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Health Equity Clearinghouse


What is Health Equity?
New Zealand Resources
  Toolkits and Guidelines
  Selected Reading
  Selected Journals
International Resources
  Toolkits and Guidelines
  Selected Reading
  Selected Journals

*see also Counties Manukau Health Library Childhood Obesity Clearinghouse


What is Health Equity?

Health equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically (WHO)


The concept acknowledges that not only are differences in health status unfair and unjust, but they are also the result of differential access to the resources necessary for people to lead healthy lives (NZ MoH)


Fact and action sheets on health inequities [University of Otago and New Zealand Medical Association]

These fact and action sheets were prepared in the lead up to a visit by Sir Michael Marmot in July 2011, hosted by the New Zealand Medical Association. The purpose of these sheets includes an attempt at a brief stocktake on health inequities in New Zealand, both on what the current state of play is and what the future policy priorities might be.

Health Equity at CM Health
A blog by CEO Geriant Martin with Dr Lance O'Sullivan



What is Health Equity? [Health Equity Institute]
This three-minute motion graphic video explains how social, economic, and environmental conditions can create health inequities and how these inequities can affect health disparities.

Dr Lance O'Sullivan on a mission for health equity [Ko Awatea ]
Dr Lance O'Sullivan is at Middlemore Hospital working on a new health equity programme. In a 2016 interview on Te Karere he talks about his belief that regardless of race, age or income, people should have the same health opportunities as the next.

What Is Health Equity, and Why Does It Matter? [IHI]
David R. Williams, Professor of Public Health at the Harvard T.H. Chan School of Public Health, has been researching health inequities in the United States for two decades. In this video, he sits down with Don Berwick, MD, President Emeritus and Senior Fellow at IHI, to talk about health equity and why it’s important.
Social Media

twitter #healthequity


New Zealand Resources



Equity [Ministry of Health]

Equity Explorer [HSQC]
The Equity Explorer provides information on how health and health care varies between groups of people, and between district health board (DHB) areas of Aotearoa New Zealand (NZ).

Two types of group are compared: ethnic groups and groups based on socioeconomic status (deprivation).

The health conditions compared are diabetes, asthma and gout.

Maori Health Clearinghouse

Pacific Health Clearinghouse

Asian Health Clearinghouse

Toolkits and Guidelines


Achieving Equity in Health Outcomes: Highlights of selected papers [NZ; 2018]
Both in New Zealand and globally, our ability to address equity challenges in health has significantly improved over the past decades. In the Western world life expectancy has increased for all populations. However persistent disparities in health access, quality of services and outcomes remain. In Aotearoa New Zealand, Māori and Pacific and those in low socioeconomic groups remain the most disadvantaged.

The Government has mandated the Ministry of Health to take a bold approach that delivers tangible changes to system behaviour with measurable results in a three to five-year horizon. An approach that operates on a repeating cycle based around deepening the understanding of equity gaps, shifting thinking about where priorities for investment of time and resources lie, followed by increasing direct action to address inequalities is being developed.

This paper traces the beginnings of health equity and the philosophical and ethical foundations that sit behind it.  It looks at a selection of the international and local literature to help understand definitions of equity. It considers how framing and thinking about the concept of equity and approaches to addressing equity have evolved, and how progress to address equity can be measured.

The Health Equity Assessment Tool: a User's Guide  [NZ]
The Health Equity Assessment Tool: A User's Guide, has been developed by the University of Otago, Wellington, to help facilitate the use of the Health Equity Assessment Tool (HEAT).

The Health Equity Assessment Tool: A User's Guide gives a brief overview of inequalities in health, introduces the HEAT and its use, presents an in-depth look at each of the HEAT questions, and provides case examples of the tool's use.  This publication is an essential guide for those working in the health and disability to apply a strong equity focus to their work.

Equity of Health Care for Māori: A Framework [NZ]
This framework guides health practitioners, health organisations and the health system to achieve equitable health care for Māori through leadership, knowledge and commitment.

