Lies, Damned Lies, and Health Inequality Measurements: Understanding the Value Judgments.
Lies, Damned Lies, and Health Inequality Measurements: Understanding the Value Judgments.
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DOI：
10.1097/ede.0000000000000319
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发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Petrie D
中科院分区：
文献类型：
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作者：
Kjellsson G;Gerdtham UG;Petrie D
补充数字内容可在文本中找到。衡量和监测社会经济健康不平等对于理解政策决定的影响至关重要。然而，对健康不平等的衡量远非价值中立，人们可以很容易地提出最能支持其选定结论的衡量标准，或有选择地排除某些衡量标准。因此，提高人们对通常隐含的价值判断的理解，对于减少研究人员误导或政策制定者被误导的风险非常重要。虽然在相对不平等和绝对不平等之间作出选择已经是一个充满价值的问题，但当健康变量既有下限又有上限时，情况往往更加复杂，因此可以用成就或不足来表示，例如死亡率/生存率。我们汇集了流行病学和卫生经济学关于健康不平等测量的最新平行讨论，并通过图形说明假设和真实的例子，更深入地了解在成就和不足方面表达的绝对和相对措施内的不同价值判断。我们表明，相对措施的成就和不足有不同的价值判断，强调健康变量的两个界限的选择不再是唯一的绝对和相对措施之间，但绝对，相对的成就和相对的不足之一。我们说明了这三个价值判断可以结合到一个单一的图表，显示根据所有三个措施的排名，并说明了这三个措施如何提供道德基准来判断人口之间的不平等的差异。
Supplemental Digital Content is available in the text. Measuring and monitoring socioeconomic health inequalities are critical for understanding the impact of policy decisions. However, the measurement of health inequality is far from value neutral, and one can easily present the measure that best supports one’s chosen conclusion or selectively exclude measures. Improving people’s understanding of the often implicit value judgments is therefore important to reduce the risk that researchers mislead or policymakers are misled. While the choice between relative and absolute inequality is already value laden, further complexities arise when, as is often the case, health variables have both a lower and upper bound, and thus can be expressed in terms of either attainments or shortfalls, such as for mortality/survival. We bring together the recent parallel discussions from epidemiology and health economics regarding health inequality measurement and provide a deeper understanding of the different value judgments within absolute and relative measures expressed both in attainments and shortfalls, by graphically illustrating both hypothetical and real examples. We show that relative measures in terms of attainments and shortfalls have distinct value judgments, highlighting that for health variables with two bounds the choice is no longer only between an absolute and a relative measure but between an absolute, an attainment- relative and a shortfall-relative one. We illustrate how these three value judgments can be combined onto a single graph which shows the rankings according to all three measures, and illustrates how the three measures provide ethical benchmarks against which to judge the difference in inequality between populations.