Handbook on Health Inequality Monitoring

Health inequality monitoring is the process by which health inequities (unfair and unjust differences in health between subgroups of the population) are repeatedly observed with the aim of evaluating policies, programmes and practices, and of informing decisions about changes to existing policy and/or the development of new initiatives. Such monitoring is essential if countries are to make progress in tackling health inequality. Health Inequality Monitoring With a Special Focus on Low- and Middle-income Countries is a handbook produced by the World Health Organization (WHO) with the primary aim of enabling countries to better monitor and evaluate their progress towards reducing health inequalities. Its primary intended readership is technical staff working within ministries of health, but the authors also suggest it may be of interest to public health professionals, researchers, students and others. The handbook will be an essential resource for those involved in the monitoring of health inequalities (or of health more generally), but there is also much of interest in this handbook for health researchers in general, particularly (though not exclusively) early-career researchers with an interest in the social determinants of health. The handbook begins by explaining the continuous cycle of health monitoring, which can be broken down into five steps: (i) identify the relevant health indicators; (ii) obtain data about the indicators; (iii) analyse the data; (iv) report the results; and (v) implement changes when warranted. It then progresses to give detailed consideration to each step in the process, through five chapters. Chapter 1 gives an overview of health inequality monitoring, describing the process, what is involved, why it is necessary and how it can lead to change. Chapter 2 goes on to describe potential data sources, including both population- and institution-based data sources, as well as strengths and limitations of the various data sources and a discussion of the process of identifying potential data sources and of overcoming a lack of data. Chapter 3 discusses the measurement of health inequality, including comment on the different groups who may suffer from inequitable health and how membership of these groups may be measured, as well as both simple and more complex methods for quantifying the degree of inequality. Chapter 4 focuses on the reporting of health inequality, and considers various practical issues such as data presentation methods for various types of data and audience. In chapter 5, a step-by-step example of health inequality assessment is provided, using data on reproductive, maternal and child health in the Philippines as an illustrative example. The use of real-life examples throughout the handbook is a real strength, as it brings what could otherwise be a fairly technical subject to life, providing motivation to the reader as well as helping to clarify the material. Another key strength in the handbook is the provision of additional information within boxes alongside the main text. ‘Tips’ boxes provide short explanations of how to apply concepts in practice; ‘Extra Information’ boxes expand on key points of the main text; ‘Highlights’ boxes summarixz topics; and ‘Read More’ boxes list key references for further reading. These lists of key references are likely to be particularly useful for early-career researchers, since the authors have identified various publications that detail the essential concepts and methods within the field of social determinants of health, many of which are ‘must-reads’ for any social epidemiologist. Much of the technical material provided in the handbook will also be extremely useful for social epidemiologists and other health researchers, particularly those relatively early in their training. For example, the authors give a detailed discussion of various methods that can be used to quantify health inequalities, comparing relative and absolute measures, and describing both simple methods (e.g. differences or ratios between extreme groups) and complex measures (e.g. the slope index of inequality and the concentration index). These technical descriptions are clear and simple and are supported by illustrative examples and pointers for further reading. The text would serve as a good introduction for PhD students and other early-career researchers, or indeed for experienced epidemiologists new to the field of health inequalities. Some of these concepts, e.g. presenting relative or absolute measures of association, have a far broader relevance beyond their use in research on the social determinants of health, and as such early-career researchers in any health discipline may find the material of interest. Some of the material in the ‘Reporting health inequalities’ chapter would also be of interest to all epidemiologists at an early stage of their training, since it provides helpful guidance on many issues to do with data presentation, for example choice of reference group. In summary, this handbook offers a detailed and step-by-step manual for the process of health inequality monitoring. In addition to successfully fulfilling its primary aim of enabling staff in ministries of health to become familiar with the process of monitoring and better able to carry out monitoring activities and interpret the literature in this area, much of the technical material provided in the handbook would serve as a good introductory text to inequalities research for early-career researchers or for those new to the subject area.