Who cares about health inequalities?

Reduction of health inequalities within and between countries is a global health priority, but little is known about the determinants of popular support for these goals. Simply put, who cares about health inequalities?

We used data from the World Health Survey (WHS) to try to answer this question, by assessing individual preferences for prioritizing reductions in health and health care inequalities. We used descriptive tables and regression analysis to study the determinants of preferences for reducing health inequalities as the primary health system goal. Determinants included individual socio-demographic characteristics (age, sex, urban residence, education, marital status, household income, self-rated health, health care use, satisfaction with health care system) and country-level characteristics (GDP per capita, disability-free life expectancy, equality in child mortality, income inequality, health and public health expenditures). We used logistic regression to assess the likelihood that individuals ranked minimizing inequalities first, and rank-ordered logistic regression to compare the ranking of other priorities against minimizing health inequalities.

We found that individuals tended to prioritize health system goals related to overall improvement (improving population health and health care responsiveness) over those related to equity (minimizing inequalities in health and responsiveness, and promoting fairness of financial contribution). Individuals in countries with higher GDP per capita, life expectancy, and equality in child mortality were more likely to prioritize minimizing health inequalities.

We concluded that individuals living in low- and middle-income countries may be willing to accept short-term increases in health inequalities in the context of overall health improvement.

A writeup of this work is forthcoming in the journal Health Policy & Planning.