Van: the Health Equity Network (HEN) Namens Steve Cummins Verzonden: Ma 12-3-2007 13:26
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Van: The Health Equity Network (HEN) namens Steve Cummins Verzonden: ma 12-3-2007 13:26 Aan: [email protected] Onderwerp: Re: use of term disparity in US
Following on from Kevin's point. In England policy documents also referred to 'health variations' rather than inequalities. A number of key policy documents and white papers used the term variation instead of inequality in the mid-90s. In fact a major ESRC research funding programme in the UK was called the Health Variations Research Programme..
Steve
Van: The Health Equity Network (HEN) namens alex scott-samuel Verzonden: za 10-3-2007 21:45 Aan: [email protected] Onderwerp: Re: use of term disparity in US
In my view, there is no correct definition of inequity or inequality. In some settings only one term is used (eg WHO talks only of inequity). In others neither term is used because a government rejects the values of fairness and justice implied in these terms - this was true of the UK in the 1980s and early 1990s and the US currently.
For me, the most satisfactory operationalisation is that inequity is the dynamic process which results in inequality. Thus, my definition of inequity is 'distributional injustice' or as Marx put it (regarding equity) 'from each according to his abilities, to each according to his needs' (of course I reject Marx's sexist pronouns). My definition of inequality is 'unfair or unjust differences in health determinants or outcomes between defined populations or subpopulations'.
I would also propose that talking of science only confuses things, as science is socially constructed and value-laden.
Best wishes, Alex
**************************************************************************** Dr Alex Scott-Samuel EQUAL (Equity in Health Research and Development Unit) Division of Public Health University of Liverpool Whelan Building Quadrangle Liverpool L69 3GB
Tel (+44)151-794-5569 Fax (+44)151-794-5588 http://pcwww.liv.ac.uk/~alexss e-mail [email protected] **************************************************************************** -----Original Message----- From: The Health Equity Network (HEN) [mailto:HEALTH-EQUITY- [email protected]] On Behalf Of Kelleher, Kevin Sent: vrijdag 9 maart 2007 9:48 To: [email protected] Subject: Re: use of term disparity in US
Can I add in a piece from an earlier life, when I was in England In the early Nineties the Tory Government in UK were "unhappy" with Inequalities and were not willing to allow official investigation/action. The then Chief Medical officer began deliberately to use the term Disparities and debate was allowed to continue.
Ultimately if one is not ideologically driven the words can mean the same but equally can also allow an ideology to let work continue by doing the same work, but named different. It is only when the ideology interferes that science is affected.
Slainte Kevin Dr Kevin Kelleher Assistant National Director of Population Health - Health Protection National Office of Health Protection Health Service Executive 31 Catherine Street Limerick IRELAND Tel: +353-61-483447 Fax: +353-61-464205
Van: The Health Equity Network (HEN) namens Mike Hughes Verzonden: vr 9-3-2007 00:46 Aan: [email protected] Onderwerp: Re: use of term disparity in US
Does the world have a view about the use of what is essentially a technical expression?
This part of an essentially technical vocabulary and is actually fraught with what linguisitc philosophers call “persuasive definitions”. (“A persuasive definition is a form of definition which purports to describe the 'true' or 'commonly accepted' meaning of a term, while in reality stipulating an uncommon or altered use…. “; Wikipedia’s current and persuasive definition).
There was, and is, a similar debate in the UK where cons and neo-cons prefer the even less politically charged “variation” to "disparity" or “inequality”. Margaret Whitehead and others have distinguished between “inequality” (all variations in health status whether unjust, just or neutral – ie those both variations that can be mended and those that can’t) and “inequity” (unnecessary and unjust variations in health - only those that can be mended).
I believe this is an entirely unhelpful and manufactured distinction and a classic case of, albeit well-meaning, “persuasive definition”. I also think it stems from not recognising that there is fundamental difference in meaning of “equality” when used to indicate “identity” in a mathematical context ; and when it is used to indicate “equivalence” in socio-economic, political or health context.
To put it bluntly 2+2=3+1=4 expresses three different ways of identifying the same abstract entity. On the other hand while I may be Tony Blair’s equal, I’m not my own equal. Rather than running away from the ideological and linguistic confrontation should we not stand our liberal ground and argue that "Of all the forms of inequality, injustice in health is the most shocking and the most inhuman"?
Mike Hughes
Van: The Health Equity Network (HEN) namens Starfield, Barbara Verzonden: do 8-3-2007 23:19 Aan: [email protected] Onderwerp: Re: use of term disparity in US
Perhaps. The rest of the world calls it inequity. Barbara Starfield, MD, MPH University Distinguished Professor Johns Hopkins University & Medical Institutions 624 North Broadway, Room 452 Baltimore, Maryland 21205 Phone 410-955-3737 Fax 410-614-9046 [email protected]
Van: The Health Equity Network (HEN) namens Barbara Krimgold Verzonden: do 8-3-2007 23:12 Aan: [email protected] Onderwerp: Re: use of term disparity in US
Hi,
While I agree with the generalization that "the United States has tended to focus on disparities in access and race/ethnicity" it is certainly not the whole story, as Olivia indicates, and many of us in US research-to-policy circles are concerned with inequalities between various advantaged and disadvantaged groups in the US, the data that allow us to measure those gaps, the best and most appropriate comparisons for various health outcomes, as well as more equitable policies -- not only health care policies but also more equitable policies in health-related sectors such as housing, education, economic opportunity, tax and transfer programs to redistribute income and wealth, etc -- that would most effectively allow us to reduce health inequities while improving overall health.
