Addressing health inequalities.

A focus on health inequalities with the aim of promoting equity in health and health services is growing apace in the developed world. Yet views on the differences in health between populations can sometimes betray a lack of clarity about when inequality matters (e.g. across groups defined by income, sex or race) and how inequality should be measured. The formulation of such policies requires that inequality is measured appropriately, and the data presented fairly. Thus, an argument based only on a ratio (e.g. that a particular problem has increased by 100%) hides the absolute difference (e.g. whether the increase was from one per million to two per million, or from five in 20 to ten in 20) and therefore how serious the increase actually is and whether it deserves additional resources. Not all health inequalities are inherently inequitable and therefore require or deserve public intervention, and the implementation of public interventions, whatever the cost, may be at the expense of other valid health needs. These authors therefore argue that governments should not agree to alleviate health inequalities as an agenda on its own without due consideration to other health-related policy objectives.

Instead, policymakers need a coherent ethical framework to establish which health inequalities lead to inequitable outcomes. This should form the basis for seeking to achieve a fair distribution of health, whilst accepting that some health inequalities will always exist in any society where people have the freedom to choose how they live, e.g. to eat unhealthily. Policymakers will then need to assess any proposed health inequality policies and interventions in terms of their value for money. It is undesirable that health inequality should take precedence over all other considerations or that health inequalities should be addressed at all costs. (1)

(1.) Oliver A, Healey A, le Grand J. Addressing health inequalities. Lancet 2002;360:565-67.