Mapping disparities in education across low- and middle-income countries

Article Mapping disparities in education across low- and middle-income countries https://doi.org/10.1038/s41586-019-1872-1 Local Burden of Disease Educational Attainment Collaborators* Received: 9 November 2018 Accepted: 12 November 2019 Published online: 25 December 2019 Open access Educational attainment is an important social determinant of maternal, newborn, and child health1–3. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting4–6. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness7,8; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health9–11. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but—to our knowledge—no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries12–14. By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations. Education, as a social determinant of health, is closely linked to several facets of the Sustainable Development Goals (SDGs) of the United Nations2. In addition to the explicit focus of SDG 4 on educational attainment, improved gender equality (SDG 5) and maternal, newborn, and child health (SDG 3) have well-documented associations with increased schooling15–17. In 2016, after years of deprioritization, aid to education reached its highest level since 200218. Despite this shift, only 22% of aid to basic education—defined as primary and lower-secondary—went to low-income countries in 2016 compared to 36% in 200219. This reflects a persistent pattern in which the distribution of aid does not align with the greatest need, even at the national level. Beyond international aid, domestic policy is also a crucial tool for expanding access to education, especially at higher levels. However, policy-makers often do not have access to a rigorous evidence base at a subnational level. This analysis presents the subnational distribution of education to support the growing evidence base of precision public health data, which shows widespread disparity of health outcomes as well as their social determinants. Mapping education across gender Despite widespread improvement in educational attainment since 2000, gender disparity persists in 2017 in many regions. Figure 1 illustrates the mean number of years of education and the proportion of individuals with no primary school attainment for men and women of reproductive age (15–49 years) in 2017. The average educational attainment is very low across much of the Sahel region of sub-Saharan Africa, consistent with previously published data14. In 2017, there was a large gender disparity in many regions, with men attaining higher average education across central and western sub-Saharan Africa and South Asia. Considerable variation remains between the highest- and lowestperforming administrative units within countries in 2017. For Uganda in 2017, this indicator ranged from 1.9 years of education (95% uncertainty interval, 0.8–3.0 years) in rural Kotido to 11.1 years (10.1–12 years) in Kampala, the capital city. Figure 1b, d displays the proportion of men and women aged 15–49 years who have not completed primary school. By considering the variation within populations in different locations, these maps help to identify areas with large populations in the vulnerable lower end of the attainment distributio