Defining and measuring health inequality: an approach based on the distribution of health expectancy.

This paper proposes an approach to conceptualizing and operationalizing the measurement of health inequality, defined as differences in health across individuals in the population. We propose that health is an intrinsic component of well-being and thus we should be concerned with inequality in health, whether or not it is correlated with inequality in other dimensions of well-being. In the measurement of health inequality, the complete range of fatal and non-fatal health outcomes should be incorporated. This notion is operationalized through the concept of healthy lifespan. Individual health expectancy is preferable, as a measurement, to individual healthy lifespan, since health expectancy excludes those differences in healthy lifespan that are simply due to chance. In other words, the quantity of interest for studying health inequality is the distribution of health expectancy across individuals in the population. The inequality of the distribution of health expectancy can be summarized by measures of individual/mean differences (differences between the individual and the mean of the population) or inter-individual differences. The exact form of the measure to summarize inequality depends on three normative choices. A firmer understanding of people's views on these normative choices will provide a basis for deliberating on a standard WHO measure of health inequality.

PIP: This paper proposes an approach to conceptualize and operationalize the measurement of health inequality, defined as differences in health across individuals in the population. The approach is based on four key notions. First, health is an intrinsic component of well-being; thus, inequality in health should be a concern, whether or not it is correlated with inequality in other dimensions of well-being. Second, in the measurement of health inequality, complete range of fatal and non-fatal health outcomes should be incorporated. Third, the quantity of interest for studying health inequality is the distribution of health expectancy across individuals in the population. Lastly, the inequality of distribution of health expectancy can be summarized by measures of individual/mean differences or interindividual differences. The exact form of the measure to summarize inequality depends on three normative choices. A firmer understanding of people's views with regard to these normative choices will provide a basis for discussion of a standard WHO measure of health inequality.

Health inequalities and social group differences: what should we measure?

Both health inequalities and social group health differences are important aspects of measuring population health. Despite widespread recognition of their magnitude in many high- and low-income countries, there is considerable debate about the meaning and measurement of health inequalities, social group health differences and inequities. The lack of standard definitions, measurement strategies and indicators has and will continue to limit comparisons--between and within countries, and over time--of health inequalities, and perhaps more importantly comparative analyses of their determinants. Such comparative work, however, will be essential to find effective policies for governments to reduce health inequalities. This article addresses the question of whether we should be measuring health inequalities or social group health differences. To help clarify the strengths and weaknesses of these two approaches, we review some of the major arguments for and against each of them.