Quality improvement: no quality without equity? [NZ; 2017]
This ‘think piece’ from the Health Quality & Safety Commission signals our intention to tackle health inequities. 


Selected Reading

Racism and health in Aotearoa New Zealand: a systematic review of quantitative studies (2020)
Quantitative racism and health research in New Zealand consistently finds that self-reported racial discrimination is associated with a range of poorer health outcomes and reduced access to and quality of healthcare. This review confirms that experience of racial discrimination is an important determinant of health in New Zealand, as it is internationally. There is a pressing need for effectively designed interventions to address the impacts of racism on health.

Experiences of Māori of Aotearoa New Zealand's public health system: a systematic review of two decades of published qualitative research (2020)
Australia and New Zealand Journal of Public Health
This paper aims to synthesise the broader perspectives of Māori patients and their whānau (extended family, family group) of their treatment within the public health system. Our research question was ‘What are the experiences of Māori in the public health and/or hospital system in Aotearoa New Zealand?’

Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition [NZ]
International Journal for Equity in Health
There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care...A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development.

Tofa Saili: A review of evidence about health equity for Pacific Peoples in New Zealand'
Pacific Perspectives (2019)
This report describes the health equity issues faced by Pacific families and communities. The report highlights approaches based on Pacific values and the strengths of Pacific communities. It is informed by the Pacific Aotearoa vision (Ministry of Pacific Peoples, 2019).

A window on the quality of Aotearoa New Zealand's health care 2019 – a view on Māori health equity
HQSC, 2019
Every year the Commission publishes a document we call A window on the quality of Aotearoa New Zealand’s health care. The Window provides a snapshot of the quality of health care in the country. While equity has always been a component of the report’s analysis over its four-year history, this year’s report focuses solely on equity. 

A window on the quality of Aotearoa New Zealand’s health care 2019 – a view on Māori health equity (Window 2019) highlights a number of areas where change is needed in the health system. The report is divided into three chapters. The first analyses inequity between how Māori and non-Māori access and receive health services, and the effects on equity of improvement activities in our system. The second chapter asks why these inequities exist, and the third chapter addresses opportunities for improvement.

Addressing equity in intergenerational wellbeing: Valuing community perspectives
Deloitte and Victoria University of Wellington, 2019.
Our partners at Victoria University of Wellington’s School of Government look at New Zealand’s wellbeing frontier and the importance of bringing in community perspectives to build effective policy.

Understanding inequalities: summary report. The impact of inequalities in the early
years on outcomes over the life course: Using international evidence to identify creative policy solutions.
Growing up in New Zealand, 2019.
The findings from the Growing Up in New Zealand study demonstrate that Maori and Pasifika children experience the highest burden of socioeconomic disadvantage in their early years as well as an unequal burden of significant co-morbidities in terms of health and development throughout their life course. By the time they start school (at age 5 years) many are already falling behind their peers in terms of preparedness for formal education and readiness to engage in learning.

The study has shown that inequalities in developmental opportunities and outcomes have their origins in early in life. Risk factors for early vulnerability cluster and there is no one single proxy marker of disadvantage. Additionally, morbidity and poor outcomes cluster. Persistent adversity is associated with a graded likelihood of poor outcomes (across the population). Further service use is not meeting measured need. Currently, access to early life universal services may be widening inequalities. A proportional-universalism approach to services is required if they are to meet real need and reduce inequalities.

'HAUORA: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry'
Waitangi Tribunal. 2019
"The Waitangi Tribunal said in a report released today that the Crown had breached the Treaty of Waitangi by failing to set up and run the primary health system in a way that reduced the gap between Maori and non-Maori health outcomes."

He oranga mo Aotearoa: Māori wellbeing for all
We consider various Māori wellbeing frameworks and measurements, the barriers to Māori wellbeing and the drivers and changes that could improve it.

