tended to grow-both in developing and developed countries-at times of economic growth. The paper suggested that this is probably due in part to technological change going hand-inhand with economic growth, and a tendency for the better-off to assimilate new technology ahead of the poor.

The second part of the paper was concerned with the issue of how to respond to this evidence. It suggested that one needs to face up to the fact that the force that makes for higher health inequalities-higher per capita incomes-is precisely the same that makes people healthier _on average._ It suggested a way of quantifying the trade-off between health inequalities and health levels. The paper also went on to argue that measures _can_ be devised to reduce health inequalities below what they would otherwise be. Policies are unlikely to turn back the tide, but they can hope to reduce its force. The difficulty is in assessing the effectiveness of anti-inequality policies if other factors-notably rising per capita incomesare operating at the same time and tending to offset the effects of these policies. Instead of comparing the headline level of health inequality across countries or over time (which reveals the effects of all differences and all changes including those relating to income), the paper suggests four approaches that can shed light on the impacts on health inequalities of antiinequality policies: cross-country comparative studies, country-based before-and-after studies with controls, benefit-incidence analysis, and decomposition analysis. The results of studies in these four genres do not give as many clear-cut answers as one might like on how best to swim against the tide of rising per capita incomes and their apparent inequality-increasing effects. But they ought at least to help us build up our stock of knowledge on the subject.

# **References**

Acheson, D. 1998. _Independent Inquiry into Inequalities in Health._ London: The Stationery Office.

- Alderman, Harold. 2000. "Anthropometry." In Margaret Grosh and Paul Glewwe, eds. _Designing Household Survey Questionnaires for Developing Countries._ Washington D.C.: World Bank.

- Alleyne, G. A. O., J. A. Casas, and C. Castillo-Salgado. 2000. "Equality, equity: why bother?" _Bulletin of the World Health Organization_ 78 (1): 76 -77.

- Bhuiya, A., M. Chowdhury, F. Ahmed, and A. M. Adams. 2001. "Bangladesh: An intervention study of factors underlying increasing equity in child survival." In T. Evans, M. Whitehead, F. Diderichsen, A. Bhuiya, and M. Wirth, eds., _Challenging Inequities in Health: From Ethics to Action._ Oxford: Oxford University Press.

- Bidani, Benu, and Martin Ravallion. 1997. "Decomposing social indicators using distributional data." _Journal of Econometrics_ 77 (1): 125 -39.

- Castro-Leal, F., J. Dayton, L. Demery, and K. Mehra. 1999. "Public social spending in Africa: do the poor benefit?" _World Bank Research Observer_ 14 (1): 49 -72.

- Castro-Leal, F., J. Dayton, L. Demery, and K. Mehra. 2000. "Public spending on health care in Africa: do the poor benefit?" _Bulletin of the World Health Organization_ 78 (1): 66 - 74.

- Christiansen, T. 1993. "Denmark." In Eddy van Doorslaer, Adam Wagstaff and Frans Rutten, eds., _Equity in the Finance and Delivery of Health Care: An International Perspective._ Oxford and New York: Oxford University Press.

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