The health equity measurement framework: a comprehensive model to measure social inequities in health
Abstract Background Despite the wealth of frameworks on social determinants of health (SDOH), two current limitations include the relative superficial description of factors affecting health and a lack of focus on measuring health equity. The Health Equity Measurement Framework (HEMF) addresses thes...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-02-01
|
| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12939-019-0935-0 |
| _version_ | 1811204293691179008 |
|---|---|
| author | Douglas C. Dover Ana Paula Belon |
| author_facet | Douglas C. Dover Ana Paula Belon |
| author_sort | Douglas C. Dover |
| collection | DOAJ |
| description | Abstract Background Despite the wealth of frameworks on social determinants of health (SDOH), two current limitations include the relative superficial description of factors affecting health and a lack of focus on measuring health equity. The Health Equity Measurement Framework (HEMF) addresses these gaps by providing a more encompassing view of the multitude of SDOH and drivers of health service utilisation and by guiding quantitative analysis for public health surveillance and policy development. The objective of this paper is to present the HEMF, which was specifically designed to measure the direct and indirect effects of SDOH to support improved statistical modelling and measurement of health equity. Methods Based on a framework synthesis, the HEMF development involved initially integrating theoretical components from existing SDOH and health system utilisation frameworks. To further develop the framework, relevant publications on SDOH and health equity were identified through a literature review in major electronic databases. White and grey literatures were critically reviewed to identify strengths and gaps in the existing frameworks in order to inform the development of a unique health equity measurement framework. Finally, over a two-year period of consultation, scholars, health practitioners, and local policy influencers from municipal and provincial governments provided critical feedback on the framework regarding its components and causal relationships. Results This unified framework includes the socioeconomic, cultural, and political context, health policy context, social stratification, social location, material and social circumstances, environment, biological factors, health-related behaviours and beliefs, stress, quality of care, and healthcare utilisation. Alongside the HEMF’s self-exploratory diagram showing the causal pathways in-depth, a number of examples are provided to illustrate the framework’s usefulness in measuring and monitoring health equity as well as informing policy-making. Conclusions The HEMF highlights intervention areas to be influenced by strategic public policy for any organisation whose purview has an effect on health, including helping non-health sectors (such as education and labour) to better understand how their policies influence population health and perceive their role in health equity promotion. The HEMF recognises the complexity surrounding the SDOH and provides a clear, overarching direction for empirical work on health equity. |
| first_indexed | 2024-04-12T03:10:37Z |
| format | Article |
| id | doaj.art-37251eac21084af38778c007fc331711 |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-04-12T03:10:37Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-37251eac21084af38778c007fc3317112022-12-22T03:50:22ZengBMCInternational Journal for Equity in Health1475-92762019-02-0118111210.1186/s12939-019-0935-0The health equity measurement framework: a comprehensive model to measure social inequities in healthDouglas C. Dover0Ana Paula Belon1Alberta Health, Government of AlbertaSchool of Public Health, University of AlbertaAbstract Background Despite the wealth of frameworks on social determinants of health (SDOH), two current limitations include the relative superficial description of factors affecting health and a lack of focus on measuring health equity. The Health Equity Measurement Framework (HEMF) addresses these gaps by providing a more encompassing view of the multitude of SDOH and drivers of health service utilisation and by guiding quantitative analysis for public health surveillance and policy development. The objective of this paper is to present the HEMF, which was specifically designed to measure the direct and indirect effects of SDOH to support improved statistical modelling and measurement of health equity. Methods Based on a framework synthesis, the HEMF development involved initially integrating theoretical components from existing SDOH and health system utilisation frameworks. To further develop the framework, relevant publications on SDOH and health equity were identified through a literature review in major electronic databases. White and grey literatures were critically reviewed to identify strengths and gaps in the existing frameworks in order to inform the development of a unique health equity measurement framework. Finally, over a two-year period of consultation, scholars, health practitioners, and local policy influencers from municipal and provincial governments provided critical feedback on the framework regarding its components and causal relationships. Results This unified framework includes the socioeconomic, cultural, and political context, health policy context, social stratification, social location, material and social circumstances, environment, biological factors, health-related behaviours and beliefs, stress, quality of care, and healthcare utilisation. Alongside the HEMF’s self-exploratory diagram showing the causal pathways in-depth, a number of examples are provided to illustrate the framework’s usefulness in measuring and monitoring health equity as well as informing policy-making. Conclusions The HEMF highlights intervention areas to be influenced by strategic public policy for any organisation whose purview has an effect on health, including helping non-health sectors (such as education and labour) to better understand how their policies influence population health and perceive their role in health equity promotion. The HEMF recognises the complexity surrounding the SDOH and provides a clear, overarching direction for empirical work on health equity.http://link.springer.com/article/10.1186/s12939-019-0935-0Health equityInequitiesHealthcareSocial determinants of healthPublic health surveillanceFramework |
| spellingShingle | Douglas C. Dover Ana Paula Belon The health equity measurement framework: a comprehensive model to measure social inequities in health International Journal for Equity in Health Health equity Inequities Healthcare Social determinants of health Public health surveillance Framework |
| title | The health equity measurement framework: a comprehensive model to measure social inequities in health |
| title_full | The health equity measurement framework: a comprehensive model to measure social inequities in health |
| title_fullStr | The health equity measurement framework: a comprehensive model to measure social inequities in health |
| title_full_unstemmed | The health equity measurement framework: a comprehensive model to measure social inequities in health |
| title_short | The health equity measurement framework: a comprehensive model to measure social inequities in health |
| title_sort | health equity measurement framework a comprehensive model to measure social inequities in health |
| topic | Health equity Inequities Healthcare Social determinants of health Public health surveillance Framework |
| url | http://link.springer.com/article/10.1186/s12939-019-0935-0 |
| work_keys_str_mv | AT douglascdover thehealthequitymeasurementframeworkacomprehensivemodeltomeasuresocialinequitiesinhealth AT anapaulabelon thehealthequitymeasurementframeworkacomprehensivemodeltomeasuresocialinequitiesinhealth AT douglascdover healthequitymeasurementframeworkacomprehensivemodeltomeasuresocialinequitiesinhealth AT anapaulabelon healthequitymeasurementframeworkacomprehensivemodeltomeasuresocialinequitiesinhealth |