Health Equity Audit

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Health Equity Audit

• Habib Naqvi
• Public Health Analyst
• Bristol Directorate for Public Health

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Overview

• Tackling inequity of inputs to achieve equality
  of outcomes
• Important contribution to reducing health
  inequalities
• Matching need with distribution or resources or
  services

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Why do health equity audit?

1. Requirement for all NHS planning
2. Provide commissioning information to meet needs
   of groups currently underserved
3. Identify where new forms of integrated services
   are needed across agencies
4. Provide robust performance evidence on extent to
   which need is being met
5. Inform local inequality targets
6. Inform LDP and support LSPs
7. Provide a common framework for all agencies to
   audit their contributions to reducing health
   inequalities
8. Information for public and voluntary sectors
   about gaps and inequities in service provision

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Remind me again, what is the difference between
health inequality and health equity?

• Both are concerned with distribution of health
  and health care
• Health inequality
• Differences in health experience or outcome
  between population groups Dimensions ,
  geography, age, sex, ethnicity, socioeconomic
  status
• Health equity
• Fair distribution of health or health care
  resources or opportunities according to
  population need
• Equal share of resource for equal need

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Types of health inequality
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Remind me again, what is the difference between
an equity profile and a health equity audit?

• Equity profile
• Descriptive
• Technical
• Starting point for equity audit
• Equity audit
• Process
• Iterative
• Linked into planning cycles

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The health equity audit cycle

• Health equity audit stages
• Where to start agree priorities and partners
• Equity profile collect, collate and analyse
  data
• Use evidence to identify effective local action
• Set targets/decisions
• Influence changes in investment and service
  delivery
• Monitor and review

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Where do I start? Priorities and topics
1

• Possible examples
• national targets
• local health inequality assessments or use of
  local health inequality indicators
• local knowledge of service variations
• examples from elsewhere/literature/research (e.g.
  in DPH annual report)
• local priorities identified in the LDP

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Where do I start? Partners
1

• Will depend on choice of topic/local priorities
• Topics may emerge from existing partnerships

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Equity profiling
2

• Process of collating and analysing data and
  evidence on need and health inequalities
• Confirm inequity exists
• Usually wont require new data collection
  often use existing sources or local data.

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Examples of data that can be used in equity
profiling
2

• Vital statistics births and deaths e.g. from
  Compendium, Mortality files, ONS
• To show variations in life expectancy, mortality,
  IMR, birth weight by area, sex, cause, social
  class
• Proxy need measures
• Morbidity data e.g. from HES, registers, primary
  care
• To show variations in prevalence or utilisation
  by area, sex, age, deprivationethnicity???
• Needs assessment
• Local authority and ward data e.g. neighbourhood
  stats
• Socioeconomic profiles/ broad determinants
• Service utilisation
• Activity data/access to services
• Coverage data e.g. screening, immunisation
• Resource allocation

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Evidence to identify effective local action
3

• Tackling health inequalities framework
• Strengthen individuals and vulnerable groups in
  disadvantaged circumstances
• Improve provision of and access to essential
  services and facilities
• Need to understand causal pathways how do we
  think inequity has arisen
• What local interventions might help?
• What evidence is there of effective action?
• What is feasible and affordable?

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Agree local targets
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• Direction (e.g. narrow gap) and destination (e.g.
  by how much and by when)
• Equity targets focus on the gap between what is
  provided and what is needed

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Targets - direction
4

• Improve life expectancy in areas with low life
  expectancy compared to national average
• Reduce infant mortality in deprived areas or
  groups
• Reduce smoking, esp. in disadvantaged groups
• Increase proportion of teenage mothers continuing
  in education/ unemployment
• Reduce higher incidence of childhood accidents in
  deprived areas (wards)
• Narrow the gap in educational attainment across
  social groups, including attainment in schools
  serving deprived areas

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Influence changes in investment and service
delivery
5

• PCT and Public Health performance (smoking
  cessation)
• New or redeveloping services e.g. South Asian
  Diabetes Facilitators, Health Trainers
• Partnership working e.g. with development
  agencies/ neighbourhood renewal etc tackling
  determinants

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Review progress and monitor
6

• Vital to close the loop
• Need indicators to support

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HEA database

• Examples of current/competed work that partially
  or completely reflect a HEA
• South Asian and access to CHD services
• Sexual health services and young BME people
• Drug related deaths in Avon

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Conclusions
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• A welcome must do
• Old wine in new bottles
• The data is there
• Linked into mainstream
• Part of everyday work