Delivering better outcomes together: Policies that reflect our diverse cultures
The cultural and ethnic face of Aotearoa New Zealand is changing. We explore why and how our institutions and policies need to move closer toward multi-culturalism to achieve better outcomes for all.

The health equity measurement framework: a comprehensive model to measure social inequities in health
International Journal for Equity in Health201918:36

Ethnic bias and clinical decision-making among New Zealand medical students: an observational study [NZ]
BMC Medical EducationBMC series – 201818:18 (2018)

The Determinants of Health for Pacific Children and Young People in New Zealand (2014) (Determinants of Health for Children and Young People). New Zealand Child and Youth Epidemiology Service (2016)

Te Ohonga Ake The Determinants of Health for Māori Children and Young People in New Zealand Series Two (2016) New Zealand Child and Youth Epidemiology Service (2016)

The cost of child health inequalities in Aotearoa New Zealand: a preliminary scoping study[NZ]
BMC Public Health 12.1 (2012): 1.

Geography matters: the prevalence of diabetes in the Auckland Region by age, gender and ethnicity [NZ]
New Zealand Medical Journal 2016; 129 (1436): 25-37

Health equity in the New Zealand health care system: a national survey. [NZ]
International Journal for Equity in Health 10.1 (2011): 1.

Health equity: what does it mean for child health [NZ]
New Zealand Medical Journal 2011; 124 (1347)

Health inequalities: unfair, measurable and remediable? The case of New Zealand. [NZ]
Paper prepared for the WHO Commission on Social Determinants of Health.

Policy implementation for health equity in Aotearoa: examining healthy eating and physical activity programmes in Maaori and Pasifika communities [NZ]
Paper prepared by Arnell Hinkle (2010)

Solutions to child poverty in New Zealand [NZ]
Report prepared for the Office of the Children;s Commissioner (2012)

The politics of Māori health (2016)

Selected Journals

Australia and New Zealand Journal of Public Health

Maori Health Review [NZ]

Pacific Health Review [NZ]

Asian Health Review [NZ]


International Resources


Equity [World Health Organisation]

Health Equity Initiative [HEI]

WHO World Database on Intersectoral Action for Health Equity (ISACS)

Toolkits and Guidelines

What are health inequalities?
The Kings Fund, 2020
Interventions to tackle health inequalities need to reflect the complexity of how health inequalities are created and perpetuated, otherwise they could be ineffective or even counterproductive. For example, efforts to tackle inequalities of health status associated with behavioural risks (such as poor diets) should address the wider network of factors that influence these behaviours (such as access to affordable healthy food, marketing and advertising regulations) and the impact that these behaviours have on health outcomes (such as access to clinical services). 

Health inequalities are not inevitable and the gaps are not fixed. 

Evidence shows that a comprehensive approach to tackling them can make a difference. Concerted, systematic action is needed across multiple fronts to address the causes of health inequalities. This includes, but goes well beyond, the health and care system.

This explainer provides an overview of how health inequalities are experienced in England’s population

Health inequalities: place-based approaches to reduce inequalities: Guidelines to support local action on health inequalities.
Public Health England, 2019
This guidance aims to reinforce a common understanding of the complex causes and costs of health inequalities and provide a practical framework and tools for places to reduce health inequalities. The accompanying documents include a slide set providing a summary and examples of how to use a place-based approach to reduce health inequalities.

Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity
National Academy of Sciences. 2019
This report provides a brief overview of stressors that affect childhood development and health, a framework for applying current brain and development science to the real world, a roadmap for implementing tailored interventions, and recommendations about improving systems to better align with our understanding of the significant impact of health equity.

Incorporating concerns for equity into health resource allocation. A guide for practitioners [UK]
 “Unfair differences in health care access, quality or health outcomes exist between and within countries around the world, and improving health equity is an important social objective for many governments and international organizations. This paper summaries the methods for analysing health equity available to policymakers regarding the allocation of health sector resources.”

