Asada Yukiko
Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada.
J Epidemiol Community Health. 2005 Aug;59(8):700-5. doi: 10.1136/jech.2004.031054.
Health inequality has long attracted keen attention in the research and policy arena. While there may be various motivations to study health inequality, what distinguishes it as a topic is moral concern. Despite the importance of this moral interest, a theoretical and analytical framework for measuring health inequality acknowledging moral concerns remains to be established.
To propose a framework for measuring the moral or ethical dimension of health inequality-that is, health inequity.
Conceptual discussion.
Measuring health inequity entails three steps: (1) defining when a health distribution becomes inequitable, (2) deciding on measurement strategies to operationalize a chosen concept of equity, and (3) quantifying health inequity information. For step (1) a variety of perspectives on health equity exist under two categories, health equity as equality in health, and health inequality as an indicator of general injustice in society. In step (2), when we are interested in health inequity, the choice of the measurement of health, the unit of time, and the unit of analysis in health inequity analysis should reflect moral considerations. In step (3) we must follow principles rather than convenience and consider six questions that arise when quantifying health inequity information. This proposed framework suggests various ways to conceptualize the moral dimension of health inequality and emphasises the logical consistency from conception to measurement.
健康不平等长期以来一直是研究和政策领域的关注焦点。虽然研究健康不平等可能有多种动机，但将其作为一个主题的独特之处在于道德关切。尽管这种道德关注很重要，但一个承认道德关切的衡量健康不平等的理论和分析框架仍有待建立。
提出一个衡量健康不平等的道德或伦理维度（即健康不公平）的框架。
概念性讨论。
衡量健康不公平需要三个步骤：（1）确定健康分布何时变得不公平，（2）决定采用何种测量策略来实施选定的公平概念，以及（3）量化健康不公平信息。对于步骤（1），在两类观点下存在多种关于健康公平的视角，一类是将健康公平视为健康平等，另一类是将健康不平等视为社会普遍不公正的指标。在步骤（2）中，当我们关注健康不公平时，健康测量的选择、时间单位以及健康不公平分析中的分析单位都应反映道德考量。在步骤（3）中，我们必须遵循原则而非便利性，并考虑在量化健康不公平信息时出现的六个问题。这个提议的框架提出了多种概念化健康不平等道德维度的方法，并强调了从概念到测量的逻辑一致性。
