We propose the "equity effectiveness loop" framework (fig 1) to highlight equity issues inherent in assessing health needs, effectiveness, and cost effectiveness of interventions, and the development and evaluation of evidence based health policy. This framework provides a method to calculate the "equity effectiveness ratio," which assesses the impact of various factors on the gap in the effectiveness of interventions across socioeconomic gradients.
Monitoring equity and research policy
Applying clinical epidemiological methods to health equity: the equity effectiveness loop
Tugwell P, deSavigny D, Hawker G: British Medical Journal 2006, 332:358-361
Methodological and data challenges to identifying the impacts of globalisation and liberalisation on inequality
Berry A: United Nations Research Institute for Social Development (UNRISD), 2005
Globalisation and liberalisation (G&L) are two of the defining features of the last couple of decades. Both have given rise to contentious debate, with views ranging from the most optimistic to the most sceptical. This paper reviews the evidence on how the two trends have affected inequality - and thus poverty - at both the global and domestic levels. The absence of consensus on these effects reflects both the dearth of adequate quantitative information and the lack of and difficulty in the analysis of the causal links among the issues.
Validating a work group climate assessment tool for improving the performance of public health organizations
Perry C, LeMay N, Rodway G, Tracy A, Galer J: Human Resources for Health 2005, 3:10
This article describes the validation of an instrument to measure work group climate in public health organizations in developing countries. The instrument, the Work Group Climate Assessment Tool (WCA), was applied in Brazil, Mozambique, and Guinea to assess the intermediate outcomes of a program to develop leadership for performance improvement. Findings discussed include how the WCA is useful for comparing the climates of different work groups, tracking the changes in climate in a single work group over time, or examining differences among individuals' perceptions of their work group climate.
Health Disparities And Health Equity: Concepts and Measurement
Annual Review of Public Health
There is little consensus about the meaning of the terms "health disparities," "health inequalities," or "health equity." The definitions can have important practical consequences, determining the measurements that are monitored by governments and international agencies and the activities given resource-support to address health disparities/inequalities or health equity. This paper aims to clarify the concepts of health disparities/inequalities and health equity, focusing on the implications of different definitions for measurement and hence for accountability.
Integrating gender, rights, and sexuality into sexual and reproductive health systems: A quality improvement approach
Eldis health policy reporter. Via WHO (Mozambique)
This document contains guidelines for assessing the integration of gender, rights and sexuality (GRS) issues into sexual and reproductive health services. The guidelines include a self-assessment GRS questionnaire designed to guide discussions among staff with the aim of producing concrete solutions to improve the integration of GRS issues. The questionnaire is divided into two sections: the needs of staff providers and the needs of clients.
Poverty, Equity & Health Research
The report stresses that reducing inequities in health requires political will, increased resources and enhanced effort to organize and deliver health products and services effectively. It also needs research – whether biomedical research to create the needed drugs, vaccines, diagnostics and medical appliances; health policy and systems research to understand and improve the organization and functioning of the health sector; social sciences and behavioural research to increase understanding of the factors that determine health and affect health-seeking behaviour; or operational research to examine how effectively systems and interventions are working on the ground and how they can be improved.
Stigma and global health: developing a research agenda
The Lancet, Volume 367, Number 9509
Stigma is a pervasive influence on disease and responses of nations, communities, families, and individuals to illness. Too little research has been done in recent years to better understand the pathogenesis and implications of stigma, how beliefs are generated, perpetuated, and translated into behaviours, and the cost of stigma to individuals, families, communities, and nations. The sense that legislation and education against stigma is sufficient may explain the shortage of interest in research in this field.
Bringing them on board: putting health policy into practice in South Africa
Wits Institute for Social and Economic Research
The successful implementation of health policy requires the backing of health care practitioners, managers, and patients. In South Africa, the introduction of free health care, although supported in principal by nurses and health facility managers, faced resistance as workloads increased and staff felt excluded from a centrally prescribed policy. Proponents of a 'street-level bureaucracy' approach to policy implementation acknowledge the day-to-day methods to cope with pressures that are adopted by frontline health care providers in the face of high demand for their services. It is these mechanisms, they argue, that effectively become public policy, rather than the decisions taken by central government.
No development without research: A challenge for capacity strengthening
Global Forum for Health Research, August 2005
Health research is indispensable for improving health and health equity and contributing to overall development. Many developing countries have made substantial investments in building and enhancing their capacities for research in health and related fields, and these efforts have been supported and extended by programmes of development agencies and research institutions located in high-income countries. Despite decades of such efforts, and notwithstanding some notable examples of success, the overall picture of progress is a mixed one.
Priorities for research to take forward the health equity policy agenda
WHO Task Force on Research Priorities for Equity in Health
Despite impressive improvements in aggregate indicators of health globally over the past few decades, health inequities between and within countries have persisted, and in many regions and countries are widening. We recommend that highest priority be given to research in five general areas: (1) global factors and processes that affect health equity and/or constrain what countries can do to address health inequities within their own borders; (2) societal and political structures and relationships that differentially affect people's chances of being healthy within a given society; (3) interrelationships between factors at the individual level and within the social context that increase or decrease the likelihood of achieving and maintaining good health; (4) characteristics of the health care system that influence health equity and (5) effective policy interventions to reduce health inequity in the first four areas.