Does the world have a view about the use of what is essentially a technical expression?
This part of an essentially technical vocabulary and is actually fraught with what linguisitc philosophers call “persuasive definitions”. (“A persuasive definition is a form of definition which purports to describe the 'true' or 'commonly accepted' meaning of a term, while in reality stipulating an uncommon or altered use…. “; Wikipedia’s current and persuasive definition).
There was, and is, a similar debate in the UK where cons and neo-cons prefer the even less politically charged “variation” to "disparity" or “inequality”. Margaret Whitehead and others have distinguished between “inequality” (all variations in health status whether unjust, just or neutral – ie those both variations that can be mended and those that can’t) and “inequity” (unnecessary and unjust variations in health - only those that can be mended).
I believe this is an entirely unhelpful and manufactured distinction and a classic case of, albeit well-meaning, “persuasive definition”. I also think it stems from not recognising that there is fundamental difference in meaning of “equality” when used to indicate “identity” in a mathematical context ; and when it is used to indicate “equivalence” in socio-economic, political or health context.
To put it bluntly 2+2=3+1=4 expresses three different ways of identifying the same abstract entity. On the other hand while I may be Tony Blair’s equal, I’m not my own equal.
Rather than running away from the ideological and linguistic confrontation should we not stand our liberal ground and argue that "Of all the forms of inequality, injustice in health is the most shocking and the most inhuman"?
Mike Hughes
>
> From: "Starfield, Barbara" <[log in to unmask]>
> Date: 2007/03/08 Thu PM 10:19:38 GMT
> To: [log in to unmask]
> Subject: Re: use of term disparity in US
>
> Perhaps. The rest of the world calls it inequity.
> Barbara Starfield, MD, MPH
> University Distinguished Professor
> Johns Hopkins University & Medical Institutions
> 624 North Broadway, Room 452
> Baltimore, Maryland 21205
> Phone 410-955-3737
> Fax 410-614-9046
> [log in to unmask]
>
>
> ----- Original Message -----
> From: The Health Equity Network (HEN) <[log in to unmask]>
> To: [log in to unmask] <[log in to unmask]>
> Sent: Thu Mar 08 16:09:31 2007
> Subject: Fw: use of term disparity in US
>
> This discussion could be interesting for the list
> Valéry
>
> ----- Original Message -----
> From: <[log in to unmask]>
> To: "Valéry Ridde" <[log in to unmask]>; "Barbara Krimgold"
> <[log in to unmask]>
> Sent: Thursday, March 08, 2007 3:44 PM
> Subject: Re: use of term disparity in US
>
>
> > The writeup that you forwarded is a bit confused. Inequality simply means
> > a difference. What I have seen more often used in international circles
> > compared to the US is the term inequity. That term is not used very often
> > in policy circles in the US.
> >
> > whereas the UK has examined more "disparities" by social class (mostly
> > occupational), the US has focused more on disparities by race/ethnicity.
> > But the term "disparity" is NOT restricted to just race/ethnicity in the
> > US. That is simply false. Just look at the Healthy People 2010 goal: "Goal
> > 2: Eliminate Health Disparities. The second goal of Healthy People 2010 is
> > to eliminate health disparities among different segments of the
> > population." Elsewhere in the Healthy People 2010 documents, they list the
> > various subgroups of interest (gender, sexual orientation, socioeconomic
> > status, etc.)--much more than race/ethnicity. And, data are presented by
> > more than just race/ethnicity.
> >
> > While the US has been collecting data on race/ethnicity for many decades,
> > we have been slower in collecting complete data on other socioeconomic
> > status markers. For instance, education was not included on the standard
> > birth and death certificates recommended for use by the states until 1989.
> > Occupation was included much earlier but we don't use it as often in our
> > presentation of health data as they do in the UK. We have collected SES
> > data for many other important national health data systems (e.g., National
> > Health Interview Survey) for many decades.
> >
> > What is interesting is that the UK is trying to learn how we collect
> > racial/ethnic data with their increasing immigrant population. You see
> > more reports coming out of the UK which do present data by "racial/ethnic"
> > categories.
> >
> > The use of the word disparity in the US is also not limited to health
> > care. It has been used for some time for a broad range of health status
> > indicators (e.g., the 1979 document that I forwarded to you referred to
> > disparities in birthweight). Indeed, this usage happened even before the
> > 1985 Task force on Black and Minority health was released by the Secretary
> > of Health and Human Services (a report considered a landmark document
> > drawing national attention to minority health concerns).
> >
> >
> > Olivia Carter-Pokras, Ph.D.
> > Associate Professor
> > Department of Epidemiology and Biostatistics
> > College of Health and Human Performance
> > University of Maryland
> > 1240D HHP Bldg.
> > College Park, MD 20742
> > Phone: 301-405-8037
> > Fax: 301-314-9366
> > [log in to unmask]
>
> ***
> Thanks for that Olivia.
> My understanding of the US context is better now but I'm also confuse now
> because I understood the inverse between "disparities" and "inequalities",
> following, for exemple, this interpretation from Exworty and al..
> Are you agree with them ?
>
> "Although the definitions of both inequalities and disparities capture
>
> the systematic differences, disparities are interpreted differently by U.S.
>
> and U.K. policymakers. Whereas the United States tends to use the term
>
> disparities, the United Kingdom commonly uses the term inequalities. The
>
> United States often concentrates on health care issues (especially access
>
> and insurance coverage) and race/ethnicity, reflecting two critical
> dimensions
>
> of U.S. society: the number of persons without health insurance
>
> (45 million in 2003) (Lillie-Blanton and Hoffman 2005) and the significance
>
> of racial politics. In the United Kingdom, the term inequality
>
> (usually referring to differences in socioeconomic status) has been
>
> "officially sanctioned" since the Labour government of Tony Blair was
>
> elected in 1997. Previously, under the Conservative administrations of
>
> Margaret Thatcher and John Major, the term and the issues were
>
> ignored or euphemistically called "variations" (Exworthy, Blane, and
>
> Marmot 2003). Recently, however, U.K. policy has tried to influence
>
> the wider/social determinants of health and has focused mainly on
>
> disparities in socioeconomic status and geography (Exworthy, Blane,
>
> and Marmot 2003). In short, the United States has tended to focus on
>
> disparities in access and race/ethnicity, and the United Kingdom has
>
> been more concerned with developing a population-based approach
>
> (with populations largely stratified by socioeconomic status), although
>
> the two countries still have much in common"
>
>
> Exworthy M, Bindman A, Davies H, Washington E. Evidence into Policy and
> Practice? Measuring the Progress of U.S. and U.K. Policies to Tackle
> Disparities and Inequalities in U.S. and U.K. Health and Health Care.
> Milbank Quarterly 2006;84(1):75-109.
>
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