There are health needs and there are inequities in health.  Both need
attention. Just because something is not inequitable doesn;t mean that it
doesn;t need attention;  in fact, this has been the entire basis for health
services up to the present time.

Your examples are examples of health inequalities, not health inequities.
Until it can be shown that breast cancer in women, sickle cell anemia, and
differences in health by age are potentially remediable, they are not
inequities. However, SERVICES that are denied to population groups that
have these problems are inequities.   Thus the importance of carefully
distinguising inequities in health from inequities  in health services.

I hope that people will stay with this listserve because the issues that
are being raised are at the heart of attempts to reduce inequities.  If we
do not understand the problems and resolve these issues, we stand no chance
of making a breakthrough in providing  the scientific underpinnings to help
to accomplish something we all want to accomplish.

Barbara Starfield



At 09:41 PM 12/4/01 +0000, you wrote:
>Surely there is a problem is in the example. Individuals have health needs
>but don't have health inequalities. But groups of individuals may have
>disproportionate health needs compared with either the population as a whole
>or a sub section of the population.Like Alan I feel that some of these are
>inequalities, and demand a response even though they may not be unjust ,
>inequitable, preventable, systematic or the result of social processes.
>Examples might be the greater incidence of breast cancer in women than men,
>racially specific illnesses such sickle cell trait or thalassaemia, or even
>the circumstantial differences that arise from the greater physical
>vulnerability of very young and very old people.
>
>Hope this is still interesting and we aren't in danger of loosing all the
>list's members.
>
>
>----- Original Message -----
>From: "Barbara Starfield" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Tuesday, December 04, 2001 5:42 PM
>Subject: Re: When is an inequality inequitable?
>
>
>> Alan has made some interesting points, but I think that some of them are
>> not inherently issues of equity but, rather, issues of meeting health
>> needs. Something does not have to be unfair in order to command attention!
>> Medical services are appropriately provided to people who have health
>> problems,  many of them an apparent result of random variations. The child
>> born with congenital anomalies needs care because it is unethical to deny
>> care under prevailing medical ethics, not because it is unfair that the
>> child was born with the problems. The issue becomes one of social justice
>> when the unfairness is systematic.  This is reflected in the ISEqH
>> definition. which has also been devised to facilitate measuring the
>> existence and extent of unfairness (inequity).
>> The definition does not construe 'social' narrowly;  we include in it
>> anything that is a result of social processes.  Altnough 'individual
>> behavior' occurs in a social context, it is not influenced SYSTEMATICALLY
>> by 'social processes' and, if it is, it comes under the definition. (For
>> example, when health education campaigns are designed to or have the
>effect
>> of having more of a positive  impact on behaviors of the more privileged
>> classes, that is an issue of  inequity---but an individual's own decision
>> to engage in certain behaviors is not)).
>>
>> (By the way, this issue of individual inequalities vs social inequalities
>> is at the heart of the problem with WHO conceptualization of inequities,
>> which you (Alan) have written so eloquently about!  I suppose you have
>seen
>> the commentaries by Almeida et al (in Lancet) and Braveman, et al (in
>> BMJ),. both of which I co-authored)
>>
>> Barbara Starfield
>>
>>
>>
>> At 11:21 AM 12/4/01 +0000, Alan Williams wrote:
>> >Picking up Brian Fleming's and Barbara Starfield's points on the above
>> >topic it would be interesting to indentify some critical instances which
>> >one network person thinks are inequitable yet another considers
>> >equitable, and then try to identify the critical difference of principle
>> >between them (after all, equity principles are inherently contestable,
>> >so it is not a matter of who is right and who is wrong, but why and how
>> >do views differ and what are their differential implications for policy
>> >and action).
>> >
>> >I think that it is unfair that someone is born congenitally malformed,
>> >even if this is a biological variation randomly distributed across a
>> >population, because that person does not have the life chances that the
>> >rest of us have, and I want to do something about it by offering other
>> >compensations whose costs are out of all proportion to the rather small
>> >benefits I can actually bring about.    Why would I want to do this if I
>> >did not consider the situation inequitable?    Should I instead say "bad
>> >luck, but it had to happen to somebody" and then walk away from it?
>> >
>> >I am surprised that the "official" definition espoused by the Sopciety
>> >interprets "social" so narrowly as to exclude groups defined by their
>> >behaviour.   Does the society then believe that it is perfectly
>> >equitable to deny treatment for lung cancer to smokers?     Does not
>> >that old virtue "Charity" play a role, through fellow-feeling, in trying
>> >to help "sinners" despite their foolishness, or is this seen as a matter
>> >of retribution rather than inequity?
>> >
>> >I think that it is on the borderlines where luck and personal
>> >responsibility are in play that it is particularly interesting to
>> >explore people's stances, and from what underlying notion(s) of
>> >distribution justice they flow.
>> >
>> >Alan Williams
>> >
>> >PS (for Barbara) I am devoting my spare time and energy to empirical
>> >research on these matters with younger and more energetic colleagues
>> >(such as Dolan and Shaw, who were recently cited), focusing mainly on
>> >problems within the UK, and popping up now and again in the UK HEN
>> >Group.   A Global persective is more than I can cope with ......
>> >
>>
>>
>> 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]
>


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]