Measuring inequality: tools and an illustration

BACKGROUND: This paper examines an aspect of the problem of measuring inequality in health services. The measures that are commonly applied can be misleading because such measures obscure the difficulty in obtaining a complete ranking of distributions. The nature of the social welfare function underlying these measures is important. The overall object is to demonstrate that varying implications for the welfare of society result from inequality measures. METHOD: Various tools for measuring a distribution are applied to some illustrative data on four distributions about mental health services. Although these data refer to this one aspect of health, the exercise is of broader relevance than mental health. The summary measures of dispersion conventionally used in empirical work are applied to the data here, such as the standard deviation, the coefficient of variation, the relative mean deviation and the Gini coefficient. Other, less commonly used measures also are applied, such as Theil's Index of Entropy, Atkinson's Measure (using two differing assumptions about the inequality aversion parameter). Lorenz curves are also drawn for these distributions. RESULTS: Distributions are shown to have differing rankings (in terms of which is more equal than another), depending on which measure is applied. CONCLUSION: The scope and content of the literature from the past decade about health inequalities and inequities suggest that the economic literature from the past 100 years about inequality and inequity may have been overlooked, generally speaking, in the health inequalities and inequity literature. An understanding of economic theory and economic method, partly introduced in this article, is helpful in analysing health inequality and inequity

Growth, grain yield and nitrogen use efficiency of Mediterranean wheat in soils amended with municipal sewage sludge

The application of sewage sludge (SS) to agricultural land can improve soil fertility and physical properties, and enhance crop production. This field study was conducted for two consecutive growing seasons to investigate the influence of SS application on winter wheat growth, grain yield, N accumulation, translocation and use, and on trace elements concentrations in soil and wheat plants under Mediterranean conditions. Treatments consisted of three rates of SS, i.e. 20, 40, and 60 Mg dry weight ha(-1) year(-1), one rate of inorganic fertilizer (IF, 120 kg N ha(-1) year(-1) plus 80 kg P2O5 ha(-1) year(-1)), and an unamended control. The application of SS resulted in tall plants with high early dry matter and N accumulation similar to or significantly higher than those obtained with IF. The lowest SS application rate resulted in grain yield similar to that obtained with IF. Nitrogen use efficiency (NUE) in SS treatments was mainly determined by uptake efficiency, which decreased with increasing SS application rate. Values of NUE and biomass production efficiency with the lowest SS rate were similar to those obtained with IF. SS application resulted in increased concentrations of total and DTPA-extractable trace elements in the soil after the first year, but concentrations were much lower than the regulation limits. Concentrations of Cu, Mn and Zn in wheat plants did not exceed those obtained with IF. Overall, SS could be considered for use as a fertilizer in wheat production systems in the area, serving also as an alternative method of SS disposal

Health care utilization and self-assessed health: specification of bivariate models using copulas

Health care utilization, Self-assessed health, Endogeneity, Discrete data, Copulas, I10, C16, C51,

Health care utilisation and immigration in Spain

Health care, Immigration, Spain, Access, Equity, H75, F22,