SHORTFALL EQUALITY
Address shortfalls from potential in health capability among different individuals and populations
WHAT IS IT?
Shortfall equality is a way to analyze inequalities. It measures the extent to which certain individuals and populations fall short of target levels. Shortfall equality is an approach to equality assessment, accounting for variation when assessing health capabilities and health achievements of different individuals and populations.
This approach sets a threshold or health norm against which to measure the gaps in health for certain individuals and populations. It involves reducing these gaps between health capabilities and health achievements, so a specific individual’s or population’s health potential can be fully realized.
Shortfall equality is an alternative approach to theorizing and measuring health inequity. It focuses on what is possible. It considers what is, what could have been, or what could be, possible, for individuals and population groups.
WHY IS IT IMPORTANT?
Shortfall equality focuses less on the accomplishments of health systems and health policies, rather, it focuses on what levels of health are possible for a given society and how to attain it. Shortfall equality helps us determine if health systems are failing to succeed in fostering the health capabilities of certain individuals and populations.
Justice should be measured by shortfall equality. Due to human diversity, different resources and circumstances for different individuals and populations are essential to achieving shortfall equality. Furthermore, reducing shortfall inequalities in premature mortality and avoidable and addressable morbidity is essential to achieving global and domestic health equity.
WHAT DOES IT LOOK LIKE?
Rather than equal health outcomes, global and domestic health equity involves the equal realization of individual and population health potential. While having good health as an end goal of policy is important, it is impossible to ensure equal health levels for everyone. Shortfall equality addresses this problem.
Experiences of people with disabilities illustrate the principle of shortfall equality. While their maximum potential for health functioning differs from others, shortfall equality accounts for these differences without lowering their own achievement goals. In this way, we can independently assess the health capabilities and health achievements of people with disabilities.
HOW DO WE DO IT?
We developed a method of measuring inequities in health among population groups. To assess shortfalls in health achievement, such as mortality, we identified a most healthy (better-off) group as the reference group and a least healthy (worse-off) group and other groups in between. By doing so, we are able to empirically and disproportionately weigh improvements in health among the least healthy (and those with mid-level health) relative to improvements among the healthiest. This allows us to effectively examine the magnitude of health inequality across different individuals and population groups.
In order to use shortfall equality in public health and health policy, we must assess and reform current systems and practices. We must evaluate global and domestic health problems and solutions in terms of a certain individual’s or population’s potential. We should recognize that different individuals and populations have differing, and equivalent, levels of health potential and that equal health outcomes are not the goal. At the same time, what’s possible anywhere should be possible everywhere.
Policies and procedures that prioritize the methodology of shortfall equality should be established. Actors and institutions must take responsibility for creating conditions to fulfill individuals’ and populations’ health capabilities and reducing shortfalls between their potential and actual levels of health.