In the first lesson in this module we introduced the goal of ‘quality of life for all people with HIV.’ We noted that the words ‘for all’ introduce an obligation to check that nobody is being left behind. In the second lesson we covered the different sources of data we can use to monitor HIV outcomes. This lesson covers the concept of health equity, which provides a framework for using data on HIV outcomes to make sure that nobody is being left behind.
Health equity is a framework for bringing our social justice values into our practice in public health and health promotion. It draws on what we learn about the changing epidemic to identify opportunities for further action and intervention.
For a long time, the HIV sector has had a strong commitment to diversity and inclusion, but these concepts are hard to measure. Health equity aims to create measurable change in the world.
To understand health equity, we can ask what counts as a health inequity. We will use a definition from Margaret Whitehead:
The language of health equity can be uncomfortable, since it implies we are failing at some aspects of our jobs. There are two ways of dealing with this. One says managing discomfort is part of the job. The other says health equity helps us identify opportunities for action today and in the future. This is the approach we recommend.
Health equity has proactive and reactive aspects to it. We can promote health equity and remove health inequities. Removing health inequities is reactive — it means identifying and closing the gaps. Promoting health equity means taking proactive steps to make prevention and service provision fairer. We always need to be doing both things at the same time, even though they may involve different activities.
We always need both aspects — removing inequities and promoting health equity.
We can use our understanding of the changing epidemiology of HIV in Australia to identify some of the gaps we might want to target. For instance, we are seeing disproportionate numbers of new HIV cases among overseas-born gay, bisexual and other men who have sex with men (GBM). This represents a difference in health outcomes that we can work to reduce.
When we talk about health outcomes, we are not just talking about HIV diagnoses. There are a large number of possible health outcomes where gaps might emerge. Research doesn’t routinely check for differences in many of these areas. So we also rely on consultation with clients and communities to identify where gaps might exist or emerge.
Examples of outcomes:
Some of these outcomes are subjective, and that’s okay. We can use any one of the different kinds of research and knowledge to identify gaps in the Australian response to HIV. Ideally we use more than one source of knowledge to get a clearer sense of what’s happening. (This is sometimes called triangulation.)
Using consultation and qualitative research is a valid way of identifying gaps, especially with small groups and rare events that don’t generate large enough numbers for statistical analysis.
One of Australia’s most well-known health equity initiatives is the federal Closing the Gap strategy. This aims to reduce the differences in health outcomes that exist between Indigenous people in Australia and settler Australians. The strategy has multiple components:
The approach emphasises listening to Indigenous people and communities about their needs, and working in an organised partnership that includes governments (Commonwealth and state/territory), Indigenous peak bodies, and communities themselves.
Find out more by visiting the Close the Gap website. Browse through the targets (see link above).
Identifying gaps creates an opportunity to think about how differences in outcomes can be prevented in future. It is an opportunity to think about what other needs people affected by a known inequity might have. Meeting these needs can help close the gaps we have identified. Thinking ahead creates opportunities to promote health equity.
In the next lesson we cover the health needs perspective, and how meeting health and other social needs contributes to quality of life and health equity.