Bridging the gap: health equality and the deficit framing of health

The analyst tasked with measuring population health, with appraising healthcare investments, or allocating healthcare resources, may frame their task in one of two possible ways: either as being concerned with health assets (e.g. health expectancy or stock of QALYs), or with health deficits (a ‘health gap’, analogous to the poverty gap). In this paper, we discuss the consequences of taking the asset or the deficit concept as one's basic building block in developing a health measurement system when one has concerns about equitable distribution. We conclude that building metrics from a primitive health gap concept is possible and indeed may offer insights not otherwise easily accessible. Copyright (C) 2009 John Wiley & Sons, Ltd.