005 to include some public option.
=25.932, P < 0.05, cc = 0.320, and f emales –x2 (df = 4) =
39.675, P < 0.05, cc = 0.356. The health statuses of
males less than 5 years old in the very good and good
categories were greater than those of females (Figure 2).
However, the females had greater health statuses in fair
and poor health status than males, with more males re-
porting very poo r healt h stat us t han females.
Based on Figure 3, even after controlling health status
and parent-reported illness (in %) by area of residence, a
significant statistical association was found: urban –x2
(df = 3) = 10.358, P < 0.05, cc = 0.238; semi-urban –x2
(df = 3) = 9.887, P = 0.021, cc = 0. 273, and rural –x2 (df
= 3) = 45.978, P < 0.001, cc = 0.365. Concomitantly,
Table 2. Health status by self-reported illness.
Self-reported illness
Health status Yes
n (%) No n (%)
Very good 30 (24.2) 227 (48.3)
Good 61 (49.2) 217 (46.2)
Fair 23 (18.5) 19 (4.0)
Poor 9 (7.3) 6 (1.3)
Very poor 1 (0.1) 1 (0.2)
Total 124 470
x2 (df = 4) = 57.494, P < 0.001, cc = 0.297, n = 594

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Figure 1. Mean age of health conditions of children less than 5 years old, 2002 and 2007.
Table 3. Health status by self-reported diagnosed illness.
Self-reported diagnosed illness
Health
status Cold Diarrhoea Asthma Unspecified No
Very
good 18 (30.5) 2 (22.2) 1 (5.9) 5 (22.7) 5 (31.3)
Good 31
(52.5) 5 (55.6) 4 (23.5) 11 (50.0) 8 (50.0)
Fair 7
(11.9) 2 (22.2) 8 (47.1) 3 (13.6) 3 (18.8)
Poor 2
(3.4) 0 (0.0) 4 (23.5) 3 (13.6) 0 (0.0)
Very
good 1 (1.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
Total 59 9 17 22 16
children less than 5 years of age were the least likely to
have very good health status (19.4%) compared to rural
(25.8%) and semi-urban children (25.9%). Furthermore,
the respondents who resided in urban areas were 2.1
times more likely to have parent-reported very poor
health status, compared to rural respondents.
In examining health status and reported illness (in %)
by social classes, significant statistical relationships were
found, P < 0.05: poor-to-poorest classes –x2 (df = 4) =
52.374, P = 0.021, cc = 0.393; middle class –x 2 (df = 3)
= 8.821, P = 0.032, cc = 0.259, and wealthy class –x2 (df
= 3) = 10.691, P = 0.02, cc = 0.234. Based on Figure 4,
middle class children who are less than 5 years old had
the greatest very good health status (37%) compared to
the wealthy class (26.8%) and the poor-to-poorest
classes (16.1%). Fourteen percent of poor-to-poorest
class children who are less than 5 years old had at most
poor health status compared to 0% of the middle class
and 4.9% of the wealthy class, while 1.8% of poor-to-
poorest classes less than 5 years of age had very poor
health status.
When health status and parent-reported illness was
examined by age, sex, social class, and area of residence,
the correlation was a weak one-correlation coefficient =
0.295, P < 0.001, n=583. A cross tabulation between
health status and health care-seeking behaviour found a
significant statistical association between the two vari-
ables –x2 (df=4) = 10.513, P < 0.033-with the correlation
being a weak one-correlation coefficient = 0.281. A child
less than 5 years old was 2.44 times more likely to be
taken for medical care if he/she had at most poor health
status. On the other hand, a child who had very good
health status was 1.97 times more likely not to be taken
to health care practitioners (Figure 5).
In 2007, an examination of the health care-seeking
behaviour and parent-reported illness of the sample re-
vealed no statistical correlation –x2 (df = 1) = 0.430, P =
0.618. Sixty-two percent of the sample, who was ill, was
taken to health care p ractitioners, while 38.5% were no t.
On the other hand, more were taken for medical care
than in 2007 in the 4-week period of the survey. No sta-
tistical correlation was noted for the aforementioned
variables in 2002 –x2 (df = 1)=1.188, P=0.276. Of those
who reported ill, 63.7% were taken to health care practi-
tioners.

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361
4. DISCUSSIONS
Infant mortality has been declining since the 1970s, and
this has further decreased since 2004 [14]; this, as the
literature shows, is not a good measure of health. The
current study found that, using general health status,
children less than 5 years of age in Jamaica had good
health. The findings revealed that 90 out of every 100
less than-5 year olds had at least good h ealth status, with
44 out of every 100 having very good health status. In
spite of the good health status of less than-5 year olds in
Jamaica in 2007, 20.8% of them had an illness in the
Figure 2. Health status by Parent-reported illness (in %) examined by gender.
