Issues in comparing the health of two populations

In addressing questions surrounding the comparison of different popula-tions' health, the first issue to be raised is whether devoting scarce analytical resources on attempting to answer them is worthwhile. A second issue is whether these questions are capable of being answered satisfactorily. Only after that does it seem important to try to address more direct questions of how best to do this. It may seem unnecessary to examine the question of whether it is important to consider whether one population is healthier than another. Primarily the importance of trying to do so lies in any uses that might be made of this information. There would seem to be two. Whether, for example, one region of a country has higher health status than another might prompt investigation of why. Second, if one region has a lower health status than another, then depending on how equity is considered in policy terms, there may be a case for devoting more resources to that region. To establish that population A is healthier than population B does not seem a worthwhile activity. It becomes so only on two counts. First, if there is a possibility of knowing why that is the case, the information might be used to alter the situation and improve things. There would seem to be a parallel here with a screening programme. To screen to determine that a subpopulation are at greater risk than the remainder of the population is normally considered to be justified only when there is some effective intervention for the higher risk group. It would not be enough simply to identify them as being at high risk. It is also the case that even when such a difference is established and some explanation provided, it may well be that the less well population might nonetheless opt for its lower level of health because of other advantages that it perceives it has. An issue here is that of the relative weight that is attached to some concept of the freedom of the individual, in particular with respect to freedom of choice. Second, a resource allocation formula might be based on the notion of health need where the greater the health need the greater the resources allocated to that region. Intra-and inter-country issues The extent to which such issues might lead to these useful outcomes is likely to be greater within a single country than if comparisons of population …