Inequality and its measurement The existence of inequalities in health and death is rarely disputed,...
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Transcript of Inequality and its measurement The existence of inequalities in health and death is rarely disputed,...
![Page 1: Inequality and its measurement The existence of inequalities in health and death is rarely disputed, but there is contention over: Causes of inequality.](https://reader033.fdocuments.net/reader033/viewer/2022051620/56649f285503460f94c41641/html5/thumbnails/1.jpg)
Inequality and its measurement
The existence of inequalities in health and death is rarely disputed, but there is contention over:
• Causes of inequality• Methods to monitor and measure• Extent of inequality, increase or decrease • What can be done
![Page 2: Inequality and its measurement The existence of inequalities in health and death is rarely disputed, but there is contention over: Causes of inequality.](https://reader033.fdocuments.net/reader033/viewer/2022051620/56649f285503460f94c41641/html5/thumbnails/2.jpg)
Inequalities indicators incorporate:• a measure (e.g. mortality rate, low birthweight
rate, unemployment rate)• an inequalities dimension (e.g. social class,
ethnicity, geographical area)• a comparison (e.g. rate ratio, range, relative or
absolute differences).– Eg births < 2500 gms / 1000 live births
• Change over time without reference to a comparitor population = health gain indicator only
• Compare between Las, PCTs, most and least deprived wards within a LA etc = health inequalities indicator
![Page 3: Inequality and its measurement The existence of inequalities in health and death is rarely disputed, but there is contention over: Causes of inequality.](https://reader033.fdocuments.net/reader033/viewer/2022051620/56649f285503460f94c41641/html5/thumbnails/3.jpg)
Health Gaps
A
C D
X axis: health measure eg teenage conception rates by LA
Y axis: frequency
Range = difference between best and worst (B-A)
B
National target measure (eg for life expectancy) = D – C
Ratio between highest and lowest = B/A (eg relative mortality rate between Social Class V and Social Class I)
![Page 4: Inequality and its measurement The existence of inequalities in health and death is rarely disputed, but there is contention over: Causes of inequality.](https://reader033.fdocuments.net/reader033/viewer/2022051620/56649f285503460f94c41641/html5/thumbnails/4.jpg)
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0 0.2 0.4 0.6 0.8 1
Cumulative % 15-17 year F population
Cu
mu
lati
ve %
un
der
18 c
on
cep
tio
ns
Line of equality PCT A PCT B
A
Measures of Spatial Inequalities in Health within PCTs
wards ranked from ward with lowest teenage pregnancy rate to ward with highest rate
On X axis: plot cumulative % population
On Y axis: plot cumulative % health measure
B
GINI Coefficient = A/(A+B)
= 0 perfect equality
= 1 perfect inequality
• Blue line PCT 9 wards
• Green line PCT 21 wards
• closer curved line (Lorenz curve) is to line of equality greater degree of equality
![Page 5: Inequality and its measurement The existence of inequalities in health and death is rarely disputed, but there is contention over: Causes of inequality.](https://reader033.fdocuments.net/reader033/viewer/2022051620/56649f285503460f94c41641/html5/thumbnails/5.jpg)
Measures of Spatial Inequalities in Health within PCTs
The trend in premature mortality rates is examined for each City deprivation quintile. A regression line is fit through the data for each quintile.
On X axis: plot time banded (3 year intervals)
On Y axis: plot DSR < 75 all causes per City deprivation quintile
Slope comparison across deprivation quintiles reveals progress in the most disadvantaged areas vs most affluent areas
![Page 6: Inequality and its measurement The existence of inequalities in health and death is rarely disputed, but there is contention over: Causes of inequality.](https://reader033.fdocuments.net/reader033/viewer/2022051620/56649f285503460f94c41641/html5/thumbnails/6.jpg)
Slope index of inequality
A regression line is drawn through a health measure stratified by a measure of socio-economic status
On X axis: plot average IMD2000 scores for ward deprivation quintiles in N&S
On Y axis: plot DSR < 75 all causes for ward deprivation quintiles in N&S
If slope reduces over time evidence of reduction in health inequalities