In this paper we have discussed under what conditions a welfare economics foundation can be
given to the largely empirical literature on the measurement of health inequality. The conditions
of anonymity, the existence of an equally distributed equivalent level of health, weak ordering
and monotonicity generally seem acceptable. Sen (1973) has argued that completeness may be
too restrictive given that many of our intuitions on inequality only support partial orderings.
Monotonicity may in some cases be too restrictive, e.g. when health in society is concentrated
among few people a policy maker may not consider it desirable to give these “happy few” a large
gain in health when the health of the others in society, the “left-behinds”, improves only marginally.
Such decision situations will be rare, however, and empirical evidence does not seem to support
such preferences (Bleichrodt et al., 2005). Therefore, monotonicity does not seem restrictive as a
general principle. Finally, anonymity can be restrictive may be violated if the policy maker cares
about other attributes of an individual than only his health and his socioeconomic status.