Inequalities in Health: Methodological Approaches to Spatial Differentiation

Abstract

The prevalence of inequalities in the general health position of communities can be assessed by using selected determinants. The aims of this article are three-fold: (1) to apply a comprehensive approach to the assessment of inequalities in the general health position of communities, (2) to determine the spatial differentiation of determinants, and (3) to present selected assessment methods and their impact on the results. To present a quantitative assessment of these inequalities in health status in communities, a composite indicator (Health Index) was developed. This Health Index is composed of 8 areas of evaluation and 60 indicators which include, amongst others, determinants of health status and healthcare at district level (LAU 1) in the Czech Republic. The data are evaluated using multicriteria decision-making methods (the WSA and TOPSIS methods). Findings suggest that, when all eight domains are assigned the same weight of one, the spatial differentiation among the districts is similar when using both methods. If different weightings are assigned to the districts, changes occur in both the index values and the rankings of the analyzed districts. For example, the allocation of weightings in both methods results in a rearrangement of the ranking of districts for which the Health Index is around the average.

Towards the 2030 Agenda: Measuring the Progress of the European Union Countries through the SDGs Achievement Index

“…The composite index method was used by Balode et al [14] to develop a methodology to pre-assess the impacts of policies identified in the NECP, a long-term energy and climate policy planning document that sets out the basic principles, measures and directions of Latvia's state energy and climate policy for the next ten years. In the study of Hübelová et al [15], a composite indicator (health index) was developed to present a quantitative assessment of inequalities in health conditions between districts in the Czech Republic. This index is composed of eight areas of evaluation: economic conditions and social protection, education, demographic indicators, environmental conditions, individual living conditions, road safety and crime, health and social care resources, and health status; a total of 60 indicators have been identified.…”

A holistic model of health inequalities for health policy and state administration: a case study in the regions of the Czech Republic

“…We employed the WSA method, a weighted sum method based on utility maximization principles, to calculate these composite indicators. This method assumes linearity and maximization of all partial utility functions, obtained by normalizing the original input data (see [25] for more details on the methods). We used Pearson's correlation coe cient for a correlation analysis to identify relationships between the categories of health inequalities.…”

A holistic model of health inequalities for health policy and state administration: a case study in the regions of the Czech Republic

“…In the second phase the same method was used for the complete categories A.1 to A.7 together and with equal weights. This result could be taken as the aggregate index of determinants of health inequalities of each district (see [ 24 ] for more details on the methods). In the WSA method criteria can be minimized or maximized.…”

“…The framework is modular and scalable. We also applied different methodological approaches to spatiotemporal analysis and comparison of results [ 24 ].…”

“…In this paper, we build upon the results of the health inequalities assessment [ 2 , 24 ]. To comprehensively record, analyze, and interpret health inequalities, it is necessary to have the broadest possible set of determinants for these inequalities.…”