Group- and individual-based approaches to health inequality: towards an integration

Abstract

When assessing health inequalities, should one compare health outcomes across predetermined groups (e.g., race, ethnicity, socioeconomic status), or across individuals? Group-based approaches comparing group-specific means do not account for intra-group heterogeneity. Yet, traditional approaches based on additive decompositions splitting total inequality in its within- and between-group components fail to elucidate the groups’ relative performance. Here, we develop a third approach based on pairwise comparisons to evaluatenot only the variability that might exist across individuals within and between groups, but also the relative performance of the different groups vis-a-vis each other—thus integrating both perspectives into a coherent framework.