Tools to measure health inequalities
The first step in addressing health inequalities is measuring them.
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.
The WHO Health Equity Assessment Toolkit (HEAT)
The Health Equity Assessment Toolkit is a software application that facilitates the assessment of within-country health inequalities. In 2021 HEAT Plus was launched, allowing for users to upload and work with their own database.
Both toolkits are organised around two main components:
- Explore inequality, which enables users to explore the situation in one setting of interest (e.g. a country, province or district) to determine the latest situation of inequality and the change in inequalities over time.
- Compare inequality, which enables users to benchmark, i.e. compare the situation in one setting of interest with the situation in other settings.
Inequalities can be assessed using disaggregated data and summary measures that are visualised in a variety of interactive graphs, maps and tables. You can exported and save the results in different formats.
Additionally a new HEAT Plus Data Repository was released. This is a repository of datasets of disaggregated data formatted for upload to HEAT Plus. The software application is part of a larger collection of WHO tools and resources that were developed to support countries in monitoring health inequalities (all accessible via the WHO Health Equity Monitor).
You can find out more in our database.
Tools to measure and improve the impact of policies and interventions
Health inequalities are caused by and linked to many factors inside as well as outside of health systems. It is important that health equity is considered in policies covering, for example labour, education, social protection, environment, and food systems.
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.
- 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),
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:
- A preliminary analysis of policies by means of a checklist;
- 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.
- A redesign of policies based on the revisions made in step 2.
Find the methodological guide (in Spanish) here.
Local action to tackle health inequalities: System, scale and sustainability
This resource (2017) has been produced to support local action to tackle health inequalities, by helping local partners to identify what specific interventions could measurably improve outcomes. It identifies different ways to think about interventions to reduce health inequalities namely:
- Intervening at different levels of risk
- intervening for impact over time
- intervening across the life course.
To have real impact, all interventions need to be at scale in order to reach large sections of the population. It was developed by Public Health England, Reducing health inequalities: system, scale and sustainability - publication Reducing health inequalities: System, scale and sustainability - slideshare
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.
Tools to measure and improve the impact of policies and interventions inside health systems
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:
- Identifying health inequalities for the eligible cohort of screening services.
- Assessing health inequalities in relation to screening services.
- Identifying actions you can take to help reduce inequalities.
The Innov8 approach for reviewing national health programmes to leave no one behind
The Innov8 approach is a resource for action on the Sustainable Development Goal (SDG) ‘leave no one behind’.
The 8-step analytic process involves a multidisciplinary team. It results in recommendations to improve health programme performance through concrete action to
- address health inequities
- support gender equality
- improve health coverage
- address critical social determinants of health.
The Innov8 technical handbook provides guidance and exercise sheets for each of the 8 steps involved.
Tools on health equity and the environment
Several tools exist to consider the interaction between health equity and the (built) environment. This include special planning and use, as well as wider considerations such as climate change.
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
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.
Place-based approaches for reducing health inequalities
This resource includes a range of information, tools and resources to support coordinated action between local government, health services and the voluntary and community sector to reduce health inequalities in England. Public Health England, the Association of Directors of Public Health, and the Local Government Association published the resource in 2019. Health inequalities: place-based approaches to reduce inequalities - GOV.UK
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.