How are health inequalities measured and monitored?

National and international organizations to address health inequalities
Common indicators and methods for monitoring health inequalities
Estimating health inequalities based on three diseases
References
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Health inequality is about measuring and comparing the health outcomes of different groups. Some common parameters to measure are life expectancy, disease rates, and disease-free life expectancy of different groups of individuals. These groups are based on gender, ethnicity, geographic area, social class, employment status, and education.

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National and international organizations to address health inequalities

Since the 1980s, several strategies have been formulated to address health inequalities at international and national levels. In 2008, the World Health Organization’s (WHO) Global Commission on Social Determinants of Health focused on the social determinants of health to “close the one-generation gap.” According to the WHO, it is imperative to identify health inequalities and their drivers as this can help achieve health equity.

In 2008, the General Directorate of Spanish Public Health requested the creation of the Commission for the Reduction of Social and Health Inequalities (CRDSS-E). The primary function of CRDSS-E was to reduce health inequities. In 2011, 125 countries around the world, including Spain, developed the Rio Political Declaration on the Social Determinants of Health, which recommends intervention by governments and international organizations.

Recently, more attention has been paid to screening and addressing health inequalities at regional, national and international levels. These studies show a high prevalence of health care disparity in several countries around the world. The difference in life expectancy is observed according to the highest and lowest level of education.

Common indicators and methods for monitoring health inequalities

According to the WHO, monitoring health inequalities is extremely important as it will help to understand differences in health between different population subgroups. This finding will be useful for health policy makers to identify which groups are being left behind and to formulate effective strategies to close health inequity gaps.

There is a wide variety of indicators for monitoring health inequalities in different countries. According to research, the Scottish government measures health inequalities based on several indicators, including well-being, low birth weight, premature mortality and deaths from cardiovascular disease. In 2022, WHO provided a step-by-step guide to strengthen the ability to quantify inequality based on sexual, reproductive, newborn, maternal and child and adolescent health.

Usually, the simplest method of measuring health inequalities is by comparing the health of individuals in the lowest socioeconomic group with those in the highest group. The result of this study shows the health outcomes of the groups. This method was applied in a Scottish study which revealed that men living in the poorest areas of Scotland lived approximately 24 years healthier than those living in the poorest areas.

While measuring inequalities in health care, the comparison between groups can be made either in absolute or relative terms. Although this method does not account for the social gradient in the health of the entire population, it does reflect that people belonging to lower social positions have poorer health.

Measuring Inequalities in Health Care: An Introduction

The researchers also assessed health inequalities in local areas. A study based in Scotland analyzed male/female life expectancy over a two-year period for each station on the train line between Jordanhill (an affluent area) and Bridgeton (a less affluent area). This study revealed that, on average, a man born in Bridgeton lived approximately 14.3 years less than those living in Jordanhill. Similarly, women living in Bridgeton live 11.7 years less than those living in Jordanhill.

In a similar study, researchers reported health inequalities in local areas in Edinburgh. This study reported a difference in life expectancy for those living in housing estates near Bankhead and Balgreen of 11 years (males) and 8 years (females).

Internationally, the researchers reported a significant reduction in inequalities in absolute mortality since 2003. This report shows an improvement in the health of different groups.

Estimating health inequalities based on three diseases

In 2021, WHO presented the first report on the status of health inequalities based on three diseases, namely human immunodeficiency virus (HIV), malaria and tuberculosis (TB). According to this report, malaria alone affects hundreds of millions of people. The researchers state that all the aforementioned diseases are diseases of poverty and marginalization. Therefore, the incidence of these diseases indicates health inequality.

According to this study, HIV, malaria and tuberculosis occur in the least educated people and those living in rural areas. Although significant progress has been made in reducing the incidence of these diseases over the past decade, some groups are still persistently affected, resulting in increased mortality and morbidity.

Image credit: sulit.photos/Shutterstock.com

Image credit: sulit.photos/Shutterstock.com

This report shows disparities in HIV, tuberculosis and malaria incidence across population subgroups in most countries included in this analysis. Significant domestic inequality has been reported between the richest and poorest subgroups within a country. This is due to the prevalence of diverse coverage of health services among the groups. According to this report, the poorest, rural and least educated subgroups are more likely to contract these diseases.

References

  • Monitoring inequalities in sexual, reproductive, maternal, newborn, child and adolescent health: a step-by-step guide. (2022) World Health Organization. [Online] Available at: https://www.who.int/data/health-equity/manual_srmncah
  • Albert-Ballestar, S. and García-Altés, A. (2021) Measuring inequalities in health: a systematic review of widely used indicators and topics. International Journal of Health Equity, 20 (73). https://doi.org/10.1186/s12939-021-01397-3
  • State of Inequality: HIV, Tuberculosis and Malaria. (2021) World Health Organization. [Online] Available at: https://www.who.int/data/stories/state-of-inequality-hiv-tuberculosis-and-malaria-a-visual-summary
  • What are health inequalities? (2021) [Online] Available at: http://www.healthscotland.scot/health-inequalities/what-are-health-inequalities
  • Arcaya, MC (2015) Health inequalities: definitions, concepts and theories. Global Health Action, 24(8), 27106. doi: 10.3402/gha.v8.27106.

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