Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Ave, Halifax, Nova Scotia, B3H 1V7, Canada.
Prev Chronic Dis. 2010 Jul;7(4):A72. Epub 2010 Jun 15.
A system that rewards population health must be able to measure and track health inequalities. Health inequalities have most commonly been measured in a bivariate fashion, as a joint distribution of health and another attribute such as income, education, or race/ethnicity. I argue this practice gives insufficient information to reduce health inequalities and propose a summary measure of health inequalities, which gives information both on overall health inequality and bivariate health inequalities. I introduce 2 approaches to develop a summary measure of health inequalities. The bottom-up approach defines attributes of interest, measures bivariate health inequalities related to these attributes separately, and then combines these bivariate health inequalities into a summary index. The top-down approach measures overall health inequality and then breaks it down into health inequalities related to different attributes. After describing the 2 approaches in terms of building-block measurement properties, aggregation, value, data and sample size requirements, and communication, I recommend that, when data are available, a summary measure should use the top-down approach. In addition, a strong communication strategy is necessary to allow users of the summary measure to understand how it was calculated and what it means.
一个奖励人口健康的系统必须能够衡量和跟踪健康不平等。健康不平等最常见的衡量方法是双变量方式，即将健康与收入、教育或种族/民族等另一个属性的联合分布进行衡量。我认为这种做法提供的信息不足以减少健康不平等，并提出了一种衡量健康不平等的综合指标，该指标既提供了整体健康不平等的信息，也提供了双变量健康不平等的信息。我提出了两种方法来开发健康不平等的综合指标。自下而上的方法定义了感兴趣的属性，分别衡量与这些属性相关的双变量健康不平等，然后将这些双变量健康不平等组合成一个综合指数。自上而下的方法衡量整体健康不平等，然后将其分解为与不同属性相关的健康不平等。在根据构建块测量特性、聚合、值、数据和样本大小要求以及沟通描述了这两种方法之后，我建议在有数据可用的情况下，综合指标应使用自上而下的方法。此外，还需要制定强有力的沟通策略，让综合指标的使用者能够理解它是如何计算的以及它意味着什么。
