Inclusion of equity in economic analyses of public health policies: systematic review and future directions

Lal, Anita; Moodie, Marj; Peeters, Anna; Carter, Rob

doi:10.1111/1753-6405.12709

Cited by 31 publications

(25 citation statements)

References 57 publications

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“…Also, the participants revealed that minimising inequalities was an important criterion for public health decision making. Methods for incorporating equity into economic evaluation are under development within health economics (Round and Paulden, 2018), however, there are few examples of this being applied to public health interventions (Lal et al , 2018). This study provides further evidence that this is an important research area for supporting local public health decision making.…”

Section: Discussionmentioning

confidence: 99%

Health economics methods for public health resource allocation: a qualitative interview study of decision makers from an English local authority

Frew

Breheny

2019

HEPL

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Local authorities in England have responsibility for public health, however, in recent years, budgets have been drastically reduced placing decision makers under unprecedented financial pressure. Although health economics can offer support for decision making, there is limited evidence of it being used in practice. The aim of this study was to undertake in-depth qualitative research within one local authority to better understand the context for public health decision making; what, and how economics evidence is being used; and invite suggestions for how methods could be improved to better support local public health decision making. The study included both observational methods and in-depth interviews. Key meetings were observed and semi-structured interviews conducted with participants who had a decision-making role to explore views on economics, to understand the barriers to using evidence and to invite suggestions for improvements to methods. Despite all informants valuing the use of health economics, many barriers were cited: including a perception of a narrow focus on the health sector; lack of consideration of population impact; and problems with translating long timescales to short term impact. Methodological suggestions included the broadening of frameworks; increased use of natural experiments; and capturing wider non-health outcomes that resonate with the priorities of multiple stakeholders.

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Section: Discussionmentioning

confidence: 99%

Health economics methods for public health resource allocation: a qualitative interview study of decision makers from an English local authority

Frew

Breheny

2019

HEPL

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“…Creating a systems value across all levels of the health system and government may be an essential starting point to advocate for necessary structural change that addresses root causes of inequities [ 45 ]. Careful consideration of how economic arguments, including costs effectiveness analyses, might be structured to explicitly weigh health equity is a potential strategy for attempting to counter this [ 58 – 60 ]. Development of health equity indicators and surveillance measures, including those related to structural determinants, are needed to demonstrate burden and gradients in health outcomes [ 61 , 62 ].…”

Section: Discussionmentioning

confidence: 99%

Values are not enough: qualitative study identifying critical elements for prioritization of health equity in health systems

Roode

Pauly

Marcellus

et al. 2020

Int J Equity Health

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Background Health system policies and programs that reduce health inequities and improve health outcomes are essential to address unjust social gradients in health. Prioritization of health equity is fundamental to addressing health inequities but challenging to enact in health systems. Strategies are needed to support effective prioritization of health equity. Methods Following provincial policy recommendations to apply a health equity lens in all public health programs, we examined health equity prioritization within British Columbia health authorities during early implementation. We conducted semi-structured qualitative interviews and focus groups with 55 senior executives, public health directors, regional directors, and medical health officers from six health authorities and the Ministry of Health. We used an inductive constant comparative approach to analysis guided by complexity theory to determine critical elements for prioritization. Results We identified seven critical elements necessary for two fundamental shifts within health systems. 1) Prioritization through informal organization includes creating a systems value for health equity and engaging health equity champions. 2) Prioritization through formal organization requires explicit naming of health equity as a priority, designating resources for health equity, requiring health equity in decision making, building capacity and competency, and coordinating a comprehensive approach across levels of the health system and government. Conclusions Although creating a shared value for health equity is essential, health equity - underpinned by social justice - needs to be embedded at the structural level to support effective prioritization. Prioritization within government and ministries is necessary to facilitate prioritization at other levels. All levels within health systems should be accountable for explicitly including health equity in strategic plans and goals. Dedicated resources are needed for health equity initiatives including adequate resourcing of public health infrastructure, training, and hiring of staff with equity expertise to develop competencies and system capacity.

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“…Since the 1978 Declaration of Alma-Ata, citations in MEDLINE that include the term "equity" increased by 216% in 2015 compared to 1980 [18]. Given the increase in publications, comprehensive reviews and analyses on equity consideration in economic evaluations have also been conducted, though most reviews have focused on specific methodologies of how to integrate equity concerns into economic evaluations [19][20][21]. Other reviews have been based on specific interventions or concepts, such as vaccines, operation research, and universal health coverage [9,18,22].…”

Section: Health Equity As a Part Of Health Economic Evaluationsmentioning

confidence: 99%

Mapping the evidence on health equity considerations in economic evaluations of health interventions: a scoping review protocol

et al. 2020

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Background: Equity in health has become an important policy agenda around the world, prompting health economists to advance methods to enable the inclusion of equity in economic evaluations. Among the methods that have been proposed to explicitly include equity are the weighting analysis, equity impact analysis, and equity trade-off analysis. This is a new development and a comprehensive overview of trends and concepts of health equity in economic evaluations is lacking. Thus, our objective is to map the current state of the literature with respect to how health equity is considered in economic evaluations of health interventions reported in the academic and gray literature. Methods: We will conduct a scoping review to identify and map evidence on how health equity is considered in economic evaluations of health interventions. We will search relevant electronic, gray literature and key journals. We developed a search strategy using text words and Medical Subject Headings terms related to health equity and economic evaluations of health interventions. Articles retrieved will be uploaded to reference manager software for screening and data extraction. Two reviewers will independently screen the articles based on their titles and abstracts for inclusion, and then will independently screen a full text to ascertain final inclusion. A simple numerical count will be used to quantify the data and a content analysis will be conducted to present the narrative; that is, a thematic summary of the data collected. Discussion: The results of this scoping review will provide a comprehensive overview of the current evidence on how health equity is considered in economic evaluations of health interventions and its research gaps. It will also provide key information to decision-makers and policy-makers to understand ways to include health equity into the prioritization of health interventions when aiming for a more equitable distribution of health resources.

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Inclusion of equity in economic analyses of public health policies: systematic review and future directions

Cited by 31 publications

References 57 publications

Health economics methods for public health resource allocation: a qualitative interview study of decision makers from an English local authority

Health economics methods for public health resource allocation: a qualitative interview study of decision makers from an English local authority

Values are not enough: qualitative study identifying critical elements for prioritization of health equity in health systems

Mapping the evidence on health equity considerations in economic evaluations of health interventions: a scoping review protocol

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