Developing an Original Theoretical Model of Population Health Equity in Nigerian Federal States

Health equity across Nigerian federal states is shaped by both individual socioeconomic characteristics and structural state-level factors including governance quality, health financing, and demographic composition, and developing an original multi-dimensional model of population health equity provides a theoretical framework for evidence-based health equity policy. This study developed an original Population Health Equity Model for Nigerian Federal States, drawing on health equity theory, social determinants of health, and demographic composition analysis. A constructive theoretical methodology was employed, combining systematic review of health equity frameworks (72 publications from 2018 to 2024), empirical multi-level analysis of NDHS data disaggregated by state, and expert consultation with 25 health equity and demography specialists. The systematic review confirmed that existing health equity frameworks were derived from countries where the social gradient is the dominant equity dimension, inadequately theorising the geographic, ethnic, and demographic equity dimensions that are primary in the Nigerian federal context. Original multi-level analysis decomposed state-level health outcome inequality into within-state socioeconomic gradient, between-state governance quality, and between-state demographic composition components. Demographic composition (age structure, urban share, dependency ratio) explained 31.4 percent of between-state maternal mortality variance, a dimension largely absent from health equity scholarship. The original Nigerian Population Health Equity Model proposes four equity dimensions: socioeconomic equity, geographic equity, demographic equity (accounting for structural demographic disadvantages), and ethnic and cultural equity. Expert review confirmed the framework's theoretical originality.

Keywords: population health equity, Nigerian federal states, health inequality, multi-level model, social determinants