Group- and Individual-Based Approaches to Health Inequality: Towards an Integration

Iñaki Permanyer , Centre for Demographic Studies
Isaac Sasson, Tel Aviv University
Francisco Villavicencio, University of Southern Denmark

When assessing health inequalities, the choice of the basic unit of analysis is key: Should one compare health outcomes across pre-determined groups (classified, for instance, by race, ethnicity, religion, or socio-economic status), or across individuals? Group-based approaches comparing group-specific means do not account for intra-group heterogeneity. On the other hand, traditional approaches based on additive decompositions splitting total inequality in its within- and between-group components fail to elucidate the groups’ relative performance. In this paper, we develop a third approach based on pairwise comparisons that allows determining not only the variability that might exist across individuals within and between groups, but also the relative performance of the different groups vis-à-vis each other. The decomposition method suggested here has the advantage of integrating comparisons across individuals and social groups into a coherent whole and meets the need for a summary measure of health inequality that gives an overall picture of health inequalities in the population, while maintaining pertinent information on group-based health inequalities. We apply this new approach to the analysis of length-of-life inequalities in the United States and their decomposition across racial and ethnic groups between 1970 and 2018.

See paper

 Presented in Session 38. Methodological innovations in the study of mortality