Health Economics & Management, Institute of Economic Research, Lund University, Box 117, 22100, Sweden; Health Economics Unit, Department of Clinical Sciences, Medicon Village, Lund University, Lund, Sweden. Electronic address: Gawain.email@example.com.
We introduce a general decomposition method applicable to all forms of bivariate rank dependent indices of socioeconomic inequality in health, including the concentration index. The technique is based on recentered influence function regression and requires only the application of OLS to a transformed variable with similar interpretation. Our method requires few identifying assumptions to yield valid estimates in most common empirical applications, unlike current methods favoured in the literature. Using the Swedish Twin Registry and a within twin pair fixed effects identification strategy, our new method finds no evidence of a causal effect of education on income-related health inequality.
This paper examines the importance of collecting and reporting data on race and ethnicity in public health and biomedical research in Canada. Literature and available statistics related to social determinants of health were reviewed and analyzed to illustrate that minority populations in Canada, especially Blacks, are likely to experience poorer health outcomes. Statistics Canada in its commitment to multiculturalism uses broad categories such as visible minorities and racialised groups as surrogates for race and ethnicity. These categories, when used in health literature may conceal underlying inequities in health between population groups. Blacks and minority groups in Canada have higher rates of unemployment, lower rates of educational attainment, and lower socioeconomic status. Whenever Canadian data based on race and ethnic categories are reported, disparities are observed. The lack of disaggregated data may hide health disparities.
The social determinants of health (SDH) are recognized as important indicators of health and well-being. Health-care services (primary, secondary, tertiary care) have not until recently been considered an SDH. Inequities in access to health care are changing this view. These inequities include barriers faced by certain population groups at point of care, such as the lack of cultural competence of health-care providers. The authors show how a social justice perspective can help nurses understand how to link inequities in access to poorer health outcomes, and they call on nurses to break the cycle of oppression that contributes to these inequities.
The book Why Are Some People Healthy and Others Not? The Determinants of Health of Populations represented a milestone in our evolving understanding of the determinants of population health. Building on Marc Lalonde's earlier A New Perspective on the Health of Canadians, it created a theoretical framework that could incorporate emerging evidence from a wide range of disciplines. Central to its authors' approach was the observation of heterogeneity, of the systematic differences in health observed when populations are partitioned on characteristics such as income, education, geographic region, etc. The universal observation of a social gradient, of a strong correlation between socio-economic class and health, led to a focus on how the social environment might influence health. Social position strongly influences both the stresses to which individuals are subject, and the resources available to cope with them. Furthermore, healthy and unhealthy responses to stress become "embedded", learned or conditioned both behaviourally and biologically, thus influencing health over the whole life course. The book's impact has been remarkable, not merely in academic citations but through its authors' subsequent work and strategic positions in Canadian health research organizations. The concept of "Population Health" has become part of our shared intellectual heritage.