THEORY AND MEASUREMENT
How should health inequalities be understood, measured, analyzed, compared and evaluated? How should we determine whether health inequalities are improving, are acceptable, and what policy makers should do about them?
Conventional approaches to determine inequalities and disparities, such as the Gini coefficient, Lorenz curve, Concentration Curve, or stratifications by socio-economic and demographic status, provide helpful descriptive statistics of the spread of health and health care within and across countries. However, these conventional methods are unable to capture inequity (what is unfair) or potential (what is possible) and are constrained as inputs to policy. This is one reason why inequitable policies have persisted.
Overcoming these limitations, we developed an alternative approach to theorizing and measuring health inequity. Our theory advances health as intrinsic and instrumental to flourishing and upholds equal respect for all humans worldwide. We measure health inequity in terms of human potential and counterfactual criteria, what is possible to be achieved and what could have been achieved. Health inequity on this view considers what is, and what could have been or what could be, possible. This is what the reference group has achieved, as well as measuring the change and rate of change in health within and among countries. The health inequity measure is the shortfall from the health status of a reference group.
The reason is that where there are no biological or genetic explanations for differences in health, failure to achieve the average maximum level is a policy choice. The policy prescription is disproportionate effort to help disadvantaged individuals and groups to ensure them the opportunity to reach their potential.
Our approach is flourishing improving for individuals and society. Health inequity is costly for individuals, families and society and health equity improves individual and societal flourishing.
