National and international organizations to address health inequalities
Common indicators and methods for monitoring health inequalities
Estimating health inequalities based on three diseases
References
Further reading
Health inequality relates to measuring and comparing the health outcomes of different groups. Some commonly measured parameters 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 1980, several strategies have been formulated to address health disparities at international and national levels. In 2008, the World Health Organization (WHO) Global Commission on Social Determinants of Health focused on the social determinants of health to “close the gap in one generation”. According to the WHO, it is imperative to identify health inequalities and their drivers, as it can help achieve health equity.
In 2008, the General Directorate of Spanish Public Health requested the formulation of the Commission for the Reduction of Social and Health Inequalities (CRDSS-E). The main function of CRDSS-E was to reduce health inequalities. In 2011, 125 countries worldwide, including Spain, developed the Rio Political Declaration on Social Determinants of Health, which recommended intervention by governments and international organizations.
Recently, more attention has been paid to examining and addressing health inequalities at the regional, national and international levels. These studies showed a high prevalence of health inequality in several countries around the world. The difference in life expectancy was observed according to the highest and lowest levels 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 care policy makers to ascertain which groups are left behind and to formulate effective strategies to bridge health disparity gaps.
There is a wide variety 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 quantitative monitoring of inequality based on sexual, reproductive, newborn, maternal, child and adolescent health.
Typically, the simplest method for measuring health inequalities is by comparing the health of individuals from the lowest socio-economic group with those from the highest group. The result of this study shows the health outcomes of the groups. This method was applied in a study based in Scotland, which found that men living in less deprived areas of Scotland survived approximately 24 years healthier than those living in more deprived areas.
When measuring health inequalities, comparisons between groups can be made in absolute or relative terms. Although this method does not take into account the social gradient in health across the population, it does reflect that individuals belonging to lower social positions experience worse health.
Measuring health inequalities: an introduction
Researchers have also assessed health inequalities within local areas. A Scotland-based study analyzed male/female wait times, over a two-year period, for each station on the train line between Jordanhill (affluent area) and Bridgeton (less affluent area). This study found that, on average, a male born in Bridgeton lives approximately 14.3 years less than those born 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 within local areas across Edinburgh. This study reported a gap in life expectancy for those living in housing estates near Bankhead and Balgreen of 11 years (male) and 8 years (female).
Internationally, researchers reported a significant reduction in absolute mortality inequalities since 2003. This report shows an improvement in health across different groups.
Estimating health inequalities based on three diseases
In 2021, WHO presented the first report on the state of health inequality 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 aforementioned diseases are diseases of poverty and marginalization. Therefore, the incidence of these diseases indicates health inequalities.
According to this study, HIV, malaria and tuberculosis occur among the least educated people and those who live in rural areas. Although significant progress has been made in reducing the frequency of these diseases in the last decade, some groups are still persistently affected, which has increased mortality and morbidity.
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This report showed disparities in the incidence of HIV, TB and malaria between population subgroups in most of the countries included in this analysis. A marked within-country disparity has been reported between the richest and poorest subgroups in a country. This is due to the spread of diverse coverage of health care services among groups. According to this report, the poorest, rural and less educated subgroups are more likely to be infected with these diseases.
References
- Monitoring inequality in sexual, reproductive, maternal, newborn, child and adolescent health: a step-by-step manual. (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 health inequalities: 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
- The 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) Inequalities in health: definitions, concepts and theories. Global Health Action24 (8), 27106. doi: 10.3402/gha.v8.27106.