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First, it is very important to know what inequity is---in measurable terms. Please consult the website of the International Society for equity in Health (www.iseqh.org <http://www.iseqh.org/> ) for such definition i.e. the presence of systematic and potentially remediable differences in one or more aspect of health in population groups differing socioeconomically, demographically, or geographically. As you can see, this definition provides a direct way to thinking about how to measure (in)equity. Of course, there a methodological challenges (such as relative versus absolute differences) and a very large literature that deals with them. Please be aware of the international Journal for Equity in Health---a free access journal (see www.equityhealthj.com <http://www.equityhealthj.com/> ) If anyone wishes a lists of papers my colleagues and I have written on various aspects of equity in health, (with lots of references within)and including an annotated bibliography, please send me an email. B ________________________________ From: The Health Equity Network (HEN) [mailto:[log in to unmask]] On Behalf Of Charles Normand Sent: Tuesday, December 05, 2006 10:23 AM To: [log in to unmask] Subject: Re: How to evaluate whether interventions reduce inequalities? Anne Marie There have been several sensible suggestions. Just one small point regarding Gini co-efficient type measures (including Kakwani etc). Experience shows that failure to be interested in kurtosis can lead to distorted results. A recent Irish study on equity in access to GPs concluded that the current arrangements compared favorably with other EU countries, but this happened because access for the very poor is very good, and this hid the fact that access for the fairly poor is very poor. Charles Normand Edward Kennedy Professor of Health Policy and Management University of Dublin Trinity College 3-4 Foster Place Dublin 2 +353 1 896 3075 [log in to unmask] Please note the new telephone number - the old one no longer works. -----Original Message----- From: The Health Equity Network (HEN) [mailto:[log in to unmask]] On Behalf Of Roger Keller Celeste Sent: 05 December 2006 11:21 To: [log in to unmask] Subject: Re: How to evaluate whether interventions reduce inequalities? Hi Anne-Marie, To measure reductions in health inequality is a very hard task. There is no unique measure and it also depends on how you define inequality. I don't think it is a silly question! There is an interesting paper (Keppel KG, Pamuk E, Lynch J, Carter-Pokras O, Kim I, Mays V, et al. Methodological issues in measuring health disparities. Vital Health Stat Serie 2. 2005 Jun(141):1-16.). There is also a chapter in the book of Kaufman and Oakes (Oakes JM, Kaufman JS. Methods in social epidemiology. San Francisco: Jossey-Bass; 2006.) Well, to be brief, I see two ways. One is to consider any difference among individuals as inequality. Then you may try traditional measures, like Gini, before-after your intervention. Another way is defining, for instance, inequality related to socioeconomic position (or any other variable). In this case you may use simple epidemiologic measures, like attributable risk, then you will compare the size of the gap between the poor and the rich before-after your intervention. Hope I could help. Roger Keller Celeste, MSc Doutorando Epidemiologia (PhD student) Instituto de Medicina Social - UERJ Rua São Francisco Xavier, 524 7o ANDAR Rio de Janeiro - Brasil ----- Original Message ----- From: Bagnall, Anne-Marie <mailto:[log in to unmask]> Sent: Monday, December 04, 2006 3:41 PM Subject: How to evaluate whether interventions reduce inequalities? Does anyone have any thoughts about how to evaluate whether an intervention reduces inequalities in health? It seems to me that we can evaluate whether an intervention is effective, and we can go some way towards evaluating the reach of an intervention i.e. whether it is used by certain disadvantaged groups, but can we actually assess reliably whether an intervention is likely to reduce or even increase health inequalities? Because health inequalities seem to be increasing so it would be useful for decision makers to have some idea, not only about whether something is effective, but also whether it is in fact likely to increase this gap? I'm sorry if this is a silly question or too simplistic. I've been puzzling over it for a while and thought it was time to ask the experts. Many thanks in advance, Anne-Marie Anne-Marie Bagnall Senior Research Fellow School of Health & Community Care Leeds Metropolitan University Calverley Street, Leeds LS1 3HE [log in to unmask] 0113 283 2600 ext. 4337 To view the terms under which this email is distributed, please go to http://disclaimer.leedsmet.ac.uk/email.htm