Dear Mel , Elisa, et al,
I admit my email was not very clear. I entirely agree with what Mel is
saying. When talking about equality in outcomes I meant at the individual
level people without the same disease. At a population level I don't think
it acceptable for people in different economic situations with the same
condition to have different outcomes, given (in as much as it makes sense to
do so) other things being equal. Although, of course to look at the question
from this angle ignores the causal effect of economic inequalities on being
ill in the first place.
I am interested in the distinction that Elisa was drawing between equity
and equality. I am probably quite ignorant here but I understand equality as
do with equal treatment or outcomes, and equity as to with equal rights.
That is a poor person has equal equity with a rich one if both are 'allowed'
to pay for treatment, the poor person is just unlucky he can't afford it.
There would be a lack of equity if he was not allowed to have medical
treatment. Although writing it out like this I can see that under some
description every discrimination could be classified as equity.
James
>Dear James and colleagues:
>In reply --
>
> >As far as I can see equality in outcomes is clearly
> > not possible and not really desirable.
>
>Are you sure that you mean this? Is it okay for people
>with the same disease but different economic
>situations to have different outcomes (length of
>survival etc)? I hardly think so, and we need to be
>careful to distinguish 'health outcomes' from
>'social outcomes'. It is a great frustration for
>clinical staff that they can and do provide equally
>painstaking treatment for people, only to find that
>those who are less well off heal up more slowly,
>are more likely to get worse or to relapse. This is
>one of the starting points for a debate on *health*
>inequality, namely, that the best intentions of
>health workers are frustrated by social reality.
>And indeed, on the economic front, the great
>expense of health care yeilds less 'returns'
>than it otherwise might.
>
>Mel B
>
>Mel Bartley
>Dept of Epidemiology and Public Health
>University College London Medical School
>1-19 Torrington Place
>London WC1E 6BT
>tel: 0171 391 1707
>fax: 0171 813 0242
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