Discrimination

In an earlier blog I discussed the role of Body-Mass Index (BMI) in measuring obesity.  An alternative measure to the BMI is to measure your waistline, since this is more directly indicative of health-threatening abdominal fat than the BMI is.  The British Heart Foundation (BHF) has a free information pack on such matters as they relate to heart disease.  The pack includes a tape which is colour-coded so you can immediately read off both your waistline and risk category.

One unexpected feature of the tape measure is that one side is labelled "European" and the other is labelled "Asian", with the colour-coded risk categories being different on each side.  This seems odd, since surely an inch is the same length whoever you are?  The BHF's accompanying booklet explains what they are doing and why:

People of Asian backgrounds are most likely to have a higher proportion of body fat to muscle than the rest of the UK population.  They also tend to carry this fat around their middle. So Asians have a greater risk of developing problems such as diabetes and coronary heart disease at a lower waist size than other people in the UK."

A quick guide to heart health, British Heart Foundation, page 30

In other words, the BHF says the threshold waist size for health risks is lower for Asians than it is for Europeans. Now, the BHF is a reputable charity whose sole concern is reducing heart disease and the extra mortality associated with it.  The BHF is not being gratuitously racist or discriminatory, since the claims are backed by the International Diabetes Federation in a recent article.  If reliable science shows ethnic differences, then the BHF wants to use this to save lives, not offend people.

An interesting contrast here is with what insurers can and cannot do.  In the UK and many other countries, insurers are forbidden from using ethnic origin in pricing.  The BHF's ethnically differentiated tape measure is permissible for the purpose of saving lives, but it would be quite illegal for insurance pricing.  If an insurer wanted to use waistline as a risk factor, it would have to have a single rating scheme for all.

Insurers are forbidden from using many other risk factors, a recognition that some social-policy objectives are more important than the insurance industry's freedom to price as it sees fit.  Another recent example is the EU-wide ban on insurance exclusions relating to pregnancy, which were once common for private health insurance.