100 Million Healthier Lives [US]
100 Million Healthier Lives is an unprecedented collaboration of change agents across sectors who are pursuing an unprecedented result.

Mission: 100 million people living healthier lives by 2020.
Vision: to fundamentally transform the way the world thinks and acts to improve health, wellbeing, and equity to get to breakthrough results.

Together, we are systematically creating a community of solutions to the most intractable challenges that stand in the way of achieving health, wellbeing and equity across the globe.  Includes guidelines and resources.

Achieving Health Equity: A Guide for Health Care Organisations [US]
This white paper provides guidance on how health care organizations can reduce health disparities related to racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

The IHI White Paper includes:

A framework, with five key components, for health care organizations to improve health equity in the communities they serve:

Make health equity a strategic priority
Develop structure and processes to support health equity work
Deploy specific strategies to address the multiple determinants of health on which health care organizations can have a direct impact
Decrease institutional racism within the organization
Develop partnerships with community organizations to improve health and equity
Guidance for measuring health equity
A case study of one health care organization that has strategically integrated work to improve health equity throughout their system
A self-assessment tool for health care organizations to gauge their current focus on and efforts to improve health equity

Equity of Care: a Toolkit for Eliminating Health Care Disparities [US]
This toolkit is a user-friendly “how-to” guide to help accelerate the elimination of health care disparities and ensure our leadership teams and board members reflect the communities we serve.

Fair Foundations [Aus.]
Fair Foundations: The VicHealth framework for health equity is a planning tool for health promotion policy and practice. It outlines the social determinants of health inequities, suggesting entry points for action.

Health Equity and Prevention Primer [US]
Health inequities are more than disparities or differences in health and safety outcomes. Inequity describes unfairness and the systematic nature of disparities. The Health Equity and Prevention Primer (HEPP) serves as a web-based training series for public health practitioners and advocates interested in policy advocacy, community change, and multi-sector engagement to achieve health equity. The Primer helps practitioners integrate a health equity lens into their initiatives in pursuit of overall health and safety.

Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities [US]
This document was created to provide examples of strategies and surveillance data which can be used to inform obesity prevention initiatives.

Improving Health Equity Through Data Collection AND Use: a Guide for Hospital Leaders [US]
To meet the needs of their diverse populations, hospitals and health systems will need to bridge the gap between collecting meaningful patient data and reviewing the data to identify inequities in health care provision and utilization, and to implement simple yet effective interventions to improve care for patients.

Improving Quality and Achieving Equity: a Guide for Hospital Leaders [US]
This guide for hospital leaders presents the evidence for racial and ethnic disparities in health care and provides the rationale for addressing them with a focus on quality, cost, risk management, and accreditation. The guide also highlights case studies and model practices, and recommends activities and resources that can help hospitals identify and address disparities in order to achieve equity for patients.

Improving Quality and Achieving Equity: the Role of Cultural Competence in Reducing Racial and Ethnic Disparities in Health Care [US]
This report identifies aspects of cultural competence that are synergistic with current efforts to develop a system that delivers higher-quality care and discusses strategies by which the quality and cultural competence movements could be linked.

A Practitioner's Guide for Advancing Health Equity [US]
Designed to help public health practitioners advance health equity through community prevention strategies. While health disparities can be addressed at multiple levels, this guide focuses on policy, systems, and environmental improvements designed to improve the places where people live, learn, work, and play. It is designed for those who are new to the concept of health equity, as well as those who are already working to create equitable environments.

Roadmap to Reduce Disparities [US]
A US guide for health care organisations to improve minority health and foster equity, which includes a 6-step framework for incorporating disparities-reduction into quality improvement processes.

What Makes Us Healthy [UK]
A new series of infographics and accompanying blogs and commentaries to describe and explain the social determinants of health in an accessible and engaging way.These determinants include political, social, economic, environmental and cultural factors which shape the conditions in which we are born, grow, live, work and age. Creating a healthy population requires greater action on these factors, not simply on treating ill health further down stream.


