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Health inequalities both between and within countries persist, for almost all diseases and health problems. Between countries, both average life expectancy and child mortality have improved more in the richest countries than the poorest (Marmot 2007). Within countries, progress on redressing health inequalities is uneven, and data are not always available over time. Analysis of 22 countries with available data found that only five of 22 countries reduced health inequalities in childhood mortality across income from 1995 to 2000 (Moser 2005). Health inequalities are differences in health across population groups defined by socioeconomic, demographic, or geographic factors. These factors can be summarized using the acronym PROGRESS: Place of residence (urban/rural), Race/ethnicity, Occupation, Gender, Religion, Education, Socioeconomic status, and Social capital/resources (Evans and Brown 2003).

Quality of care evaluation strategies are needed for meaningful assessment of health care delivery for research, quality assurance and educational purposes. For the purpose of improving strategies for measuring quality of care, this thesis first reviews methodologic features of available measurement strategies as reported in the current scientific literature. Secondly it proceeds with the development of a descriptive research design to evaluate the criterion validity of a strategy for evaluating process items by comparison with comprehensive outcome measures including physical, emotional and social function. Thirdly, the development of a new strategy for measurement of interpersonal skills, which is incorporated into the process evaluation, is described. The objective of the study is to study patients with acute myocardial infarction in order to determine whether measurable differences in the care administered to and received by these patients result in clinically significant differences in these patient's health status six months later. Acute myocardial infarction has been chosen as a disease appropriate for the testing of this strategy because if its high incidence, its functional impact upon the patient, the variation in process management items performed by different physicians, the different clinical settings involved, the relative diagnosis and availability of an inception cohort. A community hospital setting has been selected for the reason that, compared with a teaching hospital setting, the generalisability of the study to the practice of other physicians will be greater since the majority of physicians involved in the care of patients with acute myocardial infarction work in community hospital settings., Master of Science (MS)