Figure 3. Health status by parent-reported illness (in %) examined by area of residence.

P. A. Bourne / Health 2 (2010) **-**
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362
Figure 4. Health status by parent-reported illness (in %) examined by social classes.
Figure 5. Health status by health care-seeking behaviour.
4-week period of the survey, which is a 5.9% increase
over 2002. It is interesting to note the shift in this study
away from specific chronic illnesses. In 2002, 30 out of
every 1,000 less than-5 year olds in Jamaica were diag-
nosed with hypertension and arthritis (i.e. parentre-
ported), with 60 out of 1,000 having been parent-reported
with diabetes mellitus. None such cases were found in
2007, suggesting that in the case of the children who had

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363
363
those particular ch ronic illnesses, their parents had eith er
migrated with them or they had died. Concomitantly, the
country is seeing a reduction in children less th an 5 years
old with colds; however, marginal increases were seen in
diarrhoea, asthma and unspecified health conditions over
the last 6 years. Although there were increased reported
cases of illness over the studied period, in 2007, 62 out
of every 100 ill children were taken to medical practi-
tioners, and this fell from 64 in every 100 in 2002. One
of the arguments put forward by some people is that
what retards or abates health care-seeking behaviour is
medical cost. With the abolition of health care user fees
for children since 2007, the culture must be playing a
role in parents and/or guardians not taking children who
are ill to medical care facilities for treatment.
Medical cost cannot be divorced from the expenditure
that must be incurred in taking the child to the health
care facility. In 2007, 25 out of every 100 children less
than 5 years of age had parents and/or guardians who
were less than the poverty line. Although this has de-
clined by 4.2% since 2002, it nevertheless means that
there are children whose parents are incapacitated by
other factors. Marmot [21] opined that the financial in-
ability of the poor is what accounts for their lowered
health status, compared to other social classes. The cur-
rent study concurs with the findings of Marmot, as it was
revealed that children less than 5 years of age from poor
households had the least health status. This means that
poverty is not merely eroding the health status of poor
Jamaicans, but that equally it is decreasing the health
status of poor children.
Rural poverty in Jamaica is at least twice as great as
urban poverty, and approximately 4 times more than
semi-urban [13], which provides another explanation for
the poor health status of ch ildren less than 5 years of age.
The current study found that 3.2% of those children
dwelling in urban zones recorded at most poor health
status, compared to 13.6% of rural children, suggesting
that the health status of the latter group is 4.3 times
worse than the former. This means that poverty in rural
zones is exponential, eroding the quality of life of chil-
dren who are less than 5 years old. Poverty in semi-ur-
ban areas was 4% which is 2.5 times less than that for
the nation; and those less than 5 years of age recorded
the greatest health status, supporting Marmot’s perspec-
tive that poverty erodes the health status of a people.
Hence, the decline in health care-seeking behaviour for
this sample is embedded in the financial constraints of
parents and/or guardians as well as their geographical
challenges. The terrain in rural zones in Jamaica is such
that medical care facilities are not easily accessible to
residents compared to urban dwellers. With this terrain
constraint comes the additional financial burden of at-
tending medical care facilities at a location which is not
in close proximity to the home of rural residents, and
this accounts for the vast health disparity between rural
and urban children. As a result of the above, the removal
of health care utilization fees for children less than 18
years of age does not correspond to an increased utiliza-
tion of medical care services, or lowered numbers of
unhealthy children less than 5 years of age. If rural par-
ents are plagued with financial and location challenges,
their children will not have been immunized or properly
fed, and their nutritional deficiency would explain the
health disparity that exists between them and urban chil-
dren who have easier access to health care facilities.
The removal of health care utilization fees is not syn-
onymous with an increased utilization of medical care
for children less than 5 years old, as 46.5% of the sample
attended public hospitals fo r treatment in 2002, and after
the abolitio n of user fees in April 2007 utilization fell by
1.7 times compared to 2002. In order to understand stand
why there is a switch from health care utilization to mere
survival, we can examine the inflation rate. In 2007, the
inflation rate was 16.8% which is a 133% increase over
2002 (i.e. 7.2%), which translates into a 24.7% increase
in the prices of food and non-alcoholic beverages, and a
3.4% increase in health care costs [22]. Here the choice
is between basic necessities and health care utilization,
which further erodes health care utilization in spite of
the removal of user fees for children.
