CDE Appendix 1 Literature Review - Central East Local Health ...

The Culture, Diversity and Equity Project: Literature Review
Stating health equity policy goals in absolute terms, Mackenbach et al. (2002b) however argue, increases the range
of potential policy options, since any policy initiative that universally reduces, for instance, average rates of
mortality or morbidity (even if not changing the size of relative inequalities between population groups), will be
justifiable in service of this objective.
Objectives aimed at decreasing the relative ratio of inequality between SES groups, on the other hand, often require
health equity policy interventions that exclusively target the most disadvantaged. It is precisely because “[s]trategies
to maximize improvement in overall population health may have little or no impact on relative disparities or, indeed,
may cause them to increase” (Keppel et al., 2007), that many argue (including Gardner, 2008a and the Canadian
Health Disparities Task Group) that “[t]he most appropriate and effective way to improve overall population
health status is by improving the health of those in lower SES groups and other disadvantaged populations”
(Canadian Health Disparities Task Group, 2004).
Mackenbach et al. (2002b) recommend pursuing health equity policy objectives on both fronts – i.e. investing in
overall improvements in overall population health, as well as seeking to reduce health gaps between higher and
lower socio-economic groups. This has been the approach adopted in the UK (see Section 3.2.B and 3.3 for more on
UK health equity policies).
The WHO’s (2008) Closing the Gap framework also includes elements of both of these two (absolute and relative)
objectives: on the one hand, aiming to ‘improve living conditions for all’, and on the other hand, ‘to reduce
inequitable distributions of power, money and resources’.
II. Reduction of health status inequalities and/or healthcare inequalities as objective
The various frameworks discussed in the preceding section on Frameworks were largely organized around their
differing objectives: healthcare equity and/or health status equity. It is important not to confuse disparities in health
care with disparities in health status. Disparities in health status are widely agreed to be rooted in socioeconomic
circumstances that extend far beyond the health care system. As Exworthy and Washington (2006) argue:
Disparities in health care cannot remedy all the disparities in health status, because of the wider
determinants of health shaping the latter. Indeed, health care may only have an ameliorative effect on
disparities in health status and in some cases may even exacerbate them (see for instance McGinnis et al.,
2002).
Exworthy et al. (2006) provide some tangible examples (see Table 3.2 below) of the different kinds of measures
involved in assessing disparities in health status versus disparities in healthcare, drawing on statistics from the UK
and US contexts.
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