Selected Reading


Driving forward health equity – the role of accountability, policy coherence, social participation and empowerment
WHO, 2019
A scientific expert review process coordinated by the WHO European Office for Investment for Health and Development of the WHO Regional Office for Europe identified societal and institutional factors that singly and in combination offer new explanations on why progress on health equity has not been as fast as had been hoped when the association between individual determinants and inequities was first established. These four key drivers of health equity are: accountability, policy coherence, social participation and, underlying them, empowerment. Work on these drivers informs the Health Equity Status Report initiative (HESRi) and has resulted in three independent companion papers each elaborating further on one of the common goods for health equity – accountability, policy coherence and social participation – as well as this summary paper.

A Health Equity Approach to Obesity Efforts: Proceedings of a Workshop—in Brief
National Academy of Sciences. 2019
On April 1, 2019, the National Academies of Sciences, Engineering, and Medicine held a public workshop, A Health Equity Approach to Obesity Efforts, in Washington, DC. The workshop explored the history of health equity issues in demographic groups that have above-average obesity risk, and considered principles and approaches to address these issues as part of obesity prevention and treatment efforts. Speaker presentations addressed three areas: current policies and practices that either perpetuate health inequities or advance health equity; mechanisms to support community-driven solutions that can influence the social determinants of health; and approaches for fostering multisector collaboration to address disparities by exploring the issues related to the creation, implementation, and evaluation of equity-oriented programs, policies, and systems changes. Participants also discussed research needs to inform and mobilize equity-centered obesity prevention and treatment actions. This publication briefly summarizes the presentations and discussions from the workshop.

Advancing Equity in Health Systems by Addressing Racial Justice
Stanford Social Innovation review. 25 June, 2019
Lessons on racial equity underscore the need to set explicit aims, build coalitions, and flatten hierarchies in order to strengthen healthcare’s role in undoing systems of oppression.

Inclusion of equity in economic analyses of public health policies: systematic review and future directions (2017)
Twenty‐nine relevant studies were identified. The majority of studies comparing two or more interventions left interpretation of the size of the health and financial inequality differences to the reader. Newer approaches include: i) use of health inequality measures to quantify health inequalities; ii) inclusion of financial impacts, such as out‐of‐pocket expenditures; and iii) use of equity weights.

Improving Health Equity: 5 Guiding Principles for Health Care Leaders [US: IHI] (2018)
In January 2017, a team from IHI argued that health care organizations must make health equity a strategic priority. The authors identified five key steps for health care organizations: make health equity a leader-driven priority, develop structures and processes that support equity, take specific actions that address the social determinants of health, confront institutional racism within the organization, and partner with community organizations.

Insiders’ Insight: Discrimination against Indigenous Peoples through the Eyes of Health Care Professionals [Canada] (2019)

A Framework for Educating Health Professionals to Address the Social Determinants of Health [US]

Better Health Through Equity: Case Studies in Reframing Public Health Work (2015) [US]

Closing The Gap in A Generation: Health Equity Through Action on the Social Determinants of Health (Commission on the Social Determinants of Health, CSDH 2008)

Equity and Excellence: Liberating the NHS [UK]

Evidence review: Settings for addressing the social determinants of health inequities [Aus.]

Fair Society, Healthy Lives (The Marmot Review): Strategic Review of Health Inequalities in England Post 2010 (Marmot et al, 2010) [UK]

Fairer decisions, better health for all: Health equity and cost-effectiveness analysis [UK]

Health literacy: a necessary element for achieving health equity [US]

Leveraging Culture to Address Health Inequalities: Examples from Native Communities: Workshop Summary [US]

WHO European Review of Social Determinants of Health & the Health Divide (Marmot et al 2012) [EU]


Selected Journals

Diversity and Equality in Health Care

Ethnicity and Health

International Journal for Equity in Health

see also

PubMed Database Search: Health Equity



 last updated 3rd October 2019

This page was last updated at 10:08AM on September 11, 2020.