A Problem with the Individual Approach in the WHO Health Inequality Measurement

BACKGROUND: In the World Health Report 2000, the World Health Organization made the controversial choice to measure inequality across individuals rather than across groups, the standard in the field. This choice has been widely discussed and criticized. DISCUSSION: We look at the three questions: (1) is the World Health Organization's health inequality measure value-free as it claims? (2) if it is not, what is the normative position implied by its approach when measuring health inequality? and (3) is the individual approach a logically consistent methodological choice for that normative position? SUMMARY: We argue that the World Health Organization's health inequality measure is not value-free. If it was, the health inequality information that the measurement collected could not reasonably be included in its ranking of how well national health systems performed. The World Health Organization's normative position can be interpreted as a quite expansive view of justice, in which health distributions that have causes amenable to human intervention are considered to be matters of justice. Our conclusion is that if the World Health Organization's health inequality measure is to be interpreted meaningfully in a policy context, its conceptual underpinning must be re-evaluated.