Stecklov, G.: Defining health inequality: why Rawls succeeds where social welfare theory fails. J. Health Econ. 21, 497-513

Institut National d'etudes Démographiques, INRA-Jourdan, Paris, France.
Journal of Health Economics (Impact Factor: 2.58). 06/2002; 21(3):497-513. DOI: 10.1016/S0167-6296(01)00138-2
Source: PubMed


While there has been an important increase in methodological and empirical studies on health inequality, not much has been written on the theoretical foundation of health inequality measurement. We discuss several reasons why the classic welfare approach, which is the foundation of income inequality analysis, fails to provide a satisfactory foundation for health inequality analysis. We propose an alternative approach which is more closely linked to the WHO concept of equity in health and is also consistent with the ethical principles espoused by Rawls [A Theory of Justice. Harvard University Press, Cambridge, MA, 1971]. This approach in its simplest form, is shown to be closely related to the concentration curve when health and income are positively related. Thus, the criteria presented in our paper provide an important theoretical foundation for empirical analysis using the concentration curve. We explore the properties of these approaches by developing policy scenarios and examining how various ethical criteria affect government strategies for targeting health interventions.

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    • "no observed association between income and SAH -and −1 ≤ CI ≤ 1 due to the 2 µ h term. Covariance forms the basis of the measurement of socioeconomic-related inequalities in health, according to the criteria of Wagstaff et al. (1991) and Bommier and Stecklov (2002), among others. "
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    • "While different methods (including the calculation of odds ratios) have been proposed in the public health literature (Mackenbach and Kunst, 1997), the concentration curve has become the workhorse in most health economic studies. Recently, a number of papers have been published which propose a welfare economic foundation for its use (Wagstaff, 2002; Koolman and van Doorslaer, 2004; Bleichrodt and van Doorslaer, 2006) or advocate alternative approaches (Bommier and Stecklov, 2002; Becker et al., 2005; Abul Naga and Geoffard, 2006; Zheng, 2006; Dias and Jones, 2007; Fleurbaey, 2006b). "
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    • "Defining the most appropriate counterfactual scenario to determine when workers would retire in the absence of the health gradient is far from trivial. Bommier and Stecklov (2002) suggest: If equity in health is defined according to a social justice approach, " the health distribution in an ideal equitable society is one where access to health has not been determined by income or socioeconomic status. " Thus, knowing one's health status does not help in predicting a person's income, or vice versa. "
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