A Methodology for Investigating and Addressing Sexual and Reproductive Health Inequities in the Sustainable Development Agenda Investigating and Addressing Sexual and Reproductive Health Inequities
Social Determinants of Health,
Vol. 6 (2020),
14 July 2020
,
Page e25
https://doi.org/10.22037/sdh.v6i1.33678
Abstract
Background: Countries are committed to the international agenda and essential to achieving sexual and reproductive health goal is their capability to integrate equity lens in structural social determinants framing of inequalities. The aim is to propose comprehensive practical methodology which can alert countries to the injustice of sexual and reproductive health inequalities and provide tool to guide evidence-based policies and actions.
Method: The methodology was founded on literature review. This was followed by consultation meetings and workshops to drive scientific output. Finally, the methodology was applied on data in five Arab countries to illustrate its relevance.
Results: There are five contributions made. First, integrating equity lens to conceptual framing of sexual and reproductive health inequalities. Second, operationalizing the framework by articulating comprehensive list of indicators, adding distribution of gender norms, and choosing two inequality measures (index of dissimilarity and concentration index redistribution need) to allow for assessment of magnitude and comparisons. Third, illustrating the responsiveness of the health system and its relative contribution as social determinant of health. Fourth, demonstrating unfairness of root social structures and of social configurations of sexual and reproductive health. Finally, using the decomposition analysis and six questions to identify entry points for actions and responsibilities.
Conclusion: the proposed methodology provides countries clear way to assess severity and fairness of health-related conditions and not specifically sexual and reproductive inequalities. It offers an ethical urgency for addressing health inequities and guidance to main stream fairness in the full package of national policies.
- Equity
- Methodology
- Inequality
- Sexual and Reproductive Health
- Sustainable Development Agenda
How to Cite
References
Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organization, 2008.
World Health Organization. Rio political declarations on social determinants of health. World Conference on Social Determinates of Health, Rio de Janeiro, Brazil, 19-21 October 2011;
United Nations. Resolution adopted by the General Assembly on 25 September 2015 70/1. Transforming our world: the 2030 Agenda for Sustainable Development http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E
Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33(5):545–557.
Asada Y. A framework for measuring health inequity. J Epidemiol Community Health. 2005;59:700–705.
Braveman P. Health disparities and health equity: concepts and measurement. Annu Rev Public Health. 2006;27: 167–194.
World Health Organization. Briefing Note: Proposed Operational Approach and Indicators to Measure Social Determinants of Health Equity. In: For Discussion at the Seventh Meeting of Commissioners; 17–19 January; Geneva, Switzerland. Department of Equity, Poverty and Social Determinants of Health. Brief Operational Indicators Version 1.5. 11.
Spinakis A, Anastasiou G, Panousis V, Spiliopoulos K, Palaiologou S, Yfantopoulos J. Expert Review and Proposals for Measurement of Health Inequalities in the European Union—Summary Report. Luxembourg: European Commission Directorate General for Health and Consumers; 2011. ISBN 978-92-79-18529-8.
Ahmad Reza Hosseinpoor, Nicole Bergen, Aluisio J. D. Barros, Kerry L. M. Wong, Ties Boerma1 and Cesar G. Victora. Monitoring subnational regional inequalities in health: measurement approaches and challenges. International Journal for Equity in Health (2016) 15:18. Available at https://equityhealthj.biomedcentral.com/track/pdf/10.1186/s12939-016-0307-y.
World Health Organization Handbook on Health Inequality Monitoring With a Special Focus on Low- and MiddleIncome Countries. Geneva, Switzerland: World Health Organization, 2013.
World Health Organization. Briefing Note: Proposed Operational Approach and Indicators to Measure Social Determinants of Health Equity. In: For Discussion at the Seventh Meeting of Commissioners; 17–19 January; Geneva, Switzerland. Department of Equity, Poverty and Social Determinants of Health. Brief Operational Indicators Version 1.5.
O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation. Washington, DC: World Bank, 2008. 12.
