Inequity in health care — A proposed model

Abstract

The paper defines the concept of inequity in health care and reviews the various approaches to identify causal relationships which lead to inequitable health outcomes. Notably, the input and process of health care delivery, the medical and social need factors, the external environment and the indirect influences channeled through ‘mediating’ factors. It further proposes a comprehensive model which integrates the combined effects of the several categories of components involved in determining inequitable outcomes between groups and individuals. While not exhaustive, the model provides a systematic attempt to define and trace inequities in health and potential causes of such, in operational terms. It can be used, therefore, for practical measurement of levels of inequity in outcomes.

Working towards health equity for ethnic minority elders: spanning the boundaries of neighbourhood governance

“…“Health equity” has been defined as the absence of “systematic disparities in health between groups with different levels of social (dis)advantage” (Braveman and Gruskin, 2003). To achieve health equity, the care system must be designed in a way that addresses differences in access to, and availability of, services between disparate groups and differences in the utilisation and appropriateness of services for these groups (Ellencweig and Grafstein, 1986). Neighbourhood governance can potentially increase health inequities within and between neighbourhoods (Bailey and Pill, 2011; Lowndes and Sullivan, 2008).…”

“…On the other hand, research shows that neighbourhood governance can enable relational work (Bartels, 2017; Durose, 2009; Jupp, 2013). For groups that experience social and cultural distance to services, neighbourhood governance can, therefore, be an effective way of addressing one cause of health inequity: differences in the utilisation and appropriateness of services (Braveman and Gruskin, 2003; Ellencweig and Grafstein, 1986). The following sections unpack the existing literature to examine how neighbourhood governance can benefit minority residents with a large social and cultural distance to services.…”

Inequity in health a case study

“…A more integrative approach would require the assessment of varying levels of resources allocated to different sectors, of uneven care processes, of diverse external factors affecting the various groupings, and of the influence of differential needs on health outcomes. A more thorough examination of the theoretical background pertinent to the case description is presented in an earlier article (8). These two types of towns correspond to two fairly homogenous strata of Israeli society.…”