Measures of health inequalities: part 1.

Accepted for publication 24 February 2004 . . . . . . . . . . . . . . . . . . . . . . . D espite ample empirical evidence of socioeconomic differences in health since the mid-19th century, concern about the problem of measurement of health inequalities did not appear until 1991. In that year, Wagstaff et al cautioned that the conclusions reached by different authors about trends in health inequalities may vary depending on the type of measure used; these authors also proposed the measures that they considered most appropriate to evaluate trends and cross country differences in health inequalities. Subsequently, Kunst and Mackenbach published an overview of measures available to determine the magnitude of socioeconomic inequalities in health, in which they incorporated several measures not proposed by the former authors, and noted that the measurement of health inequalities depends on the objective to be pursued. At the beginning of this decade, however, a debate emerged in this area of knowledge when Murray et al suggested that these measures do not reflect health inequalities across individuals in the population. 4 The debate is between those who support measuring the inequality in the distribution of a health measure and those who support measuring the differences in a health measure among different values of another variable. This paper has two objectives: firstly, to help clarify this debate, given that similar terms often mask differences in concepts and methods, and, secondly, to incorporate these different concepts and methods in a glossary of measures of the magnitude of health inequalities that can be used to monitor changes over time and to carry out comparative studies among different areas.