How is health inequality measured and monitored?

National and international organizations to combat health inequalities
Common indicators and methods for monitoring health inequalities
Evaluation of health inequalities on the basis of three diseases
References
Further reading


Health inequality is associated with measuring and comparing the health outcomes of various groups. Some common metrics are the life expectancy, disease rate, 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 combat health inequalities

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

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

Recently, more attention has been paid to screening and tackling health inequalities at regional, national and international levels. These studies have indicated a large prevalence of health disparities in several countries around the world. The difference in life expectancy was observed according to the highest and lowest educational level.

Common indicators and methods for monitoring health inequalities

According to the WHO, monitoring health inequalities is extremely important as it will help to understand the differences in health between different subgroups of the population. This discovery will be useful for health policy makers to ascertain which groups have been left behind and formulate effective strategies to fill the gaps in health inequality.

There is a wide diversity of indicators for monitoring health inequalities in different countries. According to a study, 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 manual as a guide to strengthen the possibility of monitoring quantitative inequality based on sexual, reproductive, neonatal, maternal and child and adolescent health.

Typically, the simplest method for measuring health inequalities is to compare the health of individuals in the lowest socioeconomic group with those in the highest group. The result of this study indicates the health outcomes of the groups. This method was applied in a study based in Scotland, which revealed that men living in less favored areas of Scotland survive around 24 years longer in health than those living in deprived areas.

When measuring health inequalities, the comparison between groups can be made in absolute or relative terms. Although this method does not take into account the social gradient of health in the entire population, it reflects that individuals belonging to lower social positions have worse health.

Measuring health inequalities: an introduction

The researchers also estimated health inequalities within local areas. A study based in Scotland analyzed male / female expectation, over a two-year period, for each station on the railway line between Jordanhill (affluent location) and Bridgeton (less affluent location). This study revealed that, on average, a male born in Bridgeton lives about 14.3 years less than those living in Jordanhill. Likewise, females living in Bridgeton live 11.7 years less than those living in Jordanhill.

In a similar study, researchers reported health inequalities within local areas of Edinburgh. This study reported an average life expectancy gap for those living in residential neighborhoods near Bankhead and Balgreen of 11 years (males) and 8 years (females).

Internationally, researchers have reported a significant decrease in absolute mortality inequalities since 2003. This report indicates an improvement in health in the heterogeneous group.

Evaluation of health inequalities on the basis of three diseases

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

According to this study, HIV, malaria and tuberculosis occur in less educated people and in those residing in rural settings. Although significant progress has been made in reducing the frequency of these diseases over the past decade, some groups are still persistently affected, which has increased mortality and morbidity.

Image credit: sulit.photos/Shutterstock.com

Image credit: sulit.photos/Shutterstock.com

This report indicated inequalities in the occurrences of HIV, tuberculosis and malaria among subgroups of the population in most of the countries included in this analysis. A major inequality within the country has been reported between the richest and poorest subgroups of a country. This is due to the prevalence of various health service coverage among the groups. According to this report, the poorest, rural residents and less educated subgroups are more prone to be infected with these diseases.

References

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

Further reading

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