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A Problem with the Individual Approach in the WHO Health Inequality Measurement.

Asada Y, Hedemann T - Int J Equity Health (2002)

Bottom Line: SUMMARY: We argue that the World Health Organization's health inequality measure is not value-free.The World Health Organization's normative position can be interpreted as a quite expansive view of justice, in which health distributions that have causes amenable to human intervention are considered to be matters of justice.Our conclusion is that if the World Health Organization's health inequality measure is to be interpreted meaningfully in a policy context, its conceptual underpinning must be re-evaluated.

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Affiliation: Department of Population Health Sciences University of Wisconsin-Madison 610 N, Walnut Street, WARF, 7th Floor Madison, WI 53705-2397, USA. yasada@wisc.edu

ABSTRACT
BACKGROUND: In the World Health Report 2000, the World Health Organization made the controversial choice to measure inequality across individuals rather than across groups, the standard in the field. This choice has been widely discussed and criticized. DISCUSSION: We look at the three questions: (1) is the World Health Organization's health inequality measure value-free as it claims? (2) if it is not, what is the normative position implied by its approach when measuring health inequality? and (3) is the individual approach a logically consistent methodological choice for that normative position? SUMMARY: We argue that the World Health Organization's health inequality measure is not value-free. If it was, the health inequality information that the measurement collected could not reasonably be included in its ranking of how well national health systems performed. The World Health Organization's normative position can be interpreted as a quite expansive view of justice, in which health distributions that have causes amenable to human intervention are considered to be matters of justice. Our conclusion is that if the World Health Organization's health inequality measure is to be interpreted meaningfully in a policy context, its conceptual underpinning must be re-evaluated.

No MeSH data available.


Health distributions at the country level. Distributions of health expectancy for country A and B. The X-axis is health distribution and the y-axis is the percentage of the population. Country B's distribution is more spread than country A's.
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Figure 1: Health distributions at the country level. Distributions of health expectancy for country A and B. The X-axis is health distribution and the y-axis is the percentage of the population. Country B's distribution is more spread than country A's.

Mentions: It is beyond the scope of this paper to articulate an alternative view about the conditions necessary for an inequality to be an inequity. However, we think it is important to point out that the individual approach to measuring health inequality is likely to obscure commonly recognized inequitable inequalities. In fact, it seems to neglect inequalities that should be considered inequities even on the normative view of the WHO. Consider countries A and B where the distribution of risk is illustrated in Figure 1.


A Problem with the Individual Approach in the WHO Health Inequality Measurement.

Asada Y, Hedemann T - Int J Equity Health (2002)

Health distributions at the country level. Distributions of health expectancy for country A and B. The X-axis is health distribution and the y-axis is the percentage of the population. Country B's distribution is more spread than country A's.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC119370&req=5

Figure 1: Health distributions at the country level. Distributions of health expectancy for country A and B. The X-axis is health distribution and the y-axis is the percentage of the population. Country B's distribution is more spread than country A's.
Mentions: It is beyond the scope of this paper to articulate an alternative view about the conditions necessary for an inequality to be an inequity. However, we think it is important to point out that the individual approach to measuring health inequality is likely to obscure commonly recognized inequitable inequalities. In fact, it seems to neglect inequalities that should be considered inequities even on the normative view of the WHO. Consider countries A and B where the distribution of risk is illustrated in Figure 1.

Bottom Line: SUMMARY: We argue that the World Health Organization's health inequality measure is not value-free.The World Health Organization's normative position can be interpreted as a quite expansive view of justice, in which health distributions that have causes amenable to human intervention are considered to be matters of justice.Our conclusion is that if the World Health Organization's health inequality measure is to be interpreted meaningfully in a policy context, its conceptual underpinning must be re-evaluated.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Population Health Sciences University of Wisconsin-Madison 610 N, Walnut Street, WARF, 7th Floor Madison, WI 53705-2397, USA. yasada@wisc.edu

ABSTRACT
BACKGROUND: In the World Health Report 2000, the World Health Organization made the controversial choice to measure inequality across individuals rather than across groups, the standard in the field. This choice has been widely discussed and criticized. DISCUSSION: We look at the three questions: (1) is the World Health Organization's health inequality measure value-free as it claims? (2) if it is not, what is the normative position implied by its approach when measuring health inequality? and (3) is the individual approach a logically consistent methodological choice for that normative position? SUMMARY: We argue that the World Health Organization's health inequality measure is not value-free. If it was, the health inequality information that the measurement collected could not reasonably be included in its ranking of how well national health systems performed. The World Health Organization's normative position can be interpreted as a quite expansive view of justice, in which health distributions that have causes amenable to human intervention are considered to be matters of justice. Our conclusion is that if the World Health Organization's health inequality measure is to be interpreted meaningfully in a policy context, its conceptual underpinning must be re-evaluated.

No MeSH data available.