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      Measuring health inequalities in the context of sustainable development goals Translated title: Mesurer les inégalités en matière de santé dans le contexte des objectifs de développement durable Translated title: Medición de las desigualdades en la salud en el contexto de los objetivos de desarrollo sostenible Translated title: قياس عدم المساواة الصحية في سياق أهداف التنمية المستدامة Translated title: 在可持续发展的目标下度量健康不平等 Translated title: Определение неравенства в вопросах здравоохранения в контексте целей в области устойчивого развития

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          Abstract

          Transforming our world: the 2030 agenda for sustainable development promotes the improvement of health equity, which entails ongoing monitoring of health inequalities. The World Health Organization has developed a multistep approach to health inequality monitoring consisting of: (i) determining the scope of monitoring; (ii) obtaining data; (iii) analysing data; (iv) reporting results; and (v) implementing changes. Technical considerations at each step have implications for the results and conclusions of monitoring and subsequent remedial actions. This paper presents some technical considerations for developing or strengthening health inequality monitoring, with the aim of encouraging more robust, systematic and transparent practices. We discuss key aspects of measuring health inequalities that are relevant to steps (i) and (iii). We highlight considerations related to the selection, measurement and categorization of dimensions of health inequality, as well as disaggregation of health data and calculation of summary measures of inequality. Inequality monitoring is linked to health and non-health aspects of the 2030 agenda for sustainable development, and strong health inequality monitoring practices can help to inform equity-oriented policy directives.

          Résumé

          Transformer notre monde: le programme de développement durable à l'horizon 2030 promeut l'amélioration de l'équité en santé, ce qui implique un suivi continu des inégalités en matière de santé. L'Organisation mondiale de la Santé a élaboré une approche pour le suivi des inégalités en santé qui comprend plusieurs étapes: (i) déterminer la portée du suivi; (ii) collecter des données; (iii) analyser les données; (iv) communiquer les résultats; et (v) mettre en œuvre des changements. À chaque étape, des considérations techniques ont des conséquences sur les résultats et les conclusions du suivi et sur les mesures correctives qui en résultent. Ce document présente certaines considérations techniques pour le développement ou le renforcement du suivi des inégalités en santé, dans l'objectif d'encourager des pratiques plus fiables, plus systématiques et plus transparentes. Nous examinons des aspects clés de la mesure des inégalités en santé à prendre en compte dans les étapes (i) et (iii). Nous mettons en avant des considérations en lien avec la sélection, la mesure et la catégorisation des dimensions des inégalités en matière de santé, ainsi que la ventilation des données sur la santé et le calcul de mesures synthétiques des inégalités. Le suivi des inégalités est lié à des aspects sanitaires et non sanitaires du Programme de développement durable à l'horizon 2030, et des pratiques rigoureuses de suivi des inégalités en matière de santé peuvent contribuer à éclairer les directives axées sur l'équité.

          Resumen

          Transformar nuestro mundo: el plan de 2030 para el desarrollo sostenible promueve la mejora de la igualdad en la salud, lo que implica un seguimiento continuo de las desigualdades en salud. La Organización Mundial de la Salud ha desarrollado un enfoque de múltiples pasos para el seguimiento de la desigualdad en la salud que consiste en: (i) determinar el alcance del seguimiento; (ii) obtener datos; (iii) analizar los datos; (iv) informar sobre los resultados; e (v) implementar los cambios. Las consideraciones técnicas de cada paso tienen implicaciones para los resultados y las conclusiones del seguimiento y las acciones correctivas subsiguientes. En este documento se presentan algunas consideraciones técnicas para desarrollar o fortalecer el seguimiento de la desigualdad en la salud, con el fin de fomentar prácticas más robustas, sistemáticas y transparentes. Se analizan aspectos clave de la medición de las desigualdades en la salud relevantes para los pasos (i) y (iii). Se destacan las consideraciones relacionadas con la selección, la medición y la categorización de las dimensiones de la desigualdad en la salud, así como la desagregación de los datos de salud y el cálculo de medidas sintetizadas de desigualdad. El seguimiento de la desigualdad está vinculado a los aspectos sanitarios y no sanitarios del programa de desarrollo sostenible de 2030, y unas prácticas rigurosas de seguimiento de la desigualdad en la salud pueden ayudar a fundamentar las directrices políticas orientadas a la igualdad.

