The health equity measurement framework: a comprehensive model to measure social inequities in health

Abstract

Background Despite the wealth of frameworks on social determinants of health (SDOH), two current limitations include the relative superficial description of factors affecting health and a lack of focus on measuring health equity. The Health Equity Measurement Framework (HEMF) addresses these gaps by providing a more encompassing view of the multitude of SDOH and drivers of health service utilisation and by guiding quantitative analysis for public health surveillance and policy development. The objective of this paper is to present the HEMF, which was specifically designed to measure the direct and indirect effects of SDOH to support improved statistical modelling and measurement of health equity. Methods Based on a framework synthesis, the HEMF development involved initially integrating theoretical components from existing SDOH and health system utilisation frameworks. To further develop the framework, relevant publications on SDOH and health equity were identified through a literature review in major electronic databases. White and grey literatures were critically reviewed to identify strengths and gaps in the existing frameworks in order to inform the development of a unique health equity measurement framework. Finally, over a two-year period of consultation, scholars, health practitioners, and local policy influencers from municipal and provincial governments provided critical feedback on the framework regarding its components and causal relationships. Results This unified framework includes the socioeconomic, cultural, and political context, health policy context, social stratification, social location, material and social circumstances, environment, biological factors, health-related behaviours and beliefs, stress, quality of care, and healthcare utilisation. Alongside the HEMF’s self-exploratory diagram showing the causal pathways in-depth, a number of examples are provided to illustrate the framework’s usefulness in measuring and monitoring health equity as well as informing policy-making. Conclusions The HEMF highlights intervention areas to be influenced by strategic public policy for any organisation whose purview has an effect on health, including helping non-health sectors (such as education and labour) to better understand how their policies influence population health and perceive their role in health equity promotion. The HEMF recognises the complexity surrounding the SDOH and provides a clear, overarching direction for empirical work on health equity. Electronic supplementary material The online version of this article (10.1186/s12939-019-0935-0) contains supplementary material, which is available to authorized users.

Preferences in Information Processing, Marginalized Identity, and Non-Monogamy: Understanding Factors in Suicide-Related Behavior among Members of the Alternative Sexuality Community

“…SRB is a documented mental health problem in the alternative sexuality community [20], with existing literature highlighting mental health [21], stigma-associated emotions [13], and acquired capability [12] as risk factors. The present study employed relationship orientation (e.g., non-monogamy) [34,66], health inequity/marginalized identity [5,37], and PIP [50,58] to further investigate factors associated with SRB among members of the alternative sexuality community. As is discussed in the following sections, all three perspectives, plus known mental health and suicide exposure-related factors, added value in understanding SRB.…”

“…Health equity frameworks [37] aim to redress health disparities through understanding demographic stratification and social determinants of health. This social justice view also holds that it is valuable to attend to the multitude of marginalized minority identities (e.g., race, sexual orientation, gender) to fully account for the variety of experiences within a community.…”

Putting health equity at heart of universal coverage—the need for national programmes of action

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The Effects of Family Physician–contracted Service on Health-related Quality of Life and Equity in Health Among the Chinese Population

“…Therefore, we conducted this study using the data from a household health survey in Shaanxi Province, China, with the aim to (1) explore whether being contracted with family physician services can improve HRQoL, (2) investigate whether the inequity in HRQoL would be lessened under the implementation of FPCs, which might provide implications for policymakers in terms of advancing family practice contract services in China. Based on previous research [14,[22][23][24], we hypothesize that FPCs would help improve community residents' HRQoL and lessen the inequity in HRQoL.…”