Health Equity Audit
A Health Equity Audit (HEA) is a review procedure, which examines how health determinants, access to relevant health services, and related outcomes are distributed across the population. It advises decision-makers at all levels of governance to prioritise resources in the planning of policies, strategies, and projects in a way that reduces health inequities.
A HEA distinguishes between health inequalities and health inequities, and the overall objective is thus not to allocate resource equally across the population, but to prioritise these according to actual needs of different segments or geographic locations. (Source (.pdf))
HEA is an important instrument in reducing health inequities. It provides a framework for approaching this issue in a systematic way, and further, offers a platform for partnerships at different levels to develop equity profiles, identify priorities, and plan action.
Depending on the defined focus, the HEA can be applied to entire populations, or be restricted in scope to a specific geographic area or health service. By closely monitoring the progress, revisions can continuously be made to ensure positive equity impacts at these different levels.
HEA can be used to assess pathways that foster inequalities at various levels. This can be social and environmental conditions such as employment, transport and housing, or lifestyle and risk factors such as smoking and obesity. Moreover, a HEA can shed light on the degree of access to relevant services and facilities, such as number of health practices and recreational spaces, relative to the need in a given community.
As demonstrated in the figure below, a HEA comprises of six stages. The first is to gather relevant partners and agree on the scope of the assessment. The second stage entails collecting data and evidence to conduct an initial equity profile. In step three, this evidence is used to draft an action plan, which will ensure that resources are fairly distributed in relation to the health needs of the target group. Based on the action plan, the partners agree on targets and indicators. Step five concerns implementing the action plan, which means carrying out actual changes to reach the targets. In the final stage, the progress is monitored according to the defined targets and indicators. (Source)
The Health Equity Audit Cycle (DH, 2003b)
Useful Resources from Equity Action
- Towards a Health Inequalities Audit Process
- Review of the evidence research and economic analysis on nutrition, obesity and HI – Annexes
- Review of the prospects of creating interactive maps on obesity, diet, and socio-economic status
- Review infant feeding (breast feeding and complementary feeding by SES)
- Analysis of high and low birth weight by socio-economic status
- Making the case: Health Equity Audit. Health Development Agency, ISBN 1-84279-443-4 (2005)
- Health Equity Audit Made Simple: A briefing for Primary Care Trusts and Local Strategic Partnerships. Working document January 2003, Health Development Agency
- Health Equity Audit: A guide for the NHS (2003)
- Health equity audit: a self-assessment tool. Department of Health (2004)
Health Impact Assessment
Health Impact Assessment (HIA) is a practical tool, which allows for evaluating the health impact of policies, strategies, and initiatives in sectors that indirectly affect health, such as transportation, employment and the environment.
The overall goal of HIA is to inform decision-makers of adverse health effects of proposed actions, and support identification of appropriate policy options. (Source)
The objective of HIA is to examine variations in the social and environmental health determinants as consequences of proposed policy or practical initiatives, and thereby consider the impact on health. HIA is an important tool in tackling health inequalities given its capacity to map and make transparent the effect of an initiative on different social groups.
The purpose of HIA is both to prevent unintended consequences, and also to reinforce positive health outcomes of decisions, made in the spectrum of policy areas. The HIA is strongly reliant on inter-sectoral collaboration, both across various sectors, but also across policy making and practice. (Source)
Health Impact Assessment is a prospective tool, which can be used to adapt proposals prior to their implementation. It is a multi-step process (see figure below) of which the first stage is a preliminary screening of the proposed action and the immediately apparent health implications. The second stage is a scoping exercise, which brings together relevant actors and defines the exact nature of the assessment. Based on the agreed scope, an assessment is conducted, often with use of multiple data collection methods.
The results from this multifaceted assessment feed into an overall impact analysis, which outlines the impact scenarios of the initiative, and accordingly, presents policy options with positive effects on health. After launch, implementation is monitored with respect to defined indicators, which allows for precise evaluation of the impacts and outcomes. (Source)
HIA is widely used in the EU context, and has supported major policy initiatives such as the European Employment Strategy. (Source)
Schematic Representation of the European Policy Health Impact Assessment (EPHIA)
Useful Resources from Equity Action
- Learning from Equity in Health Impact Assessment (Process and Training)
- Current Health Impact Assessment Topic areas by country
- Health Impact Assessment: Pre meeting questionnaire summary Report
- A rapid review of enhancing the equity focus on policy orientated Health Impact Assessment
- Website by WHO on Health Impact Assessment (HIA)
- European Policy Health Impact Assessment (EPHIA). The Guide, ISBN 1-874038-75-9 (2004)
- Blog containing news and information on HIA, by the International Association for Impact Assessment’s Health Section
- Tools and Methodologies to Assess Integrated Care in Europe (Report by the EU Expert Group on Health Systems Performance Assessment)