Equity

Equity in health refers to the fairness in the distribution of health outcomes across individuals, and by extension, may also refer to the fair distribution of healthcare resources (e.g. expenditure, utilisation, access) that contribute to health. Rooted in the ethical principles of distributive justice, equity recognizes that maximising health gains (efficiency) must be balanced with ensuring a fair distribution of these gains – although opinions may vary regarding which distributional aspects are relevant. The World Health Organization defines equity as “the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically”. Key dimensions of equity include:
* Horizontal equity refers to treating those with equal healthcare needs equally, irrespective of unrelated characteristics (e.g. socio-economic status, geography).
* Vertical equity refers to treating those with different healthcare needs in an appropriately differentiated manner.
In the UK, NICE has consulted with its citizens’ panel to explore social values that may underpin deliberative decision making. Some social values suggest that certain groups may be more deserving of health gains; for example, people with severe disease (addressed by NICE’s severity weighting) or at risk of imminent death (‘rule of rescue’), illnesses resulting from factors outside the person’s control, or rare diseases, and where non-health consequences (productivity, caring responsibilities) are important. Although there have been attempts to produce quantified adjustments to account for distributional objectives (e.g. modifications to QALY gains), at present equity issues are considered qualitatively.