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Reference Value Sensitivity of Measures of Unfair Health Inequality

Health and Inequality

ISBN: 978-1-78190-553-1, eISBN: 978-1-78190-554-8

Publication date: 30 December 2013


Most politicians and ethical observers are not interested in pure health inequalities, as they want to distinguish between different causes of health differences. Measures of “unfair” inequality – direct unfairness and the fairness gap, but also the popular standardized concentration index (CI) – therefore neutralize the effects of what are considered to be “legitimate” causes of inequality. This neutralization is performed by putting a subset of the explanatory variables at reference values, for example, their means. We analyze how the inequality ranking of different policies depends on the specific choice of reference values. We show with mortality data from the Netherlands that the problem is empirically relevant and we suggest a statistical method for fixing the reference values.




Pilar García-Gómez is a Postdoctoral Fellows of the Netherlands Organization for Scientific Research –Innovational Research Incentives Scheme –Veni. Tom Van Ourti acknowledges support from the National Institute on Ageing, under grant R01AG037398. We thank the Netherlands Central Bureau of Statistics for access to the linked data sets used for this research (POLS Gezondheid 1998–2000, DO 1999–2010). We have benefited from the comments and suggestions of Owen O’Donnell. We also thank Teresa Bago d’Uva who co-authored our earlier paper that developed a more sophisticated mortality model with the same data (García-Gómez et al., 2012). The usual caveats apply and all remaining errors are our responsibility.


García-Gómez, P., Schokkaert, E. and Van Ourti, T. (2013), "Reference Value Sensitivity of Measures of Unfair Health Inequality", Health and Inequality (Research on Economic Inequality, Vol. 21), Emerald Group Publishing Limited, Leeds, pp. 157-192.



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