A new Inequity-in-Health Index based on Millennium Development Goals: methodology and validation

Population indices measuring health outcomes: A scoping review

Background

Population health indices such as disability adjusted life years (DALY) and quality adjusted life years (QALY) are often used in an effort to measure health of populations and identify areas of concern that require interventions. There has been an increase of number of population health indices since the last review published more than a decade ago. Therefore, this study aims to provide an overview of existing population health indices and examine the methods used to develop them.

Methods

The search was conducted across three databases: PubMed, CINAHL and Emerald using four key concepts: ‘health’, ‘index’, ‘context’, ‘develop’, which was supplemented with Google searching and reference scanning. A researcher screened the titles, abstracts and subsequently full texts and confirmed the findings with the research team at each stage. Data charting was performed according to the included publications and identified indices. The collation was performed by describing the indices and made observation on its development method using a priori framework consist of four processes: underpinning theory, model or framework; data selection and processing; formation of index; testing of index.

Results

Twenty-six publications describing population health indices were included, and 27 indices were identified. These indices covered the following health topics: overall health outcomes (n = 15), outcomes for specific health topics (n = 4), diseases outcome (n = 6), assist health resource allocation for priority minority subgroup or geographic area (n = 4), quality of health or health care (n = 2). Twenty-one indices measure health for general populations while six measure defined subpopulations. Fourteen of the indices reported at least one of the development processes according to the a priori framework: underpinning theory, model or framework (n = 7); data selection and processing (n = 8); formation of index (n = 12); testing of index (n = 9).

Conclusions

Few population health indices measure specific health topics or health of specific sub-population. There is also a lack of usage of theories, models or framework in developing these indices. Efforts to develop a guideline is proposed on how population health indices can be developed systematically and rigorously to ensure validity and comprehensive assessment of the indices.

[Incorporating health equity into implementation research: review of conceptual modelsIncorporação da igualdade em saúde na pesquisa de implementação: revisão de modelos conceituais]

OBJECTIVE

Search for conceptual frameworks or models that incorporate aspects of health equity into implementation research and prepare a systematic synthesis of them.

METHODS

A systematic search was done of MEDLINE-PubMed, Embase, and LILACS (1965-2016), and Scopus (1998-2016) databases, employing, in addition, a snowball strategy and gray literature search. Article type was assessed, along with elements that were included on implementation research, the science of implementation, and health equity.

RESULTS

A total of 701 articles were found, of which 100 were included for review of relevance. Of these, 19 articles related to conceptual frameworks: 12 were general, five were on ethnic or racial disparities, and two related to child health. The most frequent categories were financing, infrastructure, advocacy, quality, internal barriers, and coverage. The least frequent were other sectors, outpatient needs, health status, and equity impact assessment.

CONCLUSIONS

In order to reduce health gaps and with them health inequities, it becomes necessary to have a consolidated implementation research framework that includes aspects of health equity. This framework would facilitate improving implementation processes for interventions, services, and health programs.

Millennium Development Goals: how public health professionals perceive the achievement of MDGs

BACKGROUND

There have been various consultations on the Millennium Development Goals (MDGs) by different groups. However, even if it is clear that the health sector has led the development success of the MDGs, only a few MDG reports consider public health experts' points of view and these are mainly government driven.

DESIGNS

The World Federation of Public Health Associations (WFPHA) has executed a global survey to consult public health professionals worldwide concerning the implementation and achievements of the MDGs. The survey was conceived by WFPHA health professionals and promulgated online. Public health professionals and organisations dealing with MDGs responded to the survey. Content analysis was conducted to analyse the data.

RESULTS

Survey participants attributed the highest importance worldwide to MDGs dealing with women, poverty and hunger reduction, and disease prevention and management. Moreover, they underlined the role of education, referring both to school children and professionals. In high and upper-middle income countries, environmental challenges also received considerable attention. Notably, respondents underlined that weak governance and unstable political situations, as well as the gap between professionals and politicians, were among the main causes that detracted from MDG achievements.

CONCLUSION

The public health workforce felt it would be imperative to be included from the outset in the design and implementation of further goals. This implies that those professionals have to take an active part in the political process leading to a new and accountable framework.

[Inequities in health among Latin American and Caribbean countries (2005-2010)]

OBJECTIVE

To identify health inequalities among Latin American and Caribbean countries in recent years (2005-2010), based on the view that measurement of inequalities is the first step in identifying health inequities.

METHOD

We performed an ecological study, whose units of analysis were 20 Latin American and Caribbean countries. These units were used to build the Inequalities in Health Index. This index summarizes, in a value ranging from 0 to 1, a set of socio-economic and health indicators, developed by international organizations. These indicators are considered as proximal and contextual determinants of health.

RESULTS

According to the index calculated, the five countries with the worst health status were Haiti, Guatemala, Bolivia, Venezuela and Honduras. In contrast, the five countries with the most favorable health status were Cuba, Argentina, Uruguay, Chile and Mexico.

CONCLUSION

Even today, there are wide health inequalities in Latin America and the Caribbean. The country with the most favorable health indicators was Cuba and that with the least favorable was Haiti. We recommend systematic evaluation of health inequalities in Latin America and the Caribbean through the Inequalities in Health Index and other indices, in order to analyze actions, policies and programs to reduce inequities in this region.