Abstract
Approaches to measuring health inequalities are often problematic because they use methods that are inappropriate for categorical data. In this paper we focus on “pure” or univariate health inequality (rather than income-related or bivariate health inequality) and use a concept of individual status that allows a consistent treatment of such data. We take alternative versions of the status concept and apply methods for treating categorical data to examine self-assessed health inequality for the countries included in the World Health Survey. We also use regression analysis on the apparent determinants of these health inequality estimates. We show that the status concept that is used will affect health-inequality rankings across countries and the way health inequality is related to countries’ median health, income, demographics and governance.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Abul Naga, R H, Yalcin, T: Inequality measurement for ordered response health data. J. Health Econ. 27, 1614–1625 (2008)
Abul Naga, R H, Yalcin, T: Median independent inequality orderings. Technical, University of Aberdeen Business School (2010)
Allison, R A, Foster, J E: Measuring health inequality using qualitative data. J. Health Econ. 23, 505–552 (2004)
Asada, Y, Hurley, J, Norheim, O F, Johri, M: A three-stage approach to measuring health inequalities and inequities. Int. J. Equity Health 13, 98 (2014)
Bleichrodt, H, van Doorslaer, E: A welfare economics foundation for health inequality measurement. J. Health Econ. 25, 945–957 (2006)
Bound, J: Self-reported versus objective measures of health in retirement models. 26, 106–138 (1991)
Clarke, P M, Gerdtham, U.-G., Johannesson, M, Bingefors, K, Smith, L: On the measurement of relative and absolute income-related health inequality. Soc. Sci. Med. 55, 1923–1928. (2002)
Clarke, P, Erreygers, G: Defining and measuring health poverty. Soc. Sci. Med. 244, 112633 (2020)
Costa-Font, M, Costa-Font, J: Heterogeneous “adaptation”and “income effects” across self-reported health distribution?. J. Socio-Econ. 38, 574–580 (2009)
Costa-Font, J, Hernández-Quevedo, C: Inequalities in self-reported health: a meta-regression analysis. LSE Health working paper series in health policy and economics 32/2013, LSE Health and Social Care, London School of Economics and Political Science, London (2013)
Costa-Font, J, Cowell, F A: The measurement of health inequalities: does status matter? III Working Paper 6, International Inequalities Institute, The London School of Economics and Political Science (2016)
Costa-Font, J, Hernandez-Quevedo, C, Sato, A: A health ‘Kuznets’ curve’? cross-sectional and longitudinal evidence on concentration indices. Soc. Indic. Res. 136, 439–452 (2018a)
Costa-Font, J, Ljunge, M: The “healthy worker effect”: Do healthy people climb the occupational ladder?. Econ. Hum. Biol. 28, 119–131 (2018b)
Costa-Font, J, Cowell, F A: Measuring health inequality with categorical data: some regional patterns. Res. Econ. Inequal. 21, 53–76 (2013)
Cowell, F A: On the structure of additive inequality measures. Rev. Econ. Stud. 47, 521–531 (1980)
Cowell, F A, Flachaire, E: Inequality with ordinal data. Economica 84, 290–321 (2017)
Cowell, F A, Flachaire, E: Inequality measurement: Methods and data. In: Zimmerman, K., Sierminska, E. (eds.) Handbook of Labor, Human Resources and Population Economics. https://tinyurl.com/y88q4r56. Springer (2021a)
Cowell, F A, Flachaire, E: Maximum inequality: the case of categorical data. Res. Econ. Inequal. 29 (2021b)
Cutler, D, Richardson, E: Measuring the health of the United States population. Brookings Papers Econ. Activity Microecon. 2, 217–271 (1997)
de Barros, R P, Ferreira, F, Chanduvi, J, Vega, J: Measuring inequality of opportunities in Latin America and the Caribbean. Palgrave Macmillan Rosenblum, D (ed.) (2008)
Dowd, J B, Todd, M: Does self-reported health bias the measurement of health inequalities in us adults? evidence using anchoring vignettes from the Health and Retirement Study. J. Gerontol. Ser. B: Psychol. Sci. Soc. Sci. 66, 478–89 (2011)
Erreygers, G, Kessels, R: Socioeconomic status and health: A new approach to the measurement of bivariate inequality. Int. J. Environ. Res. Publ. Health 14, 673 (2017)
