WHO’s World Health Report 2000 (WHR) ranks countries based on a new indicator of health inequalities. It was developed to overcome the problems of “the social group approach,” the more familiar approach for scholars in this area who examine disparities in health between social groups defined a priori based on characteristics such as wealth, education, or ethnicity. The WHR solution is to characterize people solely on health status: Instead of comparing the health of the poorest with the richest, they compare the health of the sickest with the healthiest. WHR 2000 reflects the authors’ decision to devote resources earmarked for work on health equity to their approach, discontinuing WHO work to help countries develop capacity to monitor how health disparities between defined social groups change over time in relation to policies. This presentation critiques the WHR position and presents data and arguments to the effect that the WHR position is based on profound misconceptions, which do not arise in an historical vacuum. We demonstrate the lack of correspondence between the WHR measure of “health inequality” and accepted measures of socioeconomic inequality in health for 44 countries. We argue that the WHR approach removes all normative content from the process of assessing health inequalities and also lacks practical value to guide policy. We discuss the concepts of equity and inequality in light of this controversy and suggest that those who care about equity need to be very clear conceptually about what they wish to measure and why.
Learning Objectives: 1. Understand the difference between the terms health inequalities, social inequalities in health, and inequity in health; and understand the relevance to concerns about justice and human rights. 2. Understand the basis for how countries were ranked in the World Health Report 2000 on “health inequality”, and be aware of the lack of correspondence of that ranking with rankings based on measures of socioeconomic inequalities in health, and the lack of practical utility of the World Health Report measure for guiding policy. 3. Understand the importance of being conceptually clear about what is meant by equity in health.
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.