Principles of health equity

Abstract

This chapter shows how informal normative concerns about health equity raised by decision makers can be translated into formal health equity objectives that are amenable to quantitative analysis using distributional cost-effectiveness analysis (DCEA). It also clarifies the kinds of ethical concerns that can and cannot be addressed by DCEA. Four ways of thinking about ethics are distinguished: value maximizing, moral rights, fair shares, and fair processes. When considering whether and how DCEA can be used to address a specific equity concern raised by decision makers, it is important to clarify which of these four ways of thinking underpins the concern. DCEA methods for evaluating distributions are based on the value maximizing way of thinking, but the information provided by DCEA about the distributional consequences of decisions can also help to address equity concerns relating to moral rights, fair shares, and fair processes.