Analysis And Comment Health economics

Importance of relative measures in policy on health inequalities

BMJ 2006; 332 doi: (Published 20 April 2006) Cite this as: BMJ 2006;332:967
  1. Allan Low, freelance health economist1,
  2. Anne Low, freelance health economist (
  1. 1 Chopwell, Newcastle upon Tyne NE17 7AY
  2. 2 Derwentside District Council and Primary Care Trust, Consett, County Durham
  1. Correspondence to: Allan Low
  • Accepted 10 February 2006

The UK, like many other countries, is trying to reduce health inequality. Current targets, however, could end up improving the health of the richest fastest

The UK government's health inequalities policy aims to improve the health of the poorest fastest.13 Targets have been set to reduce health gaps between population groups,4 indicators have been identified for monitoring progress,1 and the new planning tool of health equity audit has been made mandatory for all primary care trusts.4 All these require the quantification and comparison of health gaps. Although we have many guidelines and directions on how to reduce socioeconomic inequalities in health, there has been little discussion or clear direction on how to quantify inequalities. This is important because the way health gaps are measured and compared affects the results. Lack of clarity about these distinctions has led to inconsistencies in the targets set and anomalies in how progress is assessed.

How should we measure health gaps?

The measurement issue has been brought into focus by the government's recent status report on delivery of the national health inequalities strategy.3 The report raises, but does not answer, two questions about how to assess progress in reducing health inequalities. Should progress be assessed in terms of:

  1. changes in absolute or relative gaps?

  2. changes in gaps between a target group and the average or changes in gaps within populations?

Below we use simple graphs to explain these distinctions and their importance for health policy.

Fig 1

Health gaps in mortality from cancer between the most deprived fifth of districts and the national average. Baseline rates are taken from Department of Health data with rounding to facilitate clarity

Distinction between relative and absolute gaps

The national targets for reducing health inequalities are set using different measures of gaps in health. The targets for infant mortality and life expectancy at birth use relative …

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