Pampalon R, Hamel D, Gamache P. A comparison of individual and area-based socio-economic data for monitoring social inequalities in health. Health Rep. 2009;20(4):85–94. 13.
Ontario Agency for Health Protection and Promotion (Public Health Ontario) Summary Measures of Socioeconomic Inequalities in Health. Toronto, ON: Queen’s Printer for Ontario, 2013.
Spinakis A, Anastasiou G, Panousis V, Spiliopoulos K, Palaiologou S, Yfantopoulos J. Expert Review and Proposals for Measurement of Health Inequalities in the European Union—Summary Report. Luxembourg: European Commission Directorate General for Health and Consumers; 2011. ISBN 978-92-79-18529-8.
Chee G, Pielemeier N, Lion A, Connor C. Why differentiating between health system support and health system strengthening is needed. Int J Health Plann Mgmt. 2013;28: 85–94.
Koolman X, van Doorslaer E. On the interpretation of a concentration index of inequality. Health Econ. 2004;13: 649–656.
Shawky S. Measuring Geographic and Wealth Inequalities in Health Distribution as Tools for Identifying Priority Health Inequalities and the Underprivileged Populations. Global Advances in Health and Medicine 2018; Volume 7: 1–10.
Wagstaff A, van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econom 2003;112:207–23.
Ahmad Reza Hosseinpoor, Eddy Van Doorslaer, Niko Speybroeck, Mohsen Naghavi, Kazem Mohammad, Reza Majdzadeh, Bahram Delavar, Hamidreza Jamshidi and Jeanette Vega. Decomposing socioeconomic inequality in infant mortality in Egypt. International Journal of Epidemiology 2006;35:1211–1219 doi:10.1093/ije/dyl16.
World Bank. Analyzing Health Equity Using Household Survey Data A Guide to Techniques and Their Implementation. Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff, Magnus Lindelow, 2008
Douglas C Dover and Ana Paula Belon. The health equity measurement framework: a comprehensive model to measure social inequities in health. International Journal for Equity in Health 18:36. Available at https://doi.org/10.1186/s12939-019-0935-0.
Shawky S, Rashad H, Khadr Z. Reproductive Health Inequalities in Egypt: Evidence for Guiding Policies; The Social Research Center/The American University in Cairo, the United Nations Population Fund / Arab States Regional Office; 2019. https://documents.aucegypt.edu/Docs/src/Reproductive%20Health%20Inequalities%20in%20Egypt.pdf
Rashad, H., S. Shawky, and Z. Khadr (2019) “Reproductive Health Equity in the Arab Region: Fairness and Social Success” Regional Study; The Social Research Center, The American University in Cairo, UNFPA/ASRO. https://documents.aucegypt.edu/Docs/src/Reproductive-Health-%20Equity-in-the-Arab-Region.pdf
Ansari Z, Carson NJ, Ackland MJ, Vaughan L, Serraglio A. A public health model of the social determinants of health. Soz Praventivmed. 2003;48(4): 242–51. Available from:. https://doi.org/10.1007/s00038-003-2052-4.
Dahlgren G. Whitehead M. Policies and Strategies to Promote Social Equit in Health. Stockholm, Sweden: Institute for Futures Studies; 1991.
Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organization, 2008.
Oakes JM, Rossi PH. The measurement of SES in health research: current practice and steps toward a new approach. Soc Sci Med. 2003;56(4):769–84.
Diderichsen F, Evans T, Whitehead M. The social basis of disparities in health. In: Evans T, editor. Challenging inequities in health: from ethics to action. New York: Oxford University Press; 2001. p. 12–23
World Health Organization. 2009. Monitoring and Evaluation of Health Systems Strengthening: An Operational Framework. Paper prepared by WHO (Ties
Boerma and Carla Abou‐Zahr), World Bank (Ed Bos), GAVI (Peter Hansen) and Global Fund (Eddie Addai and Daniel Low‐Beer) as part of the joint work on health systems strengthening and IHP+ common evaluation framework.
Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva, Switzerland: World Health Organization; 2010
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