Monitoring Health Inequality Through Neighbourhood Life Expectancy

Monitoring Health Inequality Through Neighbourhood Life Expectancy
Public Health Intelligence Occasional Bulletin No. 28

Date of publication: December 2005

HP 4179

Reducing health inequalities is now at the centre of New Zealand’s public health agenda. Yet measuring health inequality to date has consisted merely of computing average differences in mortality or morbidity between pre-defined social groups (such as occupational classes or ethnic groups). While average group differences are policy-relevant, conceptualising inequality in this way has two major limitations.

Firstly, it captures only between-group inequality and ignores within-group inequality.

Secondly, by pre-defining the social groups of interest it constrains the possible explanations for inequality that can be sought.

Instead, a more comprehensive approach to health equity is to define inequality as the variation in health across individuals in a population. This approach allows measurement of total inequality (the sum of between-group and within-group inequality) and permits unconstrained analysis of the determinants of inequality.

The aim of this occasional bulletin is firstly to estimate total health inequality at national and health district levels for New Zealand in 1999–2003. Secondly, the health of District Health Board populations is compared in terms of average level of health, distribution of health, and a composite index that integrates both.

The report concludes that neighbourhood life expectancy can be estimated robustly for populations as small as 1,000. Regular monitoring of neighbourhood life expectancy may provide health planners with an additional means to assess progress towards reducing health inequalities, complementing (but not replacing) the existing average group difference approach.

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