The Normative Dimensions of Health Disparities

Abstract

Understanding what conditions must be satisfied for a health inequality to be a health inequity (disparity) is crucial for health policy makers. The failure to understand what constitutes a health inequity, and confusing health inequalities with health inequities threatens the successful creation of health policies by diverting needed attention and resources away from addressing health inequalities that are health inequities. More generally, the failure threatens to undercut our ability to tell what research is relevant to the creation of health policies that aim to mitigate or eliminate health inequities. With this in mind, the principal aim of the present paper is to provide a framework within which to understand the relationships of concepts such as health difference, health inequality and health inequity to one another. Under the umbrella heading of “health disparities”, which is often used as a catch-all expression to refer to various, sometimes very different concepts of health, health outcomes and health determinants, the paper draws attention to two important axes in this framework; the axis of health inequalities (the empirical dimensions) and the axis of health inequities (the normative dimensions). Using the writings of John Dewey on valuation and value judgments, the paper explores how it is possible for a claim about the existence, prevalence or scope of health disparities to have both an empirical dimension and a normative dimension.