Equity

Equity is about fairness — about how health benefits and harms are distributed across the population and about addressing unfair inequalities in health. The idea is to ensure that everyone has a fair chance to benefit from the health system and to address disadvantages related to health. A key goal for equity is to reduce or eliminate unfair differences in health care and health outcomes across population groups.

Considering how to promote equity includes:

ways to narrow or reduce existing health inequities. This means selecting interventions that will improve the health of people who belong to disadvantaged groups that are more likely to experience less health or face greater risks for bad health outcomes than advantaged groups
avoiding health coverage decisions that will create or widen existing health inequities between the advantaged and disadvantaged
ensuring that certain services are provided to all people who experience the same health need, without discrimination by group or individual characteristics

Addressing current health inequities

Does the health intervention address specific health needs of population groups who are disadvantaged, underserved or particularly vulnerable in their health needs and status? For example:
- Does the intervention help meet the needs of priority populations, such as: children, women and girls, the elderly, people with disabilities, the poor, people with mental illness, people living in informal settlements and rural areas, the homeless, migrants, and refugees?
- Does the intervention help reach underserved communities and groups that previously had suboptimal coverage?
Does the health intervention address a condition that is currently neglected, or has been historically overlooked for various reasons? For example:
- Does the intervention address tropical diseases, rarer diseases, mental health, or other conditions that have not been prioritised in the past?

Avoiding new or worse health inequities

Is covering the intervention likely to create any new health inequities, widen existing health inequities, or contribute to future potential inequities? In other words, is the intervention more likely to benefit only those who are already better off or make things worse for groups that are already disadvantaged?
Consider how this may relate to:

Personal Financial Impacts: Out-of-pocket costs or lost wages needed to access the intervention

Impacts on Personal Relationships: Differential impacts on members of the household and care-giver burden, including gender equity

There are also some health services that should be provided to everyone, regardless of whether they belong to a disadvantaged group. When assessing if a health service that should be considered for all, consider:

Is this the type of intervention that should be guaranteed to everyone in society, regardless of their circumstances?
- For example, emergency medical transport and trauma services for serious injuries that all people need equally.

Equity in light of Systems Factors & Constraints

In the real-world context of the health system & other factors

Does the intervention require access to certain types of health facilities, equipment, or specialist health providers that will be harder to reach for certain members of the population (e.g., those in rural areas) – in ways that may make health inequities worse?
Does the intervention require certain types of infrastructure or technologies – such as internet access, mobile phones, clean water, electricity – that may not be reliably available in underserved areas or for disadvantaged populations?
Does implementing the intervention rely on other sectors that do not equitably serve different groups, with the result that inclusion of the intervention may reinforce disadvantages for populations who already underserved by those systems? If so, how would provision reinforce existing inequalities by gender, age, income, or geography)?
- Are there feasible and affordable ways to bridge these gaps, e.g., through transport services, mobile clinics, or new investments in underserved areas?
Conversely, does this intervention have advantages over existing health service offerings that make it easier to access, deliver with sufficient quality, or use by patients who may face systems barriers and constraints?