Monitoring Health Inequalities in 12 European Countries: Lessons Learned from the Joint Action Health Equity Europe

Abstract

To raise awareness about health inequalities, a well-functioning health inequality monitoring system (HIMS) is crucial. Drawing on work conducted under the Joint Action Health Equity Europe, the aim of this paper is to illustrate the strengths and weaknesses in current health inequality monitoring based on lessons learned from 12 European countries and to discuss what can be done to strengthen their capacities. Fifty-five statements were used to collect information about the status of the capacities at different steps of the monitoring process. The results indicate that the preconditions for monitoring vary greatly between countries. The availability and quality of data are generally regarded as strong, as is the ability to disaggregate data by age and gender. Regarded as poorer is the ability to disaggregate data by socioeconomic factors, such as education and income, or by other measures of social position, such as ethnicity. Few countries have a proper health inequality monitoring strategy in place and, where in place, it is often regarded as poorly up to date with policymakers’ needs. These findings suggest that non-data-related issues might be overlooked aspects of health inequality monitoring. Structures for stakeholder involvement and communication that attracts attention from policymakers are examples of aspects that deserve more effort.

A Scoping Review of Approaches to Improving Quality of Data Relating to Health Inequalities

“…This might be a result of our search terms not being optimal. Other factors include the extent to which health inequalities monitoring has been implemented and is a priority as part of healthcare delivery [ 76 , 77 ]. Nevertheless, this work identified evidence for several distal and proximal approaches that can be taken within the healthcare context of the United Kingdom to improve the quality of the data used for the identification and monitoring of health inequalities.…”

A City Surveillance System for Social Health Inequalities: The Case of Barcelona

“…The design of the Surveillance System formed part of the Joint Action for Health Equity in Europe (JAHEE), a joint action including 25 European countries and led by the Instituto Superiore di Sanita of Italy [ 3 , 8 ]. The objective of JAHEE was to improve the health and well-being of European citizens and achieve greater equity in health outcomes.…”

“…All of them have broad experience in analysing and doing research on health inequalities [ 4 , 5 ]. The group of experts met several times and decided by consensus upon the different aspects of the system, considering other European systems, mainly those described by the JAHEE Joint Action [ 3 ]. Moreover, the advances made regarding decisions were shared with the researchers of WP 5 of JAHEE.…”

“…Such indicators should be: (a) valid to measure the results; (b) able to reflect health inequalities; (c) possible to be shown by area and other axes of inequality; and (d) periodically obtained from routine data sources. The indicators were chosen to represent the domains selected and were based on previous reports and the exchanges made between the experts of the JAHEE project [ 3 , 9 ].…”

“…Moreover, a monitoring system would ensure that health inequalities could be tracked across space and time and, therefore, making it useful to promote an equitable society [ 1 , 2 ]. However, recently Högberg et al [ 3 ] stated that few European countries have a proper health inequality monitoring strategy in place and, when they do exist, they often do not coincide with policymakers’ needs.…”