          ملخص

          تحويل عالمناترتقي خطة التنمية المستدامة لعام 2030 بتحسين العدالة الصحية، وهو ما يستلزم المتابعة المستمرة لأوجه عدم المساواة الصحية. طورت منظمة الصحة العالمية نهجًا متعدد الخطوات لرصد عدم المساواة في الصحة يتكون من: (1) تحديد نطاق المراقبة؛ و(2) الحصول على البيانات؛ و(3) تحليل البيانات؛ و(4) الإبلاغ عن النتائج؛ و(5) تنفيذ التغييرات. يكون للاعتبارات التقنية في كل خطوة آثار على نتائج واستنتاجات الرصد والإجراءات التصحيحية اللاحقة. تعرض هذه الورقة بعض الاعتبارات التقنية لتطوير أو تعزيز مراقبة عدم المساواة الصحية، بهدف تشجيع ممارسات أكثر قوة ومنهجية وشفافية. نحن نناقش الجوانب الرئيسية لقياس عدم المساواة الصحية ذات الصلة بالخطوتين (1) و(3). نحن نبرز الاعتبارات المتعلقة باختيار وقياس وتصنيف أبعاد عدم المساواة الصحية، وكذلك تحليل البيانات الصحية وحساب المقاييس الموجزة لعدم المساواة. يرتبط رصد عدم المساواة بالجوانب الصحية وغير الصحية لجدول أعمال التنمية المستدامة لعام 2030، ويمكن أن تساعد ممارسات مراقبة عدم المساواة الصحية القوية في توجيه لوائح السياسات الموجهة نحو المساواة.

          摘要

          《改变我们的世界——2030 年可持续发展议程》旨在改善健康不平等状况,这意味着该议程将对健康不平等进行持续监测。世界卫生组织推出了一种多步骤方法以监测健康不平等,步骤包括:(i) 确定监测范围;(ii) 获取数据;(iii) 分析数据;(iv) 汇报结果;以及 (v) 实施改变。每一项步骤的技术考量都会影响到监测的结果、结论及随后的补救措施。出于鼓励更多稳健性、系统性和透明性措施之目的,本文将会为发展和加强健康不平等的监测提供一些技术考量。我们对度量健康不平等过程中的关键部分即步骤 (i) 和 (iii) 进行讨论。我们重点关注与健康不平等维度的选择、度量及分类相关的考量,以及分解健康数据和计算不平等的概括性措施。不平等监测关乎 2030 年可持续发展议程中的健康和非健康领域,强有力的健康不平等监测措施有助于形成平等导向的政策指令。

          Резюме

          Документ Преобразование нашего мира: повестка дня в области устойчивого развития на период до 2030 года содействует улучшению ситуации в обеспечении равенства в вопросах здравоохранения, что влечет за собой постоянный мониторинг неравенства в этих вопросах. Всемирная организация здравоохранения разработала многоэтапный подход к мониторингу неравенства в вопросах здравоохранения, состоящий из следующих этапов: (i) определения сферы мониторинга, (ii) получения данных, (iii) анализа данных, (iv) отчетности и (v) внедрения изменений. Технический анализ на каждом этапе имеет значение для результатов и выводов мониторинга и последующих корректирующих действий. В настоящем документе представлены некоторые результаты технического анализа по разработке или укреплению мониторинга неравенства в вопросах здравоохранения с целью поощрения более надежных, систематических и прозрачных практических действий. В статье обсуждаются ключевые аспекты определения неравенства в вопросах здравоохранения, которые имеют отношение к этапам (i) и (iii). Особое внимание уделено технологическому анализу, связанному с отбором, определением и категоризацией аспектов неравенства в вопросах здравоохранения, а также дезагрегированием данных о состоянии здоровья и расчетом сводных показателей неравенства. Мониторинг неравенства связан как с теми аспектами повестки дня по вопросам устойчивого развития до 2030 года, которые относятся к здравоохранению, так и с теми, которые не связаны со здравоохранением, поэтому четкая и последовательная практика мониторинга неравенства в вопросах здравоохранения может помочь в разработке директив, ориентированных на обеспечение равенства.

