Tools to Measure and Address Health Inequalities

Data and indicators

Data sets on health and health equity indicators can be found in the health inequalities database. They include

• EuroStat, the statistical office of the European Union
• The Global Burden of Disease Study, a tool to quantify health loss from hundreds of diseases, injuries, and risk factors
• The State of Health in the EU process, which aims to make health system information, expertise and best practices easily accessible to policymakers and everyone who helps to shape health policies.
• The WHO Health Equity Monitor, which provides evidence on existing health inequalities and makes available tools and resources for health inequality monitoring.
• The EIGE Gender Statistics Database from the European Institute for Gender Equality covers health, work and labour conditions, education, and living conditions.
• The OECD iLibrary, which offers books, papers and statistics on topics ranging from economic projections to health, employment and social protection
• The Institute of Health Equity has developed indicators for health equity from the UK that other countries can learn from.
• National statistics offices
• The WHO EURO Health Equity Dataset contains disaggregated indicators of health, 5 essential conditions needed for a healthy life, and policy performance. It accompanies the WHO European Health Equity Status Report.

A quick overview of the situation can also be found in our health equity map of Europe.

Health Impact Assessments

Health Impact Assessments (HIAs) are practical tools to evaluate the impact policies, strategies and initiatives from outside the health sector (e.g., transportation, employment and environment) have on health. The goal of HIA is to inform decision-makers of adverse health effects of proposed actions, and support identification of appropriate policy options

HIAs should look at the impact of policy first and then look at the distribution of that impact on different groups. However, equity is not at present consistently covered within HIAs.

Useful resources:

• All public bodies in Scotland have a legal responsibility to assess the impact of their policies. This Tool on Health Inequality Impact Assessments from Public Health Scotland contains a workbook to help public officials screen whether policies will have a potential impact on people, and require a full HIIA, and how to conduct a HIIA workshop if they do.
• WHO/Europe | Social determinants - Health impact assessment tool
• From the EU Joint Action on Health Inequalities (Equity Action, 2010 -2013),
  • Learning from Equity in Health Impact Assessment (Process and Training)
  • A rapid review of enhancing the equity focus on policy orientated Health Impact Assessment
  • Health Impact Assessment: Pre meeting questionnaire summary Report

Modelling Inventory and Knowledge Management System

Models are stylized representations of the real world used to assess the behaviour of a system under specific (policy) assumptions. They can provide support to policy makers throughout the policy cycle and across a wide range of policy areas. MIDAS, the Modelling Inventory and Knowledge Management System of the European Commission, documents the models it has used to determine baseline scenario(s) and assess the environmental, economic and social impacts of proposed policy options.

Health Equity in All Policies (HiAP)

Health Equity in All Policies (HiAP) is a policy strategy which targets the key social determinants of health through integrated policy response across relevant policy areas with the ultimate goal of supporting health equity.

Health Equity Audits

Health Inequalities Audits are a combination of procedures, methods and tools. You can use them to judge the effects of policies and policy implimentation on the health of the population, and the distribution of those effects within the population. EU Joint Action on Health Inequalities (2010-2013) example audits

Applying an equity lens to all policies that affect health

The Spanish Ministry of Health has produced a methodological guide to help decision makers integrate a health equity perspective in strategies, programs and activities. The practical tool aims to sensitise professionals from the health and other sectors to the impact their policies might have on health inequalities and determinants of health. The guide is part of the wider Spanish Strategy for Health Equity, in particular its goal to promote and develop awareness and tools for health equity in all policy areas. An additional document aims to facilitate the use of the guide on the local level.

The guide sets out the following three phases:

1. 1. 1. A preliminary analysis of policies by means of a checklist;
      2. A cycle of revisions, facilitated through five steps. This cycle helps evaluate
         • whether the strategy, program or activity works,
         • whether certain groups are left out,
         • what barriers groups experience
         • how the policy interacts with the determinants of health
         • how the policy should be redesigned.
      3. A redesign of policies based on the revisions made in step 2.

Find the methodological guide (in Spanish) here and (in English) here.

In 2022, an updated version of the checklist was published both in Spanish and English, that forms part of the first phase of the process mentioned above. The checklist has been updated to create a tool which, in itself, makes it possible to carry out an analysis focusing on equity and the Social Determinants of Health, and to define proposals for improvement.

Understanding the impact of individual behaviours, public services, programmes and policies are having on health and well-being in Wales

This includes the interactive Public Health Outcomes Framework reporting tool (2019) to help understand the impact individual behaviours, public services, programmes and policies are having on health and well-being in Wales. It also includes reviews and summaries on e.g., Relationships between housing and its surroundings and health, wellbeing and equity, as well as a broad range of other information like links to other websites and key data and key evidence sources. The Public Health Wales Observatory developed the tool.

Address health inequalities and equity in health work programmes, services or business planning cycles

The Health Equity Assessment Tool (HEAT) from Public Health England is a framework consisting of a series of questions and prompts, designed to support professionals across the public health system and wider health economy systematically address health inequalities and equity in their work programmes, services or business planning cycles. The Tool has 4 clear stages: Prepare; Assess; Refine and Apply; Review. It provides an easy-to-follow template which can be applied flexibly to suit different work programmes.

Equity in screening programmes

This toolkit provides guidance for public health professionals, screening providers and commissioners. It includes a series of questions to help develop an audit protocol that addresses 3 areas:

1. Identifying health inequalities for the eligible cohort of screening services.
2. Assessing health inequalities in relation to screening services.
3. Identifying actions you can take to help reduce inequalities.

Place standard tool

The Place Standard tool provides a simple framework to structure conversations about place. It allows you to think about the physical elements of a place (for example its buildings, spaces, and transport links) as well as the social aspects (for example whether people feel they have a say in decision making). The tool provides prompts for discussions, allowing you to consider all the elements of a place in a methodical way. The tool pinpoints the assets of a place as well as areas where a place could improve. Read about talking “place” – a public health conversation for everyone?

WHO Healthy City Network

The WHO Healthy City Network’s compendium of tools, resources and networks on place (2020) is a support package for implementation (2020) It brings together a wide range of resources that can be applied to achieve local-level sustainable and equitable urban development, through whole-of-city and whole-of-society

Conceptual model and policy toolkit that links health, health equity, and the environment

INHERIT Policy Toolkit

This resource includes the INHERIT Conceptual Model, as well as information, recommendations and case studies from across Europe on how to implement policies and interventions that simultaneously contribute to restoring the environment and improving health and equity.

Public Health Scotland's tools, database and publications

The Public Health Scotland Website includes a wide range of Tools and Resources on Health Inequalities, including Tools for monitoring and evaluation, information on Health Inequalities Impact Assessments, and an extensive Database of Publications.

The NHS Scotland Knowledge Network also has an extensive database of relevant books, journals and articles on health inequalities.

Practical guide on making the case for sustainable investment

How to Make the Case for Sustainable Investment in Well-being and Health Equity: A Practical Guide outlines the step-by-step process of how to synthesize, translate and communicate public health and health economics evidence into policy and practice, making the case for sustainable investment in well-being and health equity. Public Health Wales and the WHO Collaborating Centre on Investment for Health and Well-being developed the guide.

Designing public health policies and programmes

Participation tools for health – This free course by Udemy provides instruction on how to design public health policies and programmes from a participatory logic, to integrate the voices and demands of those who are recipients of the actions to undertake.