The Health Equity Measurement Framework: A Comprehensive Model to Measure Social Inequities in Health
Research article
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.
Health-related Behaviours
Health-related Behaviours refers to any activity undertaken by people that influences directly or indirectly their health. Common examples include alcohol consumption, diet and eating practises, physical activity, smoking, drug use, and sexual behaviours. Research shows Health-related Behaviours lie on the causal pathway to Health States. While many behaviours act in only one pathway (e.g., lack of condom use resulting in the increased likelihood of a sexually transmitted disease), others operate in competing pathways. For instance, higher alcohol consumption is associated with liver diseases, but its moderate and occasional intake may be used as a coping mechanism to reduce stress and mitigate its negative effects on well-being. The HEMF captures both types of pathways.
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.