Annex 1. Monitoring inequalities in social determinants of health

By applying techniques similar to those used to measure inequality in health indicators across population subgroups, inequalities in social determinants of health (SDH) indicators can be measured – that is, data pertaining to SDH indicators can be disaggregated according to relevant dimensions of inequality. In this way, it is possible to quantify and track the extent of inequality in SDH indicators over time. Specific examples of disaggregated SDH indicator data include the use of clean fuels and technologies for cooking disaggregated by place of residence, literacy rates disaggregated by place of residence and sex, and secondary school attendance disaggregated by economic status.

Although most of the general approaches to health inequality monitoring can be applied directly to the measurement of inequalities in SDH, there are a few caveats. The SDH indicator and dimension of inequality must be distinct to avoid circular or non-independent analyses. For example, it is not valid to disaggregate the SDH indicator of poverty rate by economic status, because the two variables effectively capture the same type of information. Likewise, disaggregation of the literacy rate by education level should be avoided. Alternative approaches could explore the poverty rate by place of residence or the literacy rate by age.

For the same reason, caution is required when monitoring involves SDH indicators or dimensions of inequality constructed using indices. For example, the Multidimensional Poverty Index – an SDH indicator – encompasses three dimensions of poverty: health, education and living standards (1). This SDH indicator should not be disaggregated by any of these dimensions. The WHO Health Inequality Data Repository, for example, contains Multidimensional Poverty Index data disaggregated by age, place of residence, sex of household head and subnational region (2).

References

1. Global Multidimensional Poverty Index 2023: unstacking global poverty – data for high impact action. New York: United Nations Development Programme and Oxford Poverty and Human Development Initiative; 2023 (https://hdr.undp.org/system/files/documents/hdp-document/2023mpireporten.pdf, accessed 23 September 2024).

2. Health Inequality Data Repository. Geneva: World Health Organization (https://www.who.int/data/inequality-monitor/data, accessed 20 June 2024).