Health status uses the individual self-rating of a per-
son’s overall health status [23], which ranges from ex-
cellent to poor. Health status therefore captures more of
people’s health than diagnosed illness, life expectancy,
or mortality. However, how good a measure is it? Em-
pirical studies show that self-reported health is an indi-
cator of general health. Schwarz & Strack [24] cited that
a person’s judgments are prone to systematic and
nn-systematic biases, suggesting that it may not be a
good measure of health. Diener, [25] however, argued
that the subjective index seemed to contain substantial
amounts of valid variance, indicating that subjective
measures provide some validity in assessing health, a
position with which Smith concurred [26]. Smith [26]
argued that subjective indices do have good construct
validity and that they are a respectably powerful predic-
tor of mortality risks [27], disability and morbidity [27],
though these properties vary somewhat with national or
cultural contexts. Studies have examined self-reported
health and mortality, and have found a significant corre-
lation between a subjective and an objective measure
[27-29]: life expectancy [30]; and disability [2 8]. Bourne
[30] found that the correlation between life expectancy
and self-reported health status was a strong one (correla-
tion coefficient, R=0.731); and that self-rated health ac-
counted for 53% of the variance in life expectancy.
Hence, the issue of the validity of subjective and objec-
tive indices is good, with Smith [26] opining that the
construct validity between the two is a good one.
The current research found that parent-reported illness
and the health status of children less than 5 years of age

P. A. Bourne / Health 2 (2010) 356-365
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
364
are significantly correlated. However, the statistical as-
sociation was a weak one (correlation coefficient=0.297),
suggesting that only 8% of the variance in health status
can be explained by parent-reported children’s illnesses.
This is a critical finding which reinforces the position
that self-reported illnesses (or health conditions) only
constitute a small proportion of people’s health. There-
fore, using illness to measure the health status of chil-
dren who are less than 5 years of age is not a good
measure of their health, as illness only accounts for 8%
of health status. However, based on Bourne‘s work [30],
health status is equally as good a measure of health as
life expectancy. One of the positives for the using of
health status instead of life expectancy is its coverage in
assessing more of people’s general health status by using
mortality or even morbidity data.
5. CONCLUSIONS
In summary, the general health status of children who
are less than 5 years old is good; however, social and
public health programmes are needed to improve the
health status of the rural population, which will translate
into increased health status for their children. The h ealth
disparity that existed between rural and urban children
less than 5 years of age showed that this will not be re-
moved simply because of the abolition of health care
utilization fees. In keeping with this reality, public health
specialists need to take health care to residents in order
to further improve the health status of children who are
less than 5 years old.
5.1. Conflict of Interest
The author has no conflict of interest to report.
5.2. Disclaimer
The researcher would like to note that while this study
used secondary data from the Jamaica Survey of Living
Conditions, 2007, none of the errors that are within this
paper should be ascribed to the Planning Institute of Ja-
maica or the Statistical Institute of Jamaica as they are
not there, but owing to the researcher.
REFERENCES
[1] Lindo, J. (2006) Jamaican perinatal mortality survey,
Jamaica Ministry of Health. Kingston, 1-40.
[2] McCarthy, J.E. and Evans-Gilbert, T. (2009) Descriptive
epidemiology of mortality and morbidity of health-indi-
cator diseases in hospitalized children from western Ja-
maica. American Journal of Tropical Medicine and Hy-
giene, 80, 596-600.
[3] Domenach, H. and Guengant, J. (1984) Infant mortality
and fertility in the Caribbean basin. Cah Orstom (Sci
Hum), 20, 265-72.
[4] Rodriquez, F.V., Lopez, N.B., and Choonara, I. (2002)
Child health in Cuba. Archives of Disease in Childhood,
93, 991-3.
[5] McCaw-Binns, A., Holder, Y., Spence, K., Gordon-
Strachan, G., Nam, V., and Ashley, D. (2002) Multi-
source method for determining mortality in Jamaica:
1996 and 1998. Department of Community Health and
Psychiatry, University of the West Indies. International
Biostatistics Information Services. Division of Health
Promotion and Protection, Ministry of Health, Jamaica.
Statistical Institute of Jamaica, Kingston.
[6] McCaw-Binns, A.M., Fox, K., Foster-Williams, K.,
Ashley, D.E., and Irons, B. (1996) Registration of births,
stillbirths and infant deaths in Jamaica. International
Journal of Epidemiology, 25, 807-813.
