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, relative to need. An HEA advises decision-makers at all levels of governance to prioritize 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 prioritize these according to actual needs of different segments or geographic locations. (Source)
HEA is an important instrument in reducing health inequities, which is a key priority for European governments and local authorities. The HEA provides a framework for approaching this issue in a systematic way, and further, provides 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 comprise 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 a final stage the progress is monitored according to the defined targets and indicators. (Source)
The Health Equity Audit Cycle (DH, 2003b)
Documents arising from the Nutrition and Obesity Health Inequalities Audit
- 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)