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Full reference: Dover D.C. and Belon A.P.(2019) International Journal for Equity in Health 18;36



This weeks blog is brought to you by: Professor Sir Muir Gray, Founding Director


Authors conclusion; Text from the paper chosen by 3VH.

This paper presented a complex, overarching measurement framework for health equity.  The HEMF is a synthesis of existing SDOH (Social Determinants of Health) and health system utilisation frameworks and current literature.  Yet, its purpose extends to focus on measurement. It is specifically designed to help identify and measure the interrelationships between political and socio-cultural context, health system-related policies and programs, material and social circumstances, environment, biological and psychosocial factors, perceived and evaluated needs, social location, health-related behaviours, beliefs, and health state and outcomes. It provides guidance to the design of research on public health and health services, application of statistical methods for academic studies or surveillance systems, and development of policies and programs to promote health equity.


3VH – Implications for value

Our Bottomline; equity is fairness and every service can assess how well it is doing quite simply

This is a detailed description of how to think about and measure inequity but people should not be put off by the complexity. There is a very simple measure that people who pay for or manage healthcare can use.

Firstly, there is a need to have a clear definition and here is one from the Nobel prize winner.

“… health equity has many aspects, and is best seen as a multidimensional concept. It includes concerns about achievement of health and the capability to achieve good health, not just the distribution of health care. But it also includes the fairness of processes and thus must attach importance to non-discrimination in the delivery of health care. .”
Source: Sen, A. Why Health Equity? In: Anand, S., Peter, F. and Sen, A. (Eds) (2004) Public Health, Ethics, and Equity. Oxford University Press. (p.31).

It is important to recognise that the situation expressed in the Venn diagram below can be observed in almost every health service except when the need is unequivocal, a broken leg for example



The next step is to ascertain if the there is a higher proportion of people from deprived populations in the group not receiving the specialist service as was shown in this classic study of joint replacement.


So, don’t worry about the complexity described in this week’s paper the complexity described in this week’s excellent paper,  just get a map and plot the postcodes of the patients seen by a service and relate it to the deprivation of the different local authority wards. Every service that sees people selected by professionals for referral should, and can easily, be aware of the possibility of inequity and monitor “the fairness of processes” with this in mind.