[7] World Health Organization (1948) Preamble to the Con-
stitution of the World Health Organization as adopted by
the International Health Conference, New York, June
19-22, 1946; signed on July 22, 1946 by the representa-
tives of 61 States (Official Records of the World Health
Organization, 2, 100) and entered into force on April 7,
1948. “Constitution of the World Health Organization,
1948.” In Basic Documents, 15th Edion, World Health
Organization, Geneva.
[8] World Health Organization (2004) Healthy life expec-
tancy 2002: 2004 world health report. World Health Or-
ganization, Geneva.
[9] World Health Organization (2000) WHO issues new
healthy life expectancy rankings: Japan number one in
new ‘healthy life’ system. World Health Organization,
Washington D. C. & Geneva.
[10] Jamaica Ministry of Health (1992-2007) Annual report
1991-2006. Jamaica Ministry of Health, Kingston.
[11] Statistical Institute of Jamaica (1981-2009) Demographic
statistics, Statistical Institute of Jamaica, Kingston.
[12] Planning Institute of Jamaica (1981-2009) Economic and
social survey. Planning Institute of Jamaica, Kingston.
[13] Planning Institute of Jamaica and Statistical Institute of
Jamaica (1989-2009) Jamaica Survey of Living Condi-
tions, 1988-2008. PIOJ and STATIN, Kingston.
[14] Pan American Health Organization (2007) Health in the
Americas, volume II Countries. PanAmericanHealth
Organization, Washington DC.
[15] Morgan, W. Ed. (2005) Health issues in the Caribbean.
Ian Randle, Kingston.
[16] Walker, S. (2005) Nutrition and child health develop-
ment. In Morgan, W. Ed., Health issues in the Caribbean,
Ian Randle, Kingston, 15-25.
[17] Samms-Vaugh, M., Jackson, M., and Ashley, D. (2005)
School achievement and behaviour in Jamaican children.
In Morgan, W. Ed. Health issues in the Caribbean, Ian
Randle, Kingston, 26-37.
[18] Statistical Institute of Jamaica. (2008) Jamaica survey of
living conditions, 2007, Kingston, Jamaica. Statistical
Institute of Jamaica, Planning Institute of Jamaica and
Derek Gordon Databank, University of the West Indies,
Kingston, Jamaica.
[19] Statistical Institute of Jamaica. (2003) Jamaica survey of
living conditions. Statistical Institute of Jamaica, King-
ston, Planning Institute of Jamaica and Derek Gordon
Databank, University of the West Indies.
[20] World Bank, Development Research Group, (2002).

P. A. Bourne / Health 2 (2010) 356-365
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
365
365
Poverty and human resources. Jamaica Survey of Living
Conditions (LSLC) 1988-2000: Basic Information.
[21] Marmot, M. (2002) The influence of income on health:
Views of an Epidemiologist. Does money really matter?
Or is it a marker for something else? Health Affair, 21,
31-46.
[22] Bourne, P.A. (2009) Impact of poverty, not seeking
medical care, unemployment, inflation, self-reported
illness, health insurance on mortality in Jamaica. North
American Journal of Medical Sciences, 1, 99-109.
[23] Kahneman, D. and Riis, J. (2005) Living, and thinking
about it, two perspectives. In Huppert, F. A., Kaverne, B.
and N. Baylis, The Science of Well-Being, Oxford Uni-
versity Press.
[24] Schwarz, N. and Strack, F. (1999) Reports of subjective
well-being: Judgmental processes and their methodo-
logical implications. In Kahneman, D., Diener, E.,
Schwarz, N. Eds., Well-Being: The Foundations of He-
donic Psychology. Russell Sage Foundation, New York,
61-84.
[25] Diener, E. (1984) Subjective well-being. Psychological
Bulletin, 95, 542-75.
[26] Smith, J. (1994) Measuring health and economic status
of older adults in developing countries. Gerontologist, 34,
491-6.
[27] Idler, E.L. and Benjamin, Y. (1997) Self-rated health and
mortality: A review of twenty-seven community studies.
Journal of Health and Social Behavior, 38, 21-37.
[28] Idler, E.L. and Kasl, S. (1995) Self-ratings of health: Do
they also predict change in functional ability? Journal of
Gerontology, 50, S344-S353.
[29] Schechter, S., Beatty, P., and Willis, G.B. (1998) Ask-
ing survey respondents about health status: Judgment
and response issues. In Schwarz, N., Park, D., Knauper,
B., and Sudman, S. Eds., Cognition, Aging, and Self-
Reports, Taylor and Francis, Ann Arbor.
[30] Bourne, P.A. (2009) The validity of using self-reported
illness to measure objective health. North American
Journal of Medical Sciences, 1, 232-238.