Critically appraise the conceptual and practical advantages and disadvantages of using concentration indices to measure inequity in health and in the delivery of health care. Discuss the pros and cons of using these kinds of measures to monitor and evaluate health policies that are targeted at health inequality.
What is equity?
Although equality and equity are not the same, the concepts are intimately related. With the absence of a single accepted definition of equity, there is general agreement that equity implies quality. The measurement of inequality pertains to statistical variation. Equity on the other hand requires normative judgements based on moral theories. Inequality in consumption means that different people receive different
…show more content…
Measurement of Inequality:
The Lorenz curve and the Gini coefficient:
The health Lorenz curve has on the x-axis ? the cumulative proportion of population ranked by health, and the y-axis ? the cumulative proportion of health. The Gini coefficient is a measure of the total health inequality, is 2* the area between the curve and the diagonal line.
The Concentration curve ? the x-axis is cumulative per cent of the population ranked by income, and the y-axis is the cumulative per cent of health. The Concentration index is a measure of income related health inequality, and is 2* the area between the concentration curved the diagonal.
Measuring income-related inequality in health
Socio-economic variations in health can be presented by the concentration curve and CI, as a means to assess the degree of income-related inequality in the distribution of a health variable.
The 2 key variables underlying the concentration curve are:
The health variable (assuming that we have a continuous cardinal measure of health that can be compared and aggregated across individuals), the distribution of which is the subject of interest
A variable capturing living standards
It is the y value posted in the upper right hand corner. The following data was obtained from the “Closed-System Growth” experiment:
Image: Index of health and social factors – life expectancy; maths and literacy; infant mortality; homicides; imprisonment; teenage births; trust; obesity; mental illness, including drug and alcohol addiction; and social mobility – relative to income inequality. (Wilkinson and Pickett, 2009).
The need to distribute wealth amongst the population is another way to promote health equity as it pertains to ensuring that the balance of power is not too one-sided by the rich. Another example of improving the health state is to improve the gap of economic levels by making sure that the poor does not get poorer and the middle class does not become too strained. Lastly, health is dependent on the resources available. If communities are empowered and advocate for change in their health, there is a better chance of improving the health disparities within communities (Adelman, 2008).
Income and wealth inequality refers to the degree to which income is unevenly distributed among people in an economy. The share of total income received by different groups measures inequality, this visually represented in the Lorenz curve. The line of perfect equality bisects the graph with the percentage of income
First, there is Jim Taylor, Hospital CEO, District 16; second, Tondra Young, Clinical Lab Supervisor, District 24; lastly, Corey Anderson, Floor Technician, District 21. The population of each district decreases in average income, education level and life expectancy than its preceding district, beginning with district 16, Jim Taylor’s district. District 16 has an average combined household income of approximately $120,000/ annually. In this district, 65% of the population has a college degree and the life expectancy in this district is 82 years. Whereas, Tondra Young’s district, district 24, has an average combined household income of $70,000/annually and 15% of the population has a college degree. The life expectancy of district 24 is 75 years, that’s 7 years less than district 16. In district 21, Corey Anderson’s district, the average combined household income is less than $50,000/ annually and only 5% of the districts population have college degrees. Consequently, the life expectancy of district 21 is 70 years, 5 years less than district 24 and 12 years less than district 16 (Adelman 2008). The results of this study are indisputable: there is an obvious correlation between social/economic status and health status. As each districts average income and education level decrease, average life expectancy coincides. This leads to the next question: why does social and economic status so greatly influence health status?
Why are higher income and social status associated with better health? If it were just a matter of the poorest and lowest status groups having poor health, the explanation could be things like poor living conditions. But the effect occurs all across the socio-economic spectrum. Considerable research indicates that the degree of control people have over life circumstances,
Health inequalities are preventable and unjust differences in health status experienced by certain population groups. People in lower socio-economic groups are more likely to experience health inequalities than people in higher socio-economic classes. Health inequalities are not only found between people of different
“Health is a state of complete physical, mental, spiritual and social wellbeing, and not just the absence of disease” (WHO, 1974). Health inequalities are the differences in health or healthcare opportunities in different societies this may be due to income,
Widening economic inequality in the United States is being accompanied by increasing health care disparity. While the health care system seeks to provide health care as a human right, it fails to do so often worsening the disparities (Dickman, Himmelstein, & Woolhandler, 2017). While health care today has made major strides, there are many people who are still suffering from health care system injustices. Of the people who are still uninsured a majority of them are in the middle-working class or those living in poverty. Poor Americans have less access to health care than wealthy Americans. The life expectancy gap between the rich and poor continues to widen. Health care in poor communities is too often neglected. This issue has been a trend in the United States for many years. In Abraham’s book, Mama might be better off dead these very same inequalities are evident for the Banes family. Because of these inequalities, preventive illness becomes life threatening causing care to then become extensive and even more expensive.
Because the child is from the inner-city, she may not have had equal access to quality healthcare and adequate resources for deaf children, which has hindered her from learning official sign language. In the USA, many children that are deaf do not receive “equal access to care, intervention, and follow-up services” (Sacks et al., 2014, p. 92). Socioeconomic, minority status and non-English native language are barriers to children having access to various types of services and health care that produce favorable developmental outcomes (Sacks et al., 2014).
Explain patterned inequalities in health and illness. Evaluate sources of evidence with regards to class, gender, ethnicity and age
The United States is world renowned for having the best health care if not the most accessible. Citizens have at their disposal a plethora of hospitals, physicians, and therapists to improve their well-being. Statistical data was taken back in 2010 under the Central Texas Region and studied health care coverage and income in regards to the community. The data displayed in the surveys heavily suggest that income/ health in general have a high correlation. The issue that arose with the given data imply that those who are on the lower end of the income spectrum subsequently have no health care coverage and poorer health than those with higher income. In any case with high correlation there are a number of factors influencing the statistical evidence, and in this case sociological barriers are present in regards of inequality and health care.
This article investigates the question, “ How is the relationship between inequality in income and mortality analyzed in the United States?” The authors do not clearly state any hypotheses. Particularly, the study used data from the 1980 and 1990 census as well as cumulative percentage distribution, discovering the interval enclosing the desired centile, and linear interpolation. The authors looked at the scale of income inequality, the variable, in 50 states in 1980 and 1990 of different age groups by the percentage of total household of both genders’ income collected by the underprivileged 50% of households.
Empirical studies have applied different indices to various health variables one of these variables are health financing indicators (Erreygers et al. 2012). Most commonly used income inequality measures are generalized entropy indices and the Atkinson index. These indices have an ability to examine the effects of inequalities in different areas of the income spectrum, enabling more meaningful quantitative assessments of qualitatively different inequalities (Maio 2003). First group of inequality measures are family of entropy measures. Theil and The Mean Logarithmic Deviation (MLD) are members of family of entropy measures. Theil index derives from the notion of entropy in information theory. It is a measure that assess the value of different
The Lorenz curve can be explained as an extension of the ogive that is used in economics to show the distribution of income or wealth among the population. It is a grapgh of cumulative percentage wealth, income or some other measure of wealth , against cumulative percentage of population. For instance, we can use this curve to determine the fairness