Call in the philosopher-ethicists. Alan, how about that
proposed meeting?
-----Original Message-----
From: Barbara Starfield
To: [log in to unmask]
Sent: 12/3/01 9:11 AM
Subject: Re: Tackling health inequalities
Alan:
Can you give me examples of each, please?
Also, it would be helpful if you can provide some wy to measure justice.
Without a way to measure it, we never know when we have it.
Barbara
At 09:32 AM 12/3/01 +0000, Alan Williams wrote:
>This definition is inadequate because it assumes that all potentially
>remediable inequalities are inequitable, and no irremediable ones are!
>An inequality only becaomes inequitable when it is appraised within
some
>theory of justice. No values in, no values out!
>
>Alan Williams
>
>Barbara Starfield wrote:
>>
>> 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 JudgeEUR(tm)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.
>> >
>> >IEUR(tm)d like to throw in some ideas on this:
>> >
>> >Ill-health defines health inequality
>> >
>> >' There is a powerful consensus that EURoehealthEUR is more than
the
>> absence of
>> >injury and disease. That is, EURoehealthEUR isnEUR(tm)t defined by
ill-health
>> >
>> >' However EURoehealth inequalityEUR 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 EURoehealth inequalityEUR is unnecessary or unjust.
(Although I
>> >have my concerns about this, that is another debate for another
time.)
>> >
>> >EURoeHealth needsEUR
>> >
>> >' I suspect that anyone who would wish to challenge my definition
of a
>> >health inequality as EURoedisproportionate ill-healthEUR would wish
to
>> replace it
>> >with EURoedisproportionate health needsEUR.
>> >
>> >' Unfortunately in discussions of health inequalities we often use
imprecise
>> >expressions, and expressions imprecisely, and one of those that
causes
most
>> >problems is EURoehealth needsEUR. 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 EURoedeterminantsEUR
of
health
>> >EUR"
>> >that is something less than a cause of, but more than an association
with,
>> >good/bad health.
>> >
>> >' I donEUR(tm)t have a problem in principle with a definition that
refers to
>> >disproportionate EURoehealth needsEUR. 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
EURoehealth
>> needEUR.
>> >
>> >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 donEUR(tm)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
arenEUR(tm)t
any!)
>> >
>> >' We also need to discount the EURoeequalising downEUR 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 EUR" 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]
>
Barbara Starfield, MD, MPH
University Distinguished Professor
The Johns Hopkins Medical Institutions
624 N Broadway-Room 452
Baltimore MD 21205
Phone 410 955 3737
Fax 410 614 9046
email [log in to unmask]
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