Page 93 - Htain Manual

T
his chapter will address the importance of equity considerations in the HTA

process, describe elements that address equity considerations and discuss

frameworks for integrating these concerns.

Equity as a concept is representative of ideas of social justice or fairness. As Braveman and

Gruskin point out equity is an ethical concept, grounded in principles of distributive justice.

Equity in health can therefore be defined as the absence of socially unjust or unfair health

disparities (Braveman and Gruskin: 2003). They identify four key points relating to health

equity. These are given in box 1. It is clear from this definition that the concept of equity has
both a social and ethical aspect to it and these have relevance for HTA.

Box 1.Key points in defining Health Equity
A definition of equity in health is needed that can guide measurement and hence
accountability for the effects of health interventions on existing levels of inequity. Such a
defnition is given below:

 Health equity is the absence of systematic disparities in health (or its social
determinants) between more and less advantaged social groups.
 Social advantage means wealth, power, and/or prestige—the attributes defining how
people are grouped in