Please check out the definition of equity/inequity developedd by the
International Society for Equity in Health.  It is on the website www.iseqh.org
I believe that it gets around your problem  (Equity in health is the
absence of systematic and potentially remdiable differeces in one or more
asspects of health across populations or population groups defined
socially, economically, geographically, or demographically)
There are similar definitions for equity/inequity in access to health
services and lots of information about the ISEqH and its next international
meeting in Toronto Canada, June 14-16,2002.

Barbara Starfield, MD




At 04:01 PM 11/30/2001 +0000, Mike Hughes wrote:
>I wonder if it would be helpful to return to Ken Judge’s back-to-basics
>point that we should think through what constitutes success in reducing
>health inequalities and then ask what is the best means of achieving a
>reduction.
>
>I’d like to throw in some ideas on this:
>
>Ill-health defines health inequality
>
> There is a powerful consensus that “health” is more than the
absence of
>injury and disease. That is, “health” isn’t defined by ill-health
>
> However “health inequality” surely is defined by ill-health. That 
>is, one
>of the defining characteristics of health inequality is the disproportionate
>presence of ill-health within in an identifiable section of a population.
>
> There has also been some suggestion that the disproportionate ill-health
>involved in an “health inequality” is unnecessary or unjust. (Although I
>have my concerns about this, that is another debate for another time.)
>
>“Health needs”
>
> I suspect that anyone who would wish to challenge my definition of a
>health inequality as “disproportionate ill-health” would wish to
replace it
>with “disproportionate health needs”.
>
> Unfortunately in discussions of health inequalities we often use imprecise
>expressions, and expressions imprecisely, and one of those that causes most
>problems is “health needs”. In some circumstances we use it to mean the
>presence of ill-health.  In other contexts it is used to mean a whole range
>of socio-economic factors which are regarded as “determinants” of health 
>–
>that is something less than a cause of, but more than an association with,
>good/bad health.
>
> I don’t have a problem in principle with a definition that refers to
>disproportionate “health needs”. However if we are going to use this
>definition we need to be careful that we do not  include poverty, ethnicity
>or gender (or any other factor that we would wish to use to identify an
>advanataged or disadvantaged section of the population) as a “health
need”.
>
>Reducing Health Inequalities
>
> Health inequality is a comparative term: we are comparing the health
>status of a sub section of a whole population with that of  the population
>as a whole, or we are comparing the health status of two sub sections of the
>population.
>
> Therefore individuals don’t have health inequalities in the same way
that
>they have health status or even health needs.
>
> Therefore a reduction in health inequality cannot be a reduction in the
>numbers of individuals with health inequalities (because there aren’t any!)
>
> We also need to discount the “equalising down” approach to reducing
>inequalities.  A reduction in inequality is not simply a reduction in the
>disparity between the health status of the advantaged and disadvantaged
>sections of the population.
>
> A reduction in health inequalities can only be achieved by reducing the
>quantity of ill-health and injury experienced by people within a
>disadvantaged section of the community.
>
> And this health improvement must be achieved at a faster rate than for the
>health improvement of comparatively advantaged sections of the community
>(otherwise the inequality stays the same or grows).
>
>What constitutes success in reducing health inequalities?
>
>The logic of this thinking is therefore that success in reducing health
>inequalities is
>
> A reduction in the disparity between the health status of a disadvantaged
>section of the community and the community as a whole and/or the more
>advantaged sections of the community.
>
>But it also suggests some limits on how we should measure health status:
>
> firstly the key measure is the absence of disease and injury
>
> secondly if we want say something meaningful, as well as true, about the
>relationship between poverty and poor-health, or wealth and good-health, we
>need to define health independently of poverty, or wealth.
>
>The Medical Model
>
>I have no doubt that I have laid myself open to accusations of being tied to
>the medical model of health. When considering health inequalities that is
>fairly true – perhaps there is even an argument to made that broader
>definitions of health disproportionately benefit wealthier communities.
>
>
>
>
>
>----- Original Message -----
>From: Ken Judge <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Monday, November 26, 2001 3:34 PM
>Subject: Re: Tackling health inequalities
>
>
>
>There are multiple sources of information about attempts at local
>strategies to reduce health inequalities. The latest in a long line of
>examples are the delivery plans produced for the DLTR by the 39 New Deal
>for Communities sites in England. Two or three years ago Health Action
>Zones produced similar plans. Various analyses of these plans are either
>available on HAZNET, for example, or are currently being produced by
>various teams. The problem is that there is no really convincing evidence
>that the implementation of these plans will make a significant difference.
>
>We might all agree that social and economic inequalities are the primary
>determinants of health inequalities but it is much harder to agree about
>priorities for economic and social policy. It is harder still to provide
>really convincing advice about what change in health inequalities might be
>expected from particular investments in specific policies. We might readily
>agree that all housing should meet mimimum standards, or investments in
>schooling in inner cities should be greatly improved or that child benefits
>in the social security system should be much more generous or whatever. But
>we are unable to say with any degree of precision what benefits this would
>deliver in terms of health inequalities.
>
>In short, faced with a radical Prime Minister who wanted to spend say £5
>billion to help to reduce health inequalities is the research community
>really well placed to say with conviction how this money should be spent?
>
>We need to invest more effort in thinking through what would constitute
>success in reducing health inequalities and then ask the question what are
>the best means of achieving that.
>************************************
>
>Ken Judge
>Professor of Health Promotion Policy
>Department of Public Health
>University of Glasgow
>1, Lilybank Gardens
>Glasgow G12 8RZ
>
>WORK
>Tel & Fax: 0141 330 5008
>Mobile: 0794 184 6981
>Email: [log in to unmask]
>
>
>HOME
>Tel: 0141 586 9832
>Email: [log in to unmask]
>
>***********************************
Barbara Starfield, MD, MPH, FRCGP
University Distinguished Service Professor
President, International Society for Equity in Health
Johns Hopkins School of Public Health
624 North Broadway, Rm 452
Baltimore, MD  21205
Phone 410 955 3535
Fax 410 614 9046
email [log in to unmask]