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          Most cited references12

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          Adolescent sexual and reproductive health: The global challenges

          Adolescent sexual and reproductive health (ASRH) has been overlooked historically despite the high risks that countries face for its neglect. Some of the challenges faced by adolescents across the world include early pregnancy and parenthood, difficulties accessing contraception and safe abortion, and high rates of HIV and sexually transmitted infections. Various political, economic, and sociocultural factors restrict the delivery of information and services; healthcare workers often act as a barrier to care by failing to provide young people with supportive, nonjudgmental, youth-appropriate services. FIGO has been working with partners and its member associations to break some of these barriers-enabling obstetricians and gynecologists to effect change in their countries and promote the ASRH agenda on a global scale.
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            Implicit value judgments in the measurement of health inequalities.

            Quantitative estimates of the magnitude, direction, and rate of change of health inequalities play a crucial role in creating and assessing policies aimed at eliminating the disproportionate burden of disease in disadvantaged populations. It is generally assumed that the measurement of health inequalities is a value-neutral process, providing objective data that are then interpreted using normative judgments about whether a particular distribution of health is just, fair, or socially acceptable. We discuss five examples in which normative judgments play a role in the measurement process itself, through either the selection of one measurement strategy to the exclusion of others or the selection of the type, significance, or weight assigned to the variables being measured. Overall, we find that many commonly used measures of inequality are value laden and that the normative judgments implicit in these measures have important consequences for interpreting and responding to health inequalities. Because values implicit in the generation of health inequality measures may lead to radically different interpretations of the same underlying data, we urge researchers to explicitly consider and transparently discuss the normative judgments underlying their measures. We also urge policymakers and other consumers of health inequalities data to pay close attention to the measures on which they base their assessments of current and future health policies.
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              Socioeconomic Inequality in Smoking in Low-Income and Middle-Income Countries: Results from the World Health Survey

              Objectives To assess the magnitude and pattern of socioeconomic inequality in current smoking in low and middle income countries. Methods We used data from the World Health Survey [WHS] in 48 low-income and middle-income countries to estimate the crude prevalence of current smoking according to household wealth quintile. A Poisson regression model with a robust variance was used to generate the Relative Index of Inequality [RII] according to wealth within each of the countries studied. Results In males, smoking was disproportionately prevalent in the poor in the majority of countries. In numerous countries the poorest men were over 2.5 times more likely to smoke than the richest men. Socioeconomic inequality in women was more varied showing patterns of both pro-rich and pro-poor inequality. In 20 countries pro-rich relative socioeconomic inequality was statistically significant: the poorest women had a higher prevalence of smoking compared to the richest women. Conversely, in 9 countries women in the richest population groups had a statistically significant greater risk of smoking compared to the poorest groups. Conclusion Both the pattern and magnitude of relative inequality may vary greatly between countries. Prevention measures should address the specific pattern of smoking inequality observed within a population.
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                Author and article information

                Journal
                Bull World Health Organ
                Bull. World Health Organ
                BLT
                Bulletin of the World Health Organization
                World Health Organization
                0042-9686
                1564-0604
                01 September 2018
                28 June 2018
                : 96
                : 9
                : 654-659
                Affiliations
                [a ]Department of Information, Evidence and Research, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
                [b ]Faculty of Health Sciences, University of Ottawa , Ottawa, Canada.
                Author notes
                Correspondence to Ahmad Reza Hosseinpoor (email: hosseinpoora@ 123456who.int ).
                Article
                BLT.18.210401
                10.2471/BLT.18.210401
                6154075
                30262947
                62640c75-7e53-48c1-b0e1-bebe5fa71985
                (c) 2018 The authors; licensee World Health Organization.

                This is an open access article distributed under the terms of the Creative Commons Attribution IGO License ( http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

                History
                : 14 February 2018
                : 04 June 2018
                : 04 June 2018
                Categories
                Policy & Practice

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