Aversion to income, ethnic, and geographic related health inequality: Evidence from Australia

This study investigated the Australian general public's views on trade-offs between reducing health inequalities and improving total health. It elicited relative equity weights, comparing inequalities in life expectancy at birth across three equity-relevant dimensions: income (comparing poorest versus richest fifth), ethnic (comparing Indigenous versus non-Indigenous), and geographic (comparing rural/remote versus major cities). A benefit trade-off exercise was administered via online survey to a sample of Australian adults (n = 3105) using quota sampling to ensure population representativeness across key demographic variables (age, gender, state of residence, household income and education level). When comparing income groups, 88% (95% Confidence Interval (CI): 82%-92%) of the respondents were health inequality averse, with 42% (95% CI: 34%-51%) demonstrating extreme inequality aversion. When considering Indigenous status, 85% (95% CI: 79%-90%) showed inequality aversion, and 40% (95% CI: 31%-49%) displayed extreme aversion. Lastly, looking at different geographic locations, 74% (95% CI: 66%-80%) of the respondents were inequality averse, with 37% (95% CI: 29%-46%) showing extreme inequality aversion. The relative equity weights were calculated, allowing for varying baseline inequalities in life expectancy - proportional gaps of 10.8%, 5.1% and 6.3%, respectively. The results imply that the public is willing to weight incremental health gains to the poorest fifth five times more than to the richest fifth, six times more for Indigenous versus non-Indigenous, and four times more for people living in rural and remote areas compared to major cities.