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      Measuring health inequalities between genders and age groups with realization of potential life years (RePLY) Translated title: Mesure des inégalités sanitaires entre les sexes et les tranches d'âges en termes d'années de vie potentielles vécues (RePLY) Translated title: Medición de las desigualdades sanitarias entre sexos y grupos de edad con la realización de los años de vida potenciales (RAVP)

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          Abstract

          OBJECTIVE We propose a new method to measure health inequalities caused by conditions amenable to policy intervention and use this to identify health differences between sexes and age groups. METHODS: The lowest observed mortality rates are used as a proxy of unavoidable mortality risks to develop a new measure of health outcome - realization of potential life years (RePLY). The RePLY distribution is used to measure avoidable health inequalities between sex and age groups respectively. FINDINGS: Using RePLY we find that even those countries with very high life expectancy at birth can have substantial health inequalities across different age groups. Also, gender inequality is more pronounced among those aged < 30. Among countries with a life expectancy < 60 years, there is a much larger prevalence of gender inequality against females; countries with life expectancy > 60 years have comparable numbers of cases of inequality among females and males. Finally, high avoidable health inequality is associated with low average income, high income inequality and high population fractionalization. CONCLUSION: It is important to distinguish between unavoidable and avoidable mortality when measuring health outcomes and their distribution in society. The proposed new measure (RePLY) enables policy-makers to focus on age-sex groups with low realization of potential life years and thus high avoidable mortality risks.

          Translated abstract

          OBJECTIF: Nous proposons une nouvelle méthode pour mesurer les inégalités en termes de santé pouvant être réduites par des interventions et nous l'utilisons pour identifier les différences en termes de santé entre les sexes et les tranches d'âges. MÉTHODES: Les taux de mortalité les plus bas observés ont été utilisés comme approximation des risques mortels inévitables afin de mettre au point un nouveau paramètre de mesure des résultats dans le domaine sanitaire : les années de vie potentielles vécues (RePLY). La distribution des RePLY est utilisée pour mesurer les inégalités en matière de santé évitables entre les sexes et les classes d'âges. RÉSULTATS: A l'aide de cette mesure, nous constatons que les pays bénéficiant d'une très longue espérance de vie à la naissance peuvent présenter des inégalités substantielles en matière de santé entre les classes d'âges. De même, les inégalités liées au sexe sont plus prononcées chez les moins de 30 ans. Dans les pays où l'espérance de vie est inférieure à 60 ans, on relève une prévalence bien plus marquée des inégalités liées au sexe en défaveur des femmes ; dans les pays où l'espérance de vie dépasse 60 ans, les nombres de cas d'inégalités entre hommes et femmes sont comparables. Enfin, d'importantes inégalités évitables en matière de santé sont associées à de faibles revenus moyens, à de fortes inégalités en matière de revenus et à un fort fractionnement de la population. CONCLUSION: Il importe de faire la distinction entre mortalité évitable et inévitable lorsqu'on mesure des paramètres sanitaires et leur distribution dans la société. La nouvelle mesure proposée (RePLY) permet aux décideurs de cibler leur action sur les groupes, constitués en fonction de l'âge ou du sexe, qui ne réalisent qu'une faible partie de leur potentiel de vie et ainsi sur les risques mortels évitables.

          Translated abstract

          OBJETIVO: Proponemos un nuevo método para medir las desigualdades sanitarias causadas por trastornos que puedan modificarse con intervenciones de políticas y lo hemos utilizado para identificar diferencias sanitarias entre los sexos y entre diferentes grupos de edad. MÉTODOS: Utilizando las menores tasas de mortalidad observadas como indicador indirecto del riesgo de mortalidad inevitable, hemos creado una nueva medida de los resultados sanitarios, denominada realización de los años de vida potenciales (RAVP), cuya distribución utilizamos para medir las desigualdades sanitarias evitables entre los sexos y entre diferentes grupos de edad. RESULTADOS: Utilizando la RAVP, verificamos que incluso los países con una esperanza de vida muy elevada al nacer pueden presentar desigualdades sanitarias considerables entre diferentes grupos de edad. Las desigualdades entre sexos son más marcadas entre los menores de 30 años. En los países con una esperanza de vida < 60 años hay una prevalencia mucho mayor de desigualdades entre sexos desfavorables a las mujeres; los países con esperanza de vida > 60 años tienen cifras similares de desigualdades desfavorables a los hombres y a las mujeres. Las grandes desigualdades sanitarias evitables se asociaron a bajos ingresos medios, grandes desigualdades de ingresos y gran fraccionamiento de la población. CONCLUSIÓN: A la hora de medir los resultados sanitarios y su distribución en la sociedad es importante distinguir entre mortalidad evitable e inevitable. La nueva medida propuesta permite a los planificadores de políticas centrarse en los sexos y los grupos de edad con baja RAVP y, por consiguiente, alto riesgo de mortalidad evitable.

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          Most cited references51

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          The global burden for disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020

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            Access, utilization, quality, and effective coverage: an integrated conceptual framework and measurement strategy.

            Health systems can primarily improve the health of individuals and populations by delivering high-quality interventions to those who may benefit from them. We propose a concept of effective coverage as the probability that individuals will receive health gain from an intervention if they need it. Understanding the extent to which health systems are delivering key interventions to those who will benefit from them and the factors that explain gaps in delivery are a critical input to decision-making at the local, national and global levels. We develop an integrated conceptual framework for monitoring and analyzing the delivery of high-quality interventions to those who need them. This framework can help clarify the inter-relationships between notions of access, demand for care, utilization, and coverage on the one hand and highlight the requirements for health information systems that can sustain this type of analysis. We discuss measurement strategies and demonstrate the concept by means of a simple simulation model.
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              Intergenerational equity: an exploration of the 'fair innings' argument.

              Many different equity principles may need to be traded off against efficiency when prioritizing health care. This paper explores one of them: the concept of a 'fair innings'. It reflects the feeling that everyone is entitled to some 'normal' span of health (usually expressed in life years, e.g. 'three score years and ten') and anyone failing to achieve this has been cheated, whilst anyone getting more than this is 'living on borrowed time'. Four important characteristics of the 'fair innings' notion are worth noting: firstly, it is outcome based, not process-based or resource-based; secondly, it is about a person's whole life-time experience, not about their state at any particular point in time; thirdly, it reflects an aversion to inequality; and fourthly, it is quantifiable. Even in common parlance it is usually expressed in numerical terms: death at 25 is viewed very differently from death at 85. But age at death should be no more than a first approximation, because the quality of a person's life is important as well as its length. The analysis suggests that this notion of intergenerational equity requires greater discrimination against the elderly than would be dictated simply by efficiency objectives.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                bwho
                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra )
                0042-9686
                September 2007
                : 85
                : 9
                : 681-688
                Affiliations
                [1 ] University of Queensland Australia
                [2 ] University of Queensland Australia
                Article
                S0042-96862007000900013
                ef1149a6-1f81-4224-8207-dd3357864b31

                http://creativecommons.org/licenses/by/4.0/

                History
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                SciELO Public Health

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0042-9686&lng=en
                Categories
                Health Policy & Services

                Public health
                Public health

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