Ettner, S L: New evidence on the relationship between income and health. J. Health Econ. 15, 67–85 (1996)
Fleurbaey, M: Health, equity and social welfare. Annales d’Économie et de Statistique 83/84, 21–59 (2006)
Fleurbaey, M, Schokkaert, E: Health and health care. In: Pauly, M., McGuire, T., Pita-Barros, P. (eds.) Handbook of Health Economics, vol. 2. North-Holland (2012)
Fleurbaey, M, Schokkaert, E: Unfair inequalities in health and health care. J. Health Econ. 28(1), 73–90 (2009)
Fonseca, L, Jones, A M: Inequalities in self-assessed health in the health survey of England. Technical Report, Equity Working Paper 11, University of York (2003)
Furlong, W, Feeny, D, Torrance, GW, Goldsmith, C, DePauw, S, Zhu, Z, Denton, M, Boyle, M: Multiplicative multi-attribute utility function for the Health Utilities Index Mark 3 (HUI3) system: a technical report. Working Paper 98-11, McMaster University, Centre for Health Economics and Policy Analysis (1998)
Groot, W: Adaptation and scale of reference bias in self-assessments of quality of life. J. Health Econ. 19, 403–420 (2000)
Hausman, D M, Asada, Y, Hedemann, T: Health inequalities and why they matter. Health Care Anal. 10, 177–191 (2002)
Heien, T N: The relationship between self-rated health and hospital records. Health Economics in press (2015)
Idler, E L, Benyamini, Y: Self-rated health and mortality: A review of twenty-seven community studies. J. Health Soc. Behav. 38, 21–37 (1997)
Jenkins, S P: Inequality comparisons with ordinal data. Review of Income Wealth (2021)
Jylhä, M, Guralnik, J M, Ferrucci, L, Jokela, J, Heikkinen, E: Is self-rated health comparable across cultures and genders?. J. Gerontol. Ser. B: Psychol. Sci. Soc. Sci. 53, S144–S152 (1998)
Kaufmann, D, Kraay, A, Mastruzzi, M: The worldwide governance indicators project: answering the critics. Technical Report, Policy Research Working Paper Series 4149, The World Bank (2007)
Kickbusch, I, Gleicher, D: Smart governance for health and well-being: the evidence. WHO regional office for Europe (2014)
Koolman, X, van Doorslaer, E: On the interpretation of a concentration index of inequality. Health Econ. 13(7), 649–656 (2004)
Kunst, A E, Mackenbach, J P: International variation in the size of mortality differences associated with occupational status. Int. J. Epidemiol. 23, 1–9 (1994)
Le Grand, J: Inequalities in health: some international comparisons. Eur. Econ. Rev. 31, 182–191 (1987)
Loomes, G, McKenzie, L: The use of QALYs in health care decision making. Soc. Sci. Med. 28, 299–308 (1989)
Makdissi, P, Yazbeck, M: Measuring socioeconomic health inequalities in presence of multiple categorical information. J. Health Econ. 34, 84–95 (2014)
Marmot, M: Social determinants of health inequalities. Lancet 365 (9464), 1099–104. (2005)
Sen, A: Health: perception vs. observation. Br. Med. J. 324, 860–861 (2002)
Shorrocks, A F: The class of additively decomposable inequality measures. Econometrica 48, 613–625 (1980)
Tandon, A, Murray, C J, Lauer, J A, Evans, D B: Measuring overall health system performance for 191 countries. World Health Organization, Geneva (2000)
The EuroQol Group: EuroQol: a new facility for the measurement of health-related quality of life. Health Policy 16, 199–208 (1990)
Van Doorslaer, E, Jones, A M: Inequalities in self-reported health: Validation of a new approach to measurement. J. Health Econ. 22, 61–87 (2003)
Wagstaff, A, Paci, P, van Doorslaer, E: On the measurement of inequalities in health. Soc. Sci. Med. 33, 545–557 (1991)
Wagstaff, A, van Doorslaer, E: Equity in health care financing and delivery. In: Culyer, A.J., Newhouse, J.P. (eds.) Handbook of Health Economics, pp 1803–1806. North Holland (2000)
Zheng, B: A new approach to measure socioeconomic inequality in health. J. Econ. Inequal. 9, 555–577 (2011)
Acknowledgements
We are grateful to Linchuan Xu, Xuezhu Shi and to Alejandra Hernandez for research assistance and to STICERD for financial assistance.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Costa-Font, J., Cowell, F.A. The measurement of health inequalities: does status matter?. J Econ Inequal 20, 299–325 (2022). https://doi.org/10.1007/s10888-021-09497-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10888-021-09497-4