Barbara
Barbara Kivimae Krimgold Center for the Advancement of Health 2000 Florida Avenue, NW, Suite 210 Washington DC 20009-1231 202-387-2829 [email protected] www.cfah.org
Van: The Health Equity Network (HEN) namens Valéry Ridde Verzonden: do 8-3-2007 22:09 Aan: [email protected] Onderwerp: Fw: use of term disparity in US
This discussion could be interesting for the list Valéry Thanks for that Olivia. My understanding of the US context is better now but I'm also confuse now because I understood the inverse between "disparities" and "inequalities", following, for exemple, this interpretation from Exworty and al.. Are you agree with them ?
"Although the definitions of both inequalities and disparities capture the systematic differences, disparities are interpreted differently by U.S. and U.K. policymakers. Whereas the United States tends to use the term disparities, the United Kingdom commonly uses the term inequalities. The United States often concentrates on health care issues (especially access and insurance coverage) and race/ethnicity, reflecting two critical dimensions of U.S. society: the number of persons without health insurance (45 million in 2003) (Lillie-Blanton and Hoffman 2005) and the significance of racial politics. In the United Kingdom, the term inequality (usually referring to differences in socioeconomic status) has been "officially sanctioned" since the Labour government of Tony Blair was elected in 1997.
Previously, under the Conservative administrations of Margaret Thatcher and John Major, the term and the issues were ignored or euphemistically called "variations" (Exworthy, Blane, and Marmot 2003). Recently, however, U.K. policy has tried to influence the wider/social determinants of health and has focused mainly on disparities in socioeconomic status and geography (Exworthy, Blane, and Marmot 2003). In short, the United States has tended to focus on disparities in access and race/ethnicity, and the United Kingdom has been more concerned with developing a population-based approach (with populations largely stratified by socioeconomic status), although the two countries still have much in common"
Exworthy M, Bindman A, Davies H, Washington E. Evidence into Policy and Practice? Measuring the Progress of U.S. and U.K. Policies to Tackle Disparities and Inequalities in U.S. and U.K. Health and Health Care. Milbank Quarterly 2006; 84(1):75-109.
----- Original Message ----- From:
The writeup that you forwarded is a bit confused. Inequality simply means a difference. What I have seen more often used in international circles compared to the US is the term inequity. That term is not used very often in policy circles in the US.
Whereas the UK has examined more "disparities" by social class (mostly occupational), the US has focused more on disparities by race/ethnicity. But the term "disparity" is NOT restricted to just race/ethnicity in the US. That is simply false. Just look at the Healthy People 2010 goal: "Goal 2: Eliminate Health Disparities. The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population." Elsewhere in the Healthy People 2010 documents, they list the various subgroups of interest (gender, sexual orientation, socioeconomic status, etc.) --much more than race/ethnicity. And, data are presented by more than just race/ethnicity.
While the US has been collecting data on race/ethnicity for many decades, we have been slower in collecting complete data on other socioeconomic status markers. For instance, education was not included on the standard birth and death certificates recommended for use by the states until 1989. Occupation was included much earlier but we don't use it as often in our presentation of health data as they do in the UK. We have collected SES data for many other important national health data systems (e.g., National Health Interview Survey) for many decades. What is interesting is that the UK is trying to learn how we collect racial/ethnic data with their increasing immigrant population. You see more reports coming out of the UK which do present data by "racial/ethnic" categories. The use of the word disparity in the US is also not limited to health care. It has been used for some time for a broad range of health status indicators (e.g., the 1979 document that I forwarded to you referred to disparities in birthweight). Indeed, this usage happened even before the 1985 Task force on Black and Minority health was released by the Secretary of Health and Human Services (a report considered a landmark document drawing national attention to minority health concerns).
Olivia Carter-Pokras, Ph.D. Associate Professor Department of Epidemiology and Biostatistics College of Health and Human Performance University of Maryland 1240D HHP Bldg. College Park, MD 20742 Phone: 301-405-8037 Fax: 301-314-9366 [email protected]
Date: Thu, 8 Mar 2007 10:33:57 -0500 Subject: health care - disparities, inequalties or discrimination This is an old debate that extends well beyond the "bush administration" into the practitioners working on health care "disparities". As to health care I argue that we should really be using the term health care discrimination. When Blacks receive poor quality or different quantity food from a store at the same price as whites we don't call it food disparities or inequalities. We call it what it is discrimination - perhaps institutional in nature and not intentional, but discrimination nevertheless. I can't speak for the issue in other cultures but here in the United States we will continue to have health care differences, disparities or inequalities as long as we don't appropriately name it - "health care discrimination"
See my book: dying while black, http://dyingwhileblack.org
Vernellia Randall Professor of Law University of Dayton School of Law -----Original Message----- From: The Health Equity Network (HEN) [mailto: HEALTH-EQUITY- [email protected]] On Behalf Of Valéry Ridde Sent: Thursday, March 08, 2007 2:19 PM To: [email protected] Subject: disparities or inequalities
Dear all
I do remember that in the US context they was a huge "political" debate (Bush administration ?) to substitute the word "inequalities" by "disparities" as the second one was supposed to be more "neutral".
Is anyone could help me to find any references about this debate ?
Thanks
Valéry Ridde
******************************************* Valéry Ridde, Ph. D. Unité de Santé Internationale Université de Montréal, Édifice Saint-Urbain 3875 rue Saint-Urbain, 5ème étage - Bureau 507 Montréal, Qc Canada, H2W 1V1 Téléphone: 1 (514) 890-8000 poste 15928 Télécopieur: 1 (514) 412-7108 Courriel/Email : [email protected] Skype : valery_ridde