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Review
. 2022 Mar 20;19(6):3697.
doi: 10.3390/ijerph19063697.

Summary Measures of Health Inequality: A Review of Existing Measures and Their Application

Anne Schlotheuber  1 , Ahmad Reza Hosseinpoor  1
Affiliations
Review

Summary Measures of Health Inequality: A Review of Existing Measures and Their Application

Anne Schlotheuber et al. Int J Environ Res Public Health. .

Erratum in

Abstract

Measuring and monitoring health inequalities is key to achieving health equity. While disaggregated data are commonly used to assess differences in health between different population subgroups, summary measures of health inequality also play a vital role in monitoring health inequalities. Building on disaggregated data, they quantify the level of inequality in a single number and are useful to compare inequality over time and across different health indicators, programmes and settings. We provide a comprehensive overview of existing summary measures of health inequality, including their definition, calculation, interpretation and application. The use of these measures is illustrated based on an example from the WHO's Health Equity Monitor database using the WHO's Health Equity Assessment Toolkit (HEAT) software. We discuss the strengths and limitations of different measures and provide guidance for selecting suitable summary measures for analysing health inequalities and communicating results. Summary measures of health inequality should form an integral part of health inequality monitoring to inform equity-oriented policies and programmes.

Keywords: health equity; health inequality; measurement; monitoring; summary measures.

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Conflict of interest statement

The authors declare no conflict of interest. The authors are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the World Health Organization.

Figures

Figure 1
Figure 1
Overview of summary measures of health inequality.
Figure 2
Figure 2
Three reproductive, maternal and child health indicators disaggregated by economic status: Indonesia (DHS: 1997, 2007 and 2017). Note: Circles indicate wealth quintiles. The horizontal lines indicate the difference between the most extreme wealth quintile values. Data source: WHO Health Equity Monitor database (2021 update).
Figure 3
Figure 3
Absolute economic-related inequality in three reproductive, maternal and child health indicators: Indonesia (DHS: 1997, 2007 and 2017). Note: Vertical lines around point estimates indicate 95% confidence intervals. Data source: Summary measures calculated using the WHO Health Equity Assessment Toolkit (HEAT), based on disaggregated data from the WHO Health Equity Monitor database (2021 update).
Figure 4
Figure 4
Three reproductive, maternal and child health indicators disaggregated by subnational region: Indonesia (DHS 2017). Note: Circles indicate subnational regions. The horizontal lines indicate the difference between the most extreme subnational regional values. Data source: WHO Health Equity Monitor database (2021 update).
Figure 5
Figure 5
National average and absolute economic-related inequality in births attended by skilled health personnel in 16 countries from the WHO South-East Asia and Western Pacific regions (DHS and MICS, 2015–2019). Note: Countries shown as ISO 3 country codes. Data source: Summary measures calculated using the WHO Health Equity Assessment Toolkit (HEAT), based on disaggregated data from the WHO Health Equity Monitor database (2021 update).
Figure 6
Figure 6
Decision tree for selecting appropriate summary measures of health inequality.
See this image and copyright information in PMC

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