# Precarity in the Modes of Living: Proposing an Index for Studying Health Inequities at the Ecological Level in Colombia

## TL;DR

This paper proposes a new index to study health inequities in Colombia by analyzing the ecological distribution of precarity in modes of living.

## Contribution

The paper introduces a novel precarity index based on the Latin American Social Determination of Health perspective for Colombia.

## Key findings

- Precarity in modes of living is not randomly distributed in Colombia, showing a center-periphery divide.
- The index is associated with higher under-five and infant mortality rates.
- The index emphasizes the importance of modes of living in understanding health inequities.

## Abstract

Deprivation indices are used to monitor health inequities. However, their theoretical underpinnings have been based on the context of Western industrialized countries, which have distinct social and historical backgrounds compared to Latin America and the Caribbean and countries in the Global South. Following the Latin American Social Determination of Health perspective, particularly the category Modes of Living supported by the construct of precarity, we aimed to develop an index of precarity in the modes of living at the department level in Colombia and assess its geographical distribution and potential value for public health. We conducted an ecological cross-sectional study with national administrative records. We developed a precarity index through Principal Component Analysis and performed spatial autocorrelation analyses and regression models with child mortality indicators. Our final index comprised twenty indicators representing four dimensions of the modes of living and power relations. We found precarity not to distribute randomly in Colombia, with a center-periphery divide and higher precarity observed in the country’s margin. We also found an association of our index with under-five mortality (SMR = 1.19; 95%CI 1.08–1.31) and infant mortality (SMR = 1.13; 95%CI 1.00–1.26). Our index highlights the relevance of considering the modes of living when devising deprivation indices or similar measures from Colombia or Latin America. This approach may provide different perspectives on the health-disease process and potential value for public health planning.