Equity in decline: fair distribution in a worse-off world

How do high-level African directors of policy and planning operationalize health equity? Findings from a regional survey

This study investigates the operationalization of health equity and associated challenges faced by directors of policy and planning and those in related positions in the African Region. The results of this study demonstrate that health equity is generally a priority for policymakers in practice and is operationalized in four ways: (i) targeting priority groups, (ii) focusing on the entire population; (iii) through procedural justice; and (iv) operationalizing population health data. The targeted approach, which predominated, tended to focus on individuals with lower socioeconomic status, maternal and child health services, and select infectious diseases (e.g., HIV/AIDS). The population-wide approach entailed the inclusion of health equity in institutional laws, constitutions, and national policies with efforts to ensure access to health services for all. Procedural justice largely focused on the inclusion of stakeholders in decision-making processes. Lastly, operationalizing population health data was noted to guide policy and planning to address health inequities, often through aiding in the selection of priority groups or areas for intervention and monitoring and evaluation actions focused on improving health equity. Four main domains of challenges for incorporating health equity emerged relating to: (i) understanding health equity, (ii) governance, (iii) resources, and (iv) lack of data. Our recommendations are two-fold: (i) we recommend that researchers focus on improving understandings of health equity among policymakers through knowledge translation and exchange, and (ii) we recommend that policymakers and those working within donor organizations focus on reforming any top-down processes through which priorities are set and decisions are made.

The Limitations and Potentials of Evaluating Economic Aspects of Community-Based Health Promotion: A Critical Review

Community-based health promotion (CBHP) interventions are promising approaches to address public health problems; however, their economic evaluation presents unique challenges. This review aims to explore the opportunities and limitations of evaluating economic aspects of CBHP, focusing on the assessment of intervention costs and outcomes, and the consideration of political-level changes and health equity. A systematic search of the PubMed, Web of Science and PsycInfo databases identified 24 CBHP interventions, the majority of which targeted disadvantaged communities. Only five interventions included a detailed cost/resource assessment. Outcomes at the operational level were mainly quantitative, related to sociodemographics and environment or health status, while outcomes at the political level were often qualitative, related to public policy, capacity building or networks/collaboration. The study highlights the limitations of traditional health economic evaluation methods in capturing the complexity of CBHP interventions. It proposes the use of cost-consequence analysis (CCA) as a more comprehensive approach, offering a flexible and multifaceted assessment of costs and outcomes. However, challenges remain in the measurement and valuation of outcomes, equity considerations, intersectoral costs and attribution of effects. While CCA is a promising starting point, further research and methodological advancements are needed to refine its application and improve decision making in CBHP.