Journal of Health Economics 26 (2007) 414–421 Comment Health inequality and non-monotonicity of the health related social welfare function Indranil Dutta a,b,∗ a UNU-WIDER, Helsinki 00160, Finland b Department of Economics, University of Sheffield, Sheffield, UK Received 7 November 2005; received in revised form 31 May 2006; accepted 1 August 2006 Available online 7 September 2006 Abstract In a recent paper in this journal Abasolo and Tsuchiya [Abasolo, I., Tsuchiya, A., 2004. Exploring social welfare functions and violation of monotonicity: an example from inequalities in health. Journal of Health Economics 23, 313–329] have strongly argued for the use of a non-monotonic health related social welfare function. This note discusses both the limitations of the measure proposed by Abasolo and Tsuchiya [Abasolo, I., Tsuchiya, A., 2004. Exploring social welfare functions and violation of monotonicity: an example from inequalities in health. Journal of Health Economics 23, 313–329] and the problems associated with their empirics. We are able to show how non-monotonicity may lead to paradoxical results and policies. Further we examine the empirics of Abasolo and Tsuchiya [Abasolo, I., Tsuchiya, A., 2004. Exploring social welfare functions and violation of monotonicity: an example from inequalities in health. Journal of Health Economics 23, 313–329] and provide an alternative explanation to the observed patterns in the data that do not violate monotonicity. Finally we briefly mention why the Atkinson-Sen framework may be more appropriate as a way forward. © 2006 Elsevier B.V. All rights reserved. JEL classification: D39; D63; I10 Keywords: Health inequality; Non-monotonicity; Social welfare function 1. Introduction How to meaningfully account for the equity and efficiency trade-off in health is an important issue in health economics. To that end, Dolan (1998), in a similar vein to the standard social ∗ Present address: UNU-WIDER, Katajanokanlaituri 6 B, Helsinki 00160, Finland. Tel.: +358 9 61599212; fax: +358 9 61599333. E-mail address: dutta@wider.unu.edu. 0167-6296/$ – see front matter © 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.jhealeco.2006.08.001