When used in healthcare, equity in health refers to the fairness in the distribution of health across individuals. It may also refer to the distribution of health care (for example, expenditure, utilisation or access to care), from which equity in health is assumed to be derived. Equity is rooted in ethical principles of distributive justice: its application recognises the importance not only of maximising health gains (efficiency) but also in achieving a fair distribution of these gains. Opinions may differ as to which distributional aspects are considered relevant. WHO defines equity as ‘the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically’. ‘Horizontal equity refers to those with equal needs receiving the same treatment, irrespective of characteristics (demographic or socio-economic) unrelated to need. Vertical equity refers to treating those with different needs in an appropriately different manner. In the UK, NICE has explored social values that may underpin deliberative decision-making by consulting its citizens’ panel. Some social values suggest that certain groups may be more deserving of health gains: for example those with severe disease (addressed by NICE’s end-of-life criteria) or at risk of imminent death (‘rule of rescue’), illnesses resulting from factors outside the person’s control, or rare diseases, or where non-health consequences (productivity, caring responsibilities) are important. Although there have been attempts to produce quantified adjustments, for example modifications to QALY gains, to account for distributional objectives, at present equity issues are considered qualitatively.
How to cite: Equity [online]. (2016). York; York Health Economics Consortium; 2016. https://yhec.co.uk/glossary/equity/