A featured article in the latest issue of The Milbank Quarterly is entitled Implicit Value Judgments in the Measurement of Health Inequalities. Here is the Abstract:
Context: Quantitative estimates of the magnitude, direction, and rate of change of health inequalities play a crucial role in creating and assessing policies aimed at eliminating the disproportionate burden of disease in disadvantaged populations. It is generally assumed that the measurement of health inequalities is a value-neutral process, providing objective data that are then interpreted using normative judgments about whether a particular distribution of health is just, fair, or socially acceptable.
Methods: We discuss five examples in which normative judgments play a role in the measurement process itself, through either the selection of one measurement strategy to the exclusion of others or the selection of the type, significance, or weight assigned to the variables being measured.
Findings: Overall, we find that many commonly used measures of inequality are value laden and that the normative judgments implicit in these measures have important consequences for interpreting and responding to health inequalities.
Conclusions: Because values implicit in the generation of health inequality measures may lead to radically different interpretations of the same underlying data, we urge researchers to explicitly consider and transparently discuss the normative judgments underlying their measures. We also urge policymakers and other consumers of health inequalities data to pay close attention to the measures on which they base their assessments of current and future health policies.
This is an important article, although the notion that measuring health inequities is a value-laden process seems a priori obvious, but perhaps that is my bias given my training in the humanities (where it is generally taken as a given that every human practice is value-laden). Still, a rigorous assessment like this may be useful as both evidence and from a rhetorical perspective, given the language and placement of the study, and the authors are undoubtedly correct that the normative bases of health policy have critical ethical and policy implications.