A unique blend of philosophy and quantitative research,Health Inequalitywill prove a valuable tool for academics and policymakers alike.
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Let us start this book by thinking about inequality in general. Although the notion of inequality can sometimes have moral connotations, for this book, at the outset, let us adopt the simplest definition of the word: ‘the state or condition of being unequal’ – that is, ‘not the same in any measurable aspect, such as extent or quantity.’¹ Inequality is everywhere – the length of hair is surely different among your co-workers (unless you are a monk), the income of each household of your apartment building is likely to vary, your town probably includes people with different cultural backgrounds, the park in...
In this chapter I introduce a variety of egalitarian perspectives on health equity. For the purpose of this book ‘egalitarianism’ means that we are morally concerned about health distribution itself, rather than treating it as instrument for realizing other ideals of population health. So constrained, this chapter asks: which health distributions are inequitable?
To investigate this question, we must examine how health might fit within a general philosophical discussion of equality.¹ Philosophers have argued over equality for thousands years, producing countless perspectives, while never completely agreeing with each other. Tackled squarely, my task is insurmountable. I therefore limit myself to...
The previous two chapters familiarized us with different perspectives on health equity. Some of us might be attracted to a certain perspective or might develop an account of health equity of our own based on discussion in these two chapters. Now imagine that we wish to think of measuring health equity according to a chosen perspective. To operationalize an equity perspective as a measurement strategy, whichever it may be, there are further issues to be considered. We have, for example, been talking about health only vaguely, but what exactly is the health we are talking about?
In this chapter, we...
Chapters 1 and 2 helped us decide which health inequality we might explore for the assessment of health equity. Chapter 3 asked us what measurement choices might follow in transforming an equity concept to an empirical analysis. Together they should allow us to draw such health distributions as in figure 4.1.
The obvious next step in the assessment of health equity is to quantify the amount of health inequity such a health distribution as figure 4.1 presents. Note that the question of which health inequality is inequitable has already been taken care of by the time we can draw these...
With the framework developed in part 1, we are now ready to move on to actual empirical analysis. In the chapters to follow, I show how we can apply the framework developed for measuring health inequity to empirical analysis. Adopting different perspectives on health equity from part 1, in part 2 I examine whether health equity improved in the United States between 1990 and 1995. Data used are the 1990 and 1995 U.S. National Health Interview Survey (NHIS). I analyse these same data sets according to different perspectives on health equity.
The primary objective of part 2 is to show...
Using the tools developed in chapter 5, in this chapter I examine whether health equity improved in the United States between 1990 and 1995 from the following four different perspectives on health equity:¹
Health inequality as an indicator of social justice
Health inequity as health inequality associated with a specific group characteristic
– Sex and gender
– Education and income
Health inequity as health inequality caused by socio-economic status
– The Rawlsian Difference Principle
– Walzer’s view of dominance as unjust
Health equity as satisfying the minimally adequate level of health (Capability Approach)
First, I employ the view...
If we are worried about health distribution for moral reasons, and interested in measuring it, how should we go about it? This book aims to help academics and policy-makers who have such a concern. To meet this goal, this book proposes a framework for measuring health inequality reflecting moral concerns (part 1). The framework consists of the following three steps: (1) defining when a health distribution becomes inequitable – that is, of moral concern, (2) deciding on measurement strategies to operationalize a chosen concept of health equity, and (3) summarizing a health distribution into one number. This book also shows how...
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