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Dennis Petrie - One of the best experts on this subject based on the ideXlab platform.
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On the choice of health Inequality Measure for the longitudinal analysis of income related health inequalities
Health Economics, 2012Co-Authors: Paul Allanson, Dennis PetrieAbstract:Changes in rank-dependent income-related health Inequality Measures over time may usefully be decomposed into contributions due to changes in health outcomes and changes in individuals' positions in the income distribution. This paper establishes the normative implications of this type of decomposition by embedding it within a broader analysis of changes in the ‘health achievement’ index. We further show that the choice of health Inequality Measure implies a particular vertical equity judgement, which may be expressed on a common scale in terms of the concentration index of health changes that would be Inequality preserving. We illustrate the empirical implications of this choice by reporting results from a longitudinal analysis of changes in income-related health Inequality in Great Britain using the concentration, the Erreygers and Wagstaff indices of health attainments and the concentration index of health shortfalls. Copyright © 2012 John Wiley & Sons, Ltd.
Len Smith - One of the best experts on this subject based on the ideXlab platform.
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on the Measurement of relative and absolute income related health Inequality
Social Science & Medicine, 2002Co-Authors: Philip Clarke, Ulf-g. Gerdtham, Magnus Johannesson, Kerstin Bingefors, Len SmithAbstract:In recent work on international comparisons of income-related inequalities in health, the concentration index has been used as a Measure of health Inequality. A drawback of this Measure is that it is sensitive to whether it is estimated with respect to health or morbidity. An alternative would be to use the generalized concentration index that is based on absolute rather than relative health differences. In this methodological paper, we explore the importance of the choice of health Inequality Measure by comparing the income-related Inequality in health status and morbidity between Sweden and Australia. This involves estimating a concentration index and a generalized concentration index for the eight-scale health profile of the Short Form 36 (SF-36) health survey. We then transform the scores for each scale into a Measure of morbidity and show that whether the concentration index is estimated with respect to health or morbidity has an impact on the results. The ranking between the two countries is reversed for two of the eight dimensions of SF-36 and within both countries the ranking across the eight SF-36 scales is also affected. However, this change in ranking does not occur when the generalized concentration index is compared and we conclude with the implications of these results for reporting comparisons of income-related health Inequality in different populations.
Paul Allanson - One of the best experts on this subject based on the ideXlab platform.
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On the choice of health Inequality Measure for the longitudinal analysis of income related health inequalities
Health Economics, 2012Co-Authors: Paul Allanson, Dennis PetrieAbstract:Changes in rank-dependent income-related health Inequality Measures over time may usefully be decomposed into contributions due to changes in health outcomes and changes in individuals' positions in the income distribution. This paper establishes the normative implications of this type of decomposition by embedding it within a broader analysis of changes in the ‘health achievement’ index. We further show that the choice of health Inequality Measure implies a particular vertical equity judgement, which may be expressed on a common scale in terms of the concentration index of health changes that would be Inequality preserving. We illustrate the empirical implications of this choice by reporting results from a longitudinal analysis of changes in income-related health Inequality in Great Britain using the concentration, the Erreygers and Wagstaff indices of health attainments and the concentration index of health shortfalls. Copyright © 2012 John Wiley & Sons, Ltd.
Philip Clarke - One of the best experts on this subject based on the ideXlab platform.
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on the Measurement of relative and absolute income related health Inequality
Social Science & Medicine, 2002Co-Authors: Philip Clarke, Ulf-g. Gerdtham, Magnus Johannesson, Kerstin Bingefors, Len SmithAbstract:In recent work on international comparisons of income-related inequalities in health, the concentration index has been used as a Measure of health Inequality. A drawback of this Measure is that it is sensitive to whether it is estimated with respect to health or morbidity. An alternative would be to use the generalized concentration index that is based on absolute rather than relative health differences. In this methodological paper, we explore the importance of the choice of health Inequality Measure by comparing the income-related Inequality in health status and morbidity between Sweden and Australia. This involves estimating a concentration index and a generalized concentration index for the eight-scale health profile of the Short Form 36 (SF-36) health survey. We then transform the scores for each scale into a Measure of morbidity and show that whether the concentration index is estimated with respect to health or morbidity has an impact on the results. The ranking between the two countries is reversed for two of the eight dimensions of SF-36 and within both countries the ranking across the eight SF-36 scales is also affected. However, this change in ranking does not occur when the generalized concentration index is compared and we conclude with the implications of these results for reporting comparisons of income-related health Inequality in different populations.
Yukiko Asada - One of the best experts on this subject based on the ideXlab platform.
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On the Choice of Absolute or Relative Inequality Measures
The Milbank quarterly, 2010Co-Authors: Yukiko AsadaAbstract:Context: In a recent article in this journal, Sam Harper and his colleagues (2010) call for increased awareness and open dialogue of moral judgments underlying health Inequality Measures. They recommend that analysts use relative Inequality Measures when concerned only about health Inequality but use absolute Inequality Measures when also concerned about other issues, such as the overall level of population health and the level of health for each group in the population. Methods: Using a simple, hypothetical example, this commentary shows that the relationships among Inequality, the absolute level for each group, and the overall level in the population are more complex than suggested by the analysis by Harper and his colleagues. Findings: First, analysts must make the choice of absolute or relative Inequality Measures, separately, for single- and multiple-population cases. Second, in the single-population cases, analysts can use both relative and absolute Inequality Measures when concerned only about health Inequality independent of other considerations. Third, in almost all real-world multiple-population cases, when using either the absolute or relative Inequality Measure, the assessment of health Inequality is influenced by the absolute level of health for each group. Conclusions: The choice between absolute and relative Inequality Measures is not about the independent normative significance of Inequality, as Harper and his colleagues suggest. In choosing between absolute and relative Measures, future work needs to integrate an empirical examination of values, a moral assessment of values, and a technical understanding of Inequality Measures.
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A Problem with the Individual Approach in the WHO Health Inequality Measurement
International Journal for Equity in Health, 2002Co-Authors: Yukiko Asada, Thomas HedemannAbstract: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.