In line with the World Well being Group, “Three distinguishing options, when mixed, flip mere variations or variations in well being right into a social inequity in well being. They’re systematic, socially produced (and due to this fact modifiable) and unfair.
That’s how an ISPOR Particular Curiosity Group Report by Griffiths et al. (2025) begins. The well being fairness primer supplies and overview of the literature. The paper identifies plenty of key sources of social drawback: “socioeconomic standing, race and ethnicity, gender, geographic location, incapacity” amongst others.
Whereas decreasing well being disparities is a laudable aim, there are a selection of different priorities that additionally go into the social welfare perform together with “…concern for effectivity in growing whole well being, concern to prioritize severely in poor health sufferers, and concern for guaranteeing applicable procedures of determination making.” For example, ought to well being advantages be valued equally or ought to we worth well being advantages that accrue to extra deprived or extra severely in poor health sufferers extra. Who’s well being advantages ought to we worth extra: poor sufferers who’ve delicate illness or wealthy sufferers who’ve extreme illness? The solutions to those questions aren’t easy. Because the paper notes:
…measuring and addressing well being disparities is difficult given the interaction amongst many advanced elements that form well being outcomes and can provide rise to various moral issues
The paper identifies totally different dimensions by means of which contemplating well being fairness issues may very well be helpful.
The paper additionally supplies examples of functions of distributional price effectiveness evaluation (DCEA) and prolonged price effectiveness evaluation (ECEA). DCEA requires knowledge on not less than 4 key dimensions: (i) baseline well being inequalities (ii) distributional relative remedy results, (iii) the distribution of alternative prices, and (iv) inhabitants inequality aversion.
The authors spotlight 4 key sources of inequality:
- Want: What number of sufferers of a given group have a illness?
- Receipt: Amongst these in want, what number of have entry?
- Quick-term results: How do variations in baseline dangers for the situation in addition to the consequences of the intervention
- Lengthy-term results. Variations within the alternative price of funding the innovation
Whereas we now have strategies for quantifying the impression of recent well being applied sciences, there are nonetheless limitations. First, it’s unclear if key decisionmakers perceive the problems associated to well being disparities and/or if addressing these inequalities is a precedence for them. Second, well being disparity-inclusive financial modelling is extra knowledge intensive than normal CEA modelling. Third, well being fairness is just one dimension of broader societal worth that stakeholders ought to take into account.
To be taught extra about evaluating well being fairness inside HEOR, I do advocate you learn the full paper.
