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Logo of jepicomhInstructions for authorsCurrent TOCJournal of Epidemiology and Community Health
J Epidemiol Community Health. Apr 2003; 57(4): 254–258.
PMCID: PMC1732430

Defining equity in health


Study objective: To propose a definition of health equity to guide operationalisation and measurement, and to discuss the practical importance of clarity in defining this concept.

Design: Conceptual discussion.

Setting, Patients/Participants, and Main results: not applicable.

Conclusions: For the purposes of measurement and operationalisation, equity in health is the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage—that is, wealth, power, or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage. Equity is an ethical principle; it also is consonant with and closely related to human rights principles. The proposed definition of equity supports operationalisation of the right to the highest attainable standard of health as indicated by the health status of the most socially advantaged group. Assessing health equity requires comparing health and its social determinants between more and less advantaged social groups. These comparisons are essential to assess whether national and international policies are leading toward or away from greater social justice in health.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429–445. [PubMed]
  • Anand S. The concern for equity in health. J Epidemiol Community Health. 2002 Jul;56(7):485–487. [PMC free article] [PubMed]
  • Culyer AJ. The promise of a reformed NHS: an economist's angle. BMJ. 1991 May 25;302(6787):1253–1256. [PMC free article] [PubMed]
  • Culyer AJ, Wagstaff A. Equity and equality in health and health care. J Health Econ. 1993 Dec;12(4):431–457. [PubMed]
  • Wagstaff A, van Doorslaer E, Paci P. On the measurement of horizontal inequity in the delivery of health care. J Health Econ. 1991 Jul;10(2):169–256. [PubMed]
  • Wagstaff A, van Doorslaer E, Calonge S, Christiansen T, Gerfin M, Gottschalk P, Janssen R, Lachaud C, Leu RE, Nolan B, et al. Equity in the finance of health care: some international comparisons. J Health Econ. 1992 Dec;11(4):361–387. [PubMed]
  • Chang W-C. The meaning and goals of equity in health. J Epidemiol Community Health. 2002 Jul;56(7):488–491. [PMC free article] [PubMed]
  • Braveman Paula, Tarimo Eleuther. Social inequalities in health within countries: not only an issue for affluent nations. Soc Sci Med. 2002 Jun;54(11):1621–1635. [PubMed]
  • Kaplan GA, Pamuk ER, Lynch JW, Cohen RD, Balfour JL. Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ. 1996 Apr 20;312(7037):999–1003. [PMC free article] [PubMed]
  • Kunst AE, Groenhof F, Mackenbach JP, Health EW. Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies. EU Working Group on Socioeconomic Inequalities in Health. BMJ. 1998 May 30;316(7145):1636–1642. [PMC free article] [PubMed]
  • Leon DA, Chenet L, Shkolnikov VM, Zakharov S, Shapiro J, Rakhmanova G, Vassin S, McKee M. Huge variation in Russian mortality rates 1984-94: artefact, alcohol, or what? Lancet. 1997 Aug 9;350(9075):383–388. [PubMed]
  • Macintyre S. The Black Report and beyond: what are the issues? Soc Sci Med. 1997 Mar;44(6):723–745. [PubMed]
  • Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ. Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet. 1997 Jun 7;349(9066):1655–1659. [PubMed]
  • Marmot M, Ryff CD, Bumpass LL, Shipley M, Marks NF. Social inequalities in health: next questions and converging evidence. Soc Sci Med. 1997 Mar;44(6):901–910. [PubMed]
  • Standing H. Gender and equity in health sector reform programmes: a review. Health Policy Plan. 1997 Mar;12(1):1–18. [PubMed]
  • Murray CJ, Gakidou EE, Frenk J. Health inequalities and social group differences: what should we measure? Bull World Health Organ. 1999;77(7):537–543. [PMC free article] [PubMed]
  • Gakidou EE, Murray CJ, Frenk J. Defining and measuring health inequality: an approach based on the distribution of health expectancy. Bull World Health Organ. 2000;78(1):42–54. [PMC free article] [PubMed]
  • Braveman P, Krieger N, Lynch J. Health inequalities and social inequalities in health. Bull World Health Organ. 2000;78(2):232–235. [PMC free article] [PubMed]
  • Braveman P, Starfield B, Geiger HJ. World Health Report 2000: how it removes equity from the agenda for public health monitoring and policy. BMJ. 2001 Sep 22;323(7314):678–681. [PMC free article] [PubMed]
  • Almeida C, Braveman P, Gold MR, Szwarcwald CL, Ribeiro JM, Miglionico A, Millar JS, Porto S, Costa NR, Rubio VO, et al. Methodological concerns and recommendations on policy consequences of the World Health Report 2000. Lancet. 2001 May 26;357(9269):1692–1697. [PubMed]
  • Krieger N. A glossary for social epidemiology. J Epidemiol Community Health. 2001 Oct;55(10):693–700. [PMC free article] [PubMed]
  • Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991 Jun 8;337(8754):1387–1393. [PubMed]
  • Wilkinson RG. Socioeconomic determinants of health. Health inequalities: relative or absolute material standards? BMJ. 1997 Feb 22;314(7080):591–595. [PMC free article] [PubMed]
  • Starfield B. Improving equity in health: a research agenda. Int J Health Serv. 2001;31(3):545–566. [PubMed]
  • Oliver Adam, Healey Andrew, Le Grand Julian. Addressing health inequalities. Lancet. 2002 Aug 17;360(9332):565–567. [PubMed]
  • Ngwena C. The recognition of access to health care as a human right in South Africa: is it enough? Health Hum Rights. 2000;5(1):26–44. [PubMed]
  • Leary Virginia A. The right to health in international human rights law. Health Hum Rights. 1994 Fall;1(1):24–56. [PubMed]
  • Torres Mary Ann. The human right to health, national courts, and access to HIV/AIDS treatment: a case study from Venezuela. Chic J Int Law. 2002 Spring;3(1):105–114. [PubMed]
  • Giesen D. A right to health care?: A comparative perspective. Health Matrix Clevel. 1994 Summer;4(2):277–295. [PubMed]
  • Alleyne GA, Casas JA, Castillo-Salgado C. Equality, equity: why bother? Bull World Health Organ. 2000;78(1):76–77. [PMC free article] [PubMed]
  • Mackenbach JP, Kunst AE. Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997 Mar;44(6):757–771. [PubMed]
  • Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33(5):545–557. [PubMed]

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