Inequalities in Health ─ Concepts, Measures, and Ethics

Of every thousand children born in Iceland, two will die before their first birthday, but in Mozambique the death rate is sixty times higher. Even within countries - including some of the wealthiest - inequalities in longevity and health can be substantial. In recent years, epidemiologists have documented the extent of these inequalities both between and within countries, stimulating in turn research both on their sources and on possible means for their alleviation. These extensive and influential efforts in research and in policy development have raised health inequalities to a prominent position among the central concerns of both national and global health.

Less attention has been given to careful analysis and refinement of some key concepts and values that guide and motivate these studies of health inequalities. The essays in this book demonstrate the need to identify and debate alternative positions on the choice of measures of health inequality; the definitions of 'inequality' and 'inequity' in health, and their interrelationship; the ethical basis for attaching priority to narrowing gaps in longevity and health among individuals, groups, and societies; and the possible solutions to a series of puzzles involving uncertainty and variable population size.

The authors of these essays are philosophers, economists, epidemiologists, and physicians contributing to our understanding of ethical issues in population health. Their contributions will be of interest to anyone interested in inequalities in health, including specialists in health policy, public health, epidemiology, moral philosophy, demography, and health economics.

Nir Eyal is Associate Professor of Global Health and Social Medicine (Medical Ethics) at the Harvard Medical School, with a joint appointment at Harvard's Program in Ethics and Health. He is writing, among other things, on egalitarianism, consequentialism, health resource rationing, and ethical issues in the delivery of care in resource-poor settings.

Samia A. Hurst is Swiss National Science Foundation professor of Bioethics at Geneva University's medical school in Switzerland, and member of several ethics committees including the research Ethics Review Committee at the World Health Organization. Her research focuses on fairness in clinical practice, and the protection of vulnerable persons.

Ole F. Norheim is a physician specializing in internal medicine and professor in medical ethics, University of Bergen. He is currently heading the research project Priority Setting in Global Health. His research interests include fair resource allocation for health in high- and low-income countries, with particular emphasis on how to measure population-level impacts of priority setting decisions.

Dan Wikler, a philosopher, is Mary B. Saltonstall Professor of Ethics and Population Health at the Harvard School of Public Health. He served as the first Staff Ethicist for the World Health Organization (1999-2001) and continues to work with World Health Organization on ethical issues in global health and health research. His principal research interests are ethical dimensions of population health research and policy.