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

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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. 56
The Culture, Diversity and Equity Project: Literature Review Table 3.2: Examples of Disparities and Inequalities in Health and Health Care Source: Exworthy et al., 2006 Ultimately, it is recommended by Mackenbach et al. (2002b) that both kinds of disparities (health status and healthcare) feature as objectives in any policy concerned with reducing health inequities. Scope Health Equity policies also vary considerably, internationally and intra-nationally, by the scope of ‘disadvantaged groups’ they consider and target, and the breadth of system areas or domains engaged by health equity policy initiatives. I. Breadth of disadvantaged groups considered The scope of disadvantaged groups targeted by health equity policies depends greatly on local histories and politics, and statistical/census data. US healthcare equity policies for instance tend to focus, almost exclusively, on racial and ethnic minorities, and rarely if ever speak in terms of socioeconomic status or class position, as is the norm in the European healthcare context. In the UK context, Strategic Health Authorities and the UK Department of Health focus in particular on six ‘equality strands’ – race, gender, disability, age, sexual orientation and gender identity, and religion and belief – and human 57
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Appendix 1: Health Equity Literatur
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The Culture, Diversity and Equity P
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REFERENCES ACAS [Advisory Conciliat
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