In accordance 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 offers and overview of the literature. The paper identifies quite a few key sources of social drawback: “socioeconomic standing, race and ethnicity, gender, geographic location, incapacity” amongst others.
Whereas lowering well being disparities is a laudable objective, there are a selection of different priorities that additionally go into the social welfare perform together with “…concern for effectivity in rising complete well being, concern to prioritize severely in poor health sufferers, and concern for guaranteeing applicable procedures of determination making.” As an illustration, 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 gentle illness or wealthy sufferers who’ve extreme illness? The solutions to those questions are usually not simple. Because the paper notes:
…measuring and addressing well being disparities is difficult given the interaction amongst many advanced components that form well being outcomes and can provide rise to numerous moral considerations
The paper identifies completely different dimensions via which contemplating well being fairness considerations might be helpful.
The paper additionally offers examples of functions of distributional value effectiveness evaluation (DCEA) and prolonged value effectiveness evaluation (ECEA). DCEA requires knowledge on a minimum of 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 results of the intervention
- Lengthy-term results. Variations within the alternative value of funding the innovation
Whereas we now have strategies for quantifying the influence of latest well being applied sciences, there are nonetheless boundaries. 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 customary CEA modelling. Third, well being fairness is just one dimension of broader societal worth that stakeholders ought to think about.
To study extra about evaluating well being fairness inside HEOR, I do suggest you learn the full paper.
