Le revenu équivalent-santé, un outil pour l'analyse des inégalités sociales de santé

Abstract

This paper argues that the analysis of social inequalities in health should be part of the general analysis of inequalities in living standards. An index of living standards is proposed, namely, healthy-equivalent income, which takes account of individual preferences about the relative importance of health among other dimensions. As it is shown, the criterion which evaluates social situations by looking at the distribution of healthy-equivalent incomes, giving priority to the worst-off in this distribution, is the only one that satisfies basic conditions of efficiency and equity. This approach is compared to related empirical approaches (cost-benefit analysis, health concentration curve). It is argued that the correlation between health and income (or socio-economic status) does deteriorate the distribution of healthy-equivalent incomes, but does not deserve the excessive amount of attention devoted to it in social epidemiology because it is only a component of inequalities in living standards. More specifically, improving the situation of the worst-off in terms of healthy-equivalent income should be adopted as the objective of health public policies, instead of reducing this correlation, which is not a defensible objective.