The UK government's health inequalities policy aims to improve the health of the poorest fastest. But the way health gaps are currently measured gives a misleading impression of progress, argue health economist Allan Low and Director of public health, Anne Low.
They explain how national targets for reducing health inequalities are set using different measures of gaps in health. For example, the targets for infant deaths and life expectancy at birth use relative gaps, whereas the targets for deaths from cancer and circulatory diseases use absolute gaps.
Using data on cancer deaths, they show that measuring absolute gaps between the most deprived and most affluent areas of England gives a misleading impression of progress. Relative gaps should therefore be used to measure progress, they write.
Relative gaps can also be used to compare health inequalities with inequalities in provision of health services, they add. For example, if a minority ethnic group has a greater rate of ill health than the rest of the population, comparison of this health gap with the equivalent gap in service provision can be used to assess the need for greater access to relevant services.
"Most descriptions of the national inequality targets do not specify whether the reductions required are relative or absolute, as if it does not matter," say the authors. "We have shown why it does matter."
"Lack of transparency in this regard has led to the inconsistent use of relative and absolute gaps in government targets going unquestioned. It has also resulted in confusion over how to establish local health improvement targets that are consistent with national policy on reducing health inequalities," they conclude.