In this issue of Annals of the Rheumatic Diseases, Sokka et al (see page 1666), by analysing the data from the Quantitative Standard Monitoring of Rheumatoid Arthritis (QUEST-RA) cohort, with over 6000 patients from 25 countries, warn us of possible disparities in the health of patients with rheumatoid arthritis.1 This international team of researchers found a clear association between gross domestic product and the average status of the patients. We believe it is imperative to review some concepts that may help to understand the implications of these results.

Health inequalities, disparities, or variability in health, may be defined as differences in health status or in the distribution of health determinants between different population groups (ie, differences in mobility between older individuals and younger ones, or differences in death rates between social classes). It is important to distinguish them from inequities. Inequity means that the difference is unfair, a matter of injustice. Some health inequalities are attributable to biological variations or even to the free choice of individuals, while others may be attributable to external sources, mainly outside the control of those concerned. In the first case it may be impossible, or ethically or ideologically unacceptable to modify the health determinants and so the health inequalities are inevitable. In the second, the uneven distribution may be unnecessary and avoidable as well as unjust and unfair, so that the resulting health inequalities also lead to inequity in health.2 3

Reports on health inequalities exist between countries, within countries, between regions, health systems (including hospitals and …