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 evaluate not 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.