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A framework for measuring health inequity
  1. Yukiko Asada
  1. Correspondence to:
 Dr Y Asada
 Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada;


Background: Health inequality has long attracted keen attention in the research and policy arena. While there may be various motivations to study health inequality, what distinguishes it as a topic is moral concern. Despite the importance of this moral interest, a theoretical and analytical framework for measuring health inequality acknowledging moral concerns remains to be established.

Study objective: To propose a framework for measuring the moral or ethical dimension of health inequality—that is, health inequity.

Design: Conceptual discussion.

Conclusions: Measuring health inequity entails three steps: (1) defining when a health distribution becomes inequitable, (2) deciding on measurement strategies to operationalise a chosen concept of equity, and (3) quantifying health inequity information. For step (1) a variety of perspectives on health equity exist under two categories, health equity as equality in health, and health inequality as an indicator of general injustice in society. In step (2), when we are interested in health inequity, the choice of the measurement of health, the unit of time, and the unit of analysis in health inequity analysis should reflect moral considerations. In step (3) we must follow principles rather than convenience and consider six questions that arise when quantifying health inequity information. This proposed framework suggests various ways to conceptualise the moral dimension of health inequality and emphasises the logical consistency from conception to measurement.

  • health inequity
  • health inequality
  • measurement

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  • Funding: this project was supported by grant number 1 R03 HS 13116 from the US Agency for Healthcare Research and Quality, and the Canadian Institute of Health Research Training Program for Ethics and Health Policy and Research.

  • Conflicts of interest: none declared.

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