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A Problem with the Individual Approach in the WHO Health Inequality Measurement

DOI: 10.1186/1475-9276-1-2

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We look at the three questions: (1) is the World Health Organization's health inequality measure value-free as it claims? (2) if it is not, what is the normative position implied by its approach when measuring health inequality? and (3) is the individual approach a logically consistent methodological choice for that normative position?We argue that the World Health Organization's health inequality measure is not value-free. If it was, the health inequality information that the measurement collected could not reasonably be included in its ranking of how well national health systems performed. The World Health Organization's normative position can be interpreted as a quite expansive view of justice, in which health distributions that have causes amenable to human intervention are considered to be matters of justice. Our conclusion is that if the World Health Organization's health inequality measure is to be interpreted meaningfully in a policy context, its conceptual underpinning must be re-evaluated.In the World Health Report 2000, the World Health Organization (WHO) proposed two principles by which the performance of national health system should be assessed: "goodness, the best attainable average level" and "fairness, the smallest feasible differences among individuals and groups" [1], p. xi]. These two principles are translated into five indicators in its index of national health system's performance, and one of them is the level of health inequality within nations. For this, the WHO made the controversial choice to measure inequality across individuals rather than across groups, the standard in the field [2,3]. Although the WHO's choice has already been widely discussed and criticized [4-13], we believe there are further important points to make.We look at the following three questions in this paper. First, is the WHO health inequality measure in fact value-free as it claims? Second, if, as we will argue, it is not, what is the normative position implied by the W


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