Health Inequality Measurement and Impacts: Methods and Applications

Monitoring health inequalities and assessing the impacts of policy interventions requires valid measurements of social characteristics and health outcomes, and the relationships between them. Despite recent progress, methodological challenges remain. First, standard bivariate health inequality measures (BHIMs) – linear associations between a health dependent variable and a socioeconomic independent variable – may contradict social justice because measured health inequality can increase when income inequality is reduced, and vice versa (the Nordic paradox critique). I generalise existing simulation studies to address the contribution of rank dependency and alternative underlying causal pathways. Second, BHIMs may reflect fair health differences associated with adult socioeconomic outcomes partly within a person’s control (the inequality of opportunity critique). I propose parental gradients – bivariate associations between health in adulthood and fraction-ranked parental socioeconomic status in childhood, a determinant outside a person’s control – as simple inequality of opportunity for health metrics. Third, an evaluation challenge is how to extend distributional cost-effectiveness analysis (DCEA) methods to quantify health inequality impacts of interventions outside the health sector. To illustrate a co-funding solution, I evaluate the lifetime population health and health inequality impacts of the Universal Infant Free School Meal (UIFSM) programme. This thesis helps improve our understanding of strengths and limitations of BHIMs used for both research and policy monitoring purposes. It also advances the DCEA methodology by illustrating a cross-sectoral co-funding proposal, while providing new evidence about a topical childhood policy.