Abstract
The World Health Organization defines social determinants of health as “complex, integrated, and overlapping social structures and economic systems” that are responsible for most health inequities. Similar to the individual-level risk factors such as behavioral and biological risk factors that influence disease, we consider social determinants of health such as the distribution of income, wealth, influence and power as risk factors for risk of disease. We operationally define health inequity in a disease within a population due to a risk factor that is unfair and avoidable as the difference between the disease outcome with and without the risk factor in the population. We derive expressions for difference in health inequity between two populations due to a risk factor that is unfair and avoidable for a given disease. The difference in heath inequity between two population groups due to a risk factor increases with increasing difference in relative risks and the difference in prevalence of the risk factor in the two populations. The difference in health inequity could be larger than the difference in health outcomes between the two populations in some situations. Compared to health disparities which are typically measured and monitored using absolute or relative disparities of health outcomes, the methods presented in this manuscript provide a different, yet complementary, picture because they parse out the contributions of unfair and avoidable risk factors.
Highlights
One of the overarching goals of the Healthy People 2020 (HP2020) Initiative in the U.S is “achieving health equity, eliminating disparities and improving the health of all groups” [1]
Some have proposed that health disparities are a good metric for health equity [5] since their widespread presence indicates a state of inequity. (Definitions of health disparities differ, with, for example, HP2020 defining a health disparity as “a particular type of health difference that is closely linked with social economic, and/or environmental disadvantage” [6] and others defining health disparities as “differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes” [7].)
DHI increases with increasing prevalence of RF in the second population and with increasing relative risks for all the prevalence of disease considered for the two populations
Summary
One of the overarching goals of the Healthy People 2020 (HP2020) Initiative in the U.S is “achieving health equity, eliminating disparities and improving the health of all groups” [1]. 1990’s, Whitehead articulated the goal of health equity, which is not to eliminate all health differences, but to “reduce or eliminate those which result from factors which are considered to be both avoidable and unfair” [2]. There is no one standard definition for health equity in the literature [4]. For this and other reasons, measurement of health equity is a challenging prospect—one that some consider untenable. Some have proposed that health disparities are a good metric for health equity [5] since their widespread presence indicates a state of inequity. (Definitions of health disparities differ, with, for example, HP2020 defining a health disparity as “a particular type of health difference that is closely linked with social economic, and/or environmental disadvantage” [6] and others defining health disparities as “differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes” [7].)
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