Decomposing differences in health and inequality using quasi-objective health indices

People in Canada and the United States often make claims regarding whose country has a better health system. Several researchers have attempted to address this question by analysing subjective health measures in the two countries, thus assuming a common definition of ‘good’ health. Using data from the Joint Canada/US Survey of Health, which provides rich and comparable health information for the two countries, I generate two quasi-objective health indices and show that Canadians and Americans define ‘good’ health differently. After controlling for cross-country reporting heterogeneity, health differences between Americans and Canadians are eliminated for intermediate health statuses, while health differences at the tails of the health distribution lead to slightly better average population health in Canada. With respect to health inequality, my results show that income and education gradients increase steeply with poor health in both countries. Hence, considering differences along the health distribution is crucial when assessing population health or health inequality.