CONCEPTS AND DEFINITIONS

What is GEGA's concept of Equity?

GEGA's work is informed by a perspective that places health squarely within a larger framework of social justice. While some health variations between people are inevitable, e.g. the fact that the elderly generally have worse health than younger populations, many health inequalities are avoidable and associated with unjust social constructs. Furthermore, empirical evidence in both rich and poor countries demonstrates that such inequalities cut across all societies, and that health is closely associated with underlying political, economic and cultural influences and with social position. It is these inequalities with which Equity Gauges are concerned.

An Equity Gauge perspective therefore involves striving towards a world in which disadvantaged population groups (whether defined by age, gender, race-ethnicity, socio-economic class or residence) can better achieve their full health potential, as indicated by the health standards of those groups in society who are most advantaged. It calls for affirmative and preferential action to improve the health of those with the poorest health when they face unjust obstacles to achieving that potential.

What is an Equity Gauge?

An Equity Gauge is a health development project that uses an active approach to monitoring and addressing inequity in health and health care. It moves beyond a mere description or passive monitoring of equity indicators to a set of concrete actions designed to effect real and sustained change in reducing unfair disparities in health and health care. This entails an on-going set of strategically planned and coordinated actions that involves a range of different actors who cut across a number of different disciplines and sectors. It is not a typical health research project, or even limited to actions in the public health domain.

What is the Equity Gauge Strategy?

The Equity Gauge Strategy is explicitly based on 3 "pillars of action", each considered to be equally important and essential to a successful outcome. The three pillars are:

• Research and monitoring to measure and describe inequities
• Advocacy and public participation to promote the use of information to effect change involving a broad range of stakeholders from civil society working together in a movement for equity
• Community involvement to involve the poor and marginalized as active participants rather than passive recipients

Therefore, the Equity Gauge Strategy consists of a set of interconnected and overlapping actions, and is not, as the name might suggest, just a set of measurements. For example, the selection of equity indicators to measure and monitor should be informed by the views of community groups and by a consideration of what would be useful from an advocacy perspective. In turn, the advocacy pillar relies reliable indicators developed by the measurement pillar and may involve community members or public figures.

Another important feature of the three-pillar design of the Equity Gauge Strategy is that the integration of the pillars into the project does not necessarily follow a temporal sequence. Often research projects tend to collect information, disseminate it and then undertake advocacy activities in that order. This linear approach to changing policy or affecting change has often been found to be ineffective. In an Equity Gauge, the actions of all three of its pillars should be happening concurrently.

Geographic Focus
The current Gauges encompass different approaches to geographic scope. Some Equity Gauges operate at a countrywide level, some monitor a subset of districts or provinces in a country, a few operate at a regional level and others focus specifically on equity within a city or municipality. Of the twelve Equity Gauges, nine have a national focus, and three (Cape Town, Ecuador, and Nairobi) focus at the municipal level.

A range of stakeholders
Stakeholder partnerships represent the diversity of local context. The range of partnerships includes Parliamentarians and Councillors, the media, Ministries and Departments of Health, academic institutions, churches, traditional leaders, women's organisations, community based and non-governmental organisations, local authority organisations, and civic groups. Such a diversity of stakeholders not only encourages wide social and political investment in Gauge goals, but also supports capacity development within Gauge countries. The specific goals of and partner agencies involved in each of the twelve current Equity Gauges appears in the Appendix.

Indicators to be measured
The Gauges choose indicators according to the particular needs of the country as well as of the stakeholders. However, emphasis is placed upon generating trend data within all Gauges to enable understanding of progress over time. Indicators are measured across a variety of dimensions of health as well as determinants of health, or PROGRESS variables. Dimensions of health include:

• Health status
• Health care financing and resource allocation
• Access to health care
• Quality of health care (MCH, Communicable Disease, trauma etc)
• Other underlying health determinants (e.g. PROGRESS variables, and health behaviors)

Dimensions of health include also include other health-affecting resources. The PROGRESS variables identify common determinants of health:

• Place of residence
• Religion
• Occupation
• Gender
• Race/ethnicity
• Education
• Socioeconomic status
• Social Networks/capital

Although there certainly are other socioeconomic and other determinants of health, such as language, political status, behaviors, genetic factors, or physical environment, and would be appropriately integrated into Gauge strategies, many of these factors can be appropriately integrated into the PROGRESS variables, which captures the bulk of current concerns.