According to the definition, an HIA not only focuses on the effects on population health, but also on the distribution of these effects within the population. In addition, equity is one of the core values of a good HIA. Therefore, equity should be an integral part of any HIA. However, since this is not always the case, this tool will provide some pointers on how to include an equity perspective.
To ensure the focus on equity within an HIA, it should be clear to all stakeholders involved what is meant by the terms “inequality” and “inequity”. These definitions are provided in the Introduction of the toolkit.
In addition to reaching agreement between stakeholders upon what health inequalities are, it is important to consider which population groups could be at risk of these inequalities. The PROGRESS Plus equity lens (Kavanagh et al, 2008; Evans & Brown, 2003) can assist in identifying these potential population groups (see Table 8). Even if a policy or intervention is designed with the specific aim of reducing inequalities between population groups (for example men and women), it is important to evaluate whether that same intervention creates inequalities between other groups (for example the poorly and highly educated).
|P||Place of Residence||Rural/urban, country/state/region, housing characteristics|
|R||(Race)/Ethnicity||Ethnic background (including Roma)|
|O||Occupation||Professional, skilled, unskilled, unemployed etc.|
|G||Gender||Male or female|
|E||Education||Years in and/or level of education attained, school type|
|S||Social Capital||Neighbourhood / community / family support|
|S||Socioeconomic position (SEP)||Income, means-tested benefits/welfare, affluence measures, etc.|
|All SEP (wider interpretation)||SEP income related, plus occupation, education, and elements of place of residence||Age||Age range|
|Disability||Existence of physical or emotional/mental disability|
|Sexual orientationHeterosexual, gay, lesbian, bisexual, transgender||Heterosexual, gay, lesbian, bisexual, transgender|
|Other vulnerable groups||School non-attenders, looked after young persons, young persons in criminal justice system, victims of abuse, runaways, teenage parents|
In order to ensure that equity is considered adequately throughout the HIA process, equity-related questions can be formulated in each of the HIA phases. In Equity Action, a Joint Action between the EU and Member States which aims to reduce health inequalities, a series of equity-related questions were developed which can be integrated into existing health impact assessment methods (Gunther, 2011). These questions are described in appendix 4. The full document, including this set of questions and useful tips about conducting an equity focused HIA, can be found here.