Using relative and absolute measures for monitoring health inequalities: experiences from cross-national analyses on maternal and child health

Abstract

BackgroundAs reducing socio-economic inequalities in health is an important public health objective, monitoring of these inequalities is an important public health task. The specific inequality measure used can influence the conclusions drawn, and there is no consensus on which measure is most meaningful. The key issue raising most debate is whether to use relative or absolute inequality measures. Our paper aims to inform this debate and develop recommendations for monitoring health inequalities on the basis of empirical analyses for a broad range of developing countries.MethodsWealth-group specific data on under-5 mortality, immunisation coverage, antenatal and delivery care for 43 countries were obtained from the Demographic and Health Surveys. These data were used to describe the association between the overall level of these outcomes on the one hand, and relative and absolute poor-rich inequalities in these outcomes on the other.ResultsWe demonstrate that the values that the absolute and relative inequality measures can take are bound by mathematical ceilings. Yet, even where these ceilings do not play a role, the magnitude of inequality is correlated with the overall level of the outcome. The observed tendencies are, however, not necessities. There are countries with low mortality levels and low relative inequalities. Also absolute inequalities showed variation at most overall levels.ConclusionOur study shows that both absolute and relative inequality measures can be meaningful for monitoring inequalities, provided that the overall level of the outcome is taken into account. Suggestions are given on how to do this. In addition, our paper presents data that can be used for benchmarking of inequalities in the field of maternal and child health in low and middle-income countries.

The Scottish excess in mortality compared to the English and Welsh. Is it a country of residence or country of birth excess?

“…Although relative risks were consistently higher for the 25 to 64 year olds this reflects their much lower absolute rate of death. This is because relative risks are not independent of the overall rate and will tend to be higher when the absolute rate is low(er) (Houweling et al, 2007). Absolute differences (not shown) were actually higher in the older age group.…”

Trends in social inequalities in male mortality, 2001–08. Intercensal estimates for England and Wales

“…They concluded that there was some empirical evidence that higher relative inequalities were associated with lower overall levels. Houweling et al (2007), in a cross-national analysis of child health, also found that the magnitude of relative differences were empirically related to the overall level of the outcomes. However Houweling et al (2007) also found that absolute inequalities tend to be low at both very high and very low overall levels.…”

“…Houweling et al (2007), in a cross-national analysis of child health, also found that the magnitude of relative differences were empirically related to the overall level of the outcomes. However Houweling et al (2007) also found that absolute inequalities tend to be low at both very high and very low overall levels. Thus it would appear that there is a strong association between low mortality rates and high relative inequalities, but it is not impossible to achieve a reduction in relative rates when overall mortality rates are falling.…”

Trends in remaining life expectancy at retirement age (65 years) by educational level in Norway 1961-2009

“…A frequently suggested explanation has been the tobacco epidemic [45,48,49]. Educationbased inequalities in tobacco use are still increasing, and these increases vary between men and women [48,50], which might partly explain the trends we found [39,43,51]. The delayed and lower uptake of tobacco use among women compared with men may explain the weaker increase in e 65 among less-educated women from the 1980s and thereafter.…”