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Comment
. 2010 Dec;88(4):616-22; discussion 623-7.
doi: 10.1111/j.1468-0009.2010.00614.x.

On the choice of absolute or relative inequality measures

Yukiko Asada  1
Affiliations
Comment

On the choice of absolute or relative inequality measures

Yukiko Asada. Milbank Q. 2010 Dec.

Abstract

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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Figures

Figure 1
Figure 1
A Hypothetical Example of Comparing Health Inequalities across Populations.
See this image and copyright information in PMC

Comment on

References

    1. Asada Y. Health Inequality: Morality and Measurement. Toronto: University of Toronto Press; 2007.
    1. Erreygers G. Can a Single Indicator Measure Both Attainment and Shortfall Inequality? Journal of Health Economics. 2009;28:885–93. - PubMed
    1. Gakidou E, Murray CJL, Frenk J. Measuring Preferences on Health System Performance Assessment. 2000. Global Programme on Evidence for Health Policy Discussion Paper 20. Available at http://www.who.int/healthinfo/paper20.pdf (accessed September 9, 2010)
    1. Harper S, King NB, Meersman SC, Reichman ME, Breen N, Lynch J. Implicit Value Judgments in the Measurement of Health Inequalities. The Milbank Quarterly. 2010;88(1):4–29. Available at http://www.milbank.org/quarterly/8801feat.html (accessed November 4, 2010. - PMC - PubMed
    1. Temkin L. Inequality. New York: Oxford University Press; 1993.

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