'Mirror, Mirror, on the Wall, Who in this Land is Fairest of All?' Distributional Sensitivity in the Measurement of Socioeconomic Inequality of Health

Department of Economics, University of Antwerp, City Campus, Prinsstraat 13, 2000 Antwerpen, Belgium.
Journal of Health Economics (Impact Factor: 2.25). 11/2011; 31(1):257-70. DOI: 10.1016/j.jhealeco.2011.10.009
Source: PubMed

ABSTRACT This paper explores four alternative indices for measuring health inequalities in a way that takes into account attitudes towards inequality. First, we revisit the extended concentration index which has been proposed to make it possible to introduce changes into the distributional value judgements implicit in the standard concentration index. Next, we suggest an alternative index based on a different weighting scheme. In contrast to the extended concentration index, this new index has the 'symmetry' property. We also show how these indices can be generalized so that they satisfy the 'mirror' property, which may be seen as a desirable property when dealing with bounded variables. We compare the different indices empirically for under-five mortality rates and the number of antenatal visits in developing countries.

Download full-text


Available from: Tom Van Ourti, Jun 18, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Formally evaluating how specific policy measures influence environmental justice is challenging, especially in the context of regulatory analyses in which quantitative comparisons are the norm. However, there is a large literature on developing and applying quantitative measures of health inequality in other settings, and these measures may be applicable to environmental regulatory analyses. In this paper, we provide information to assist policy decision makers in determining the viability of using measures of health inequality in the context of environmental regulatory analyses. We conclude that quantification of the distribution of inequalities in health outcomes across social groups of concern, considering both within-group and between-group comparisons, would be consistent with both the structure of regulatory analysis and the core definition of environmental justice. Appropriate application of inequality indicators requires thorough characterization of the baseline distribution of exposures and risks, leveraging data generally available within regulatory analyses. Multiple inequality indicators may be applicable to regulatory analyses, and the choice among indicators should be based on explicit value judgments regarding the dimensions of environmental justice of greatest interest.
    International Journal of Environmental Research and Public Health 09/2013; 10(9):4039-59. DOI:10.3390/ijerph10094039 · 1.99 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country's socioeconomic-related child health inequality. Using data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality. Despite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education), regional location, and access to health services, such as facility-based delivery. The Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality - that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system - to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child health.
    PLoS ONE 01/2013; 8(1):e53696. DOI:10.1371/journal.pone.0053696 · 3.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper is a critical review of composite well-being indices that account for inequality. Many well-being indices build upon the idea that while income and wealth are important, they do not constitute a person’s actual quality of life. However, first of all, the analysis finds that while well-being indices aim to go “beyond GDP” and other primarily economic indicators, many of them, unfortunately, do not focus on inequality at all. Secondly, most indices which include inequality in their measurement, only account for economic inequality. Thirdly, the article finds that the most comprehensive wellbeing index in terms of inequality is the Inequality-adjusted Human Development Index which adjusts for economic, health and education inequality. This article finds that well-being indices should make further strides to ensure the capture of non-economic inequality in terms of education and health.
    Social Indicators Research 11/2014; 119(2). DOI:10.1007/s11205-013-0513-6 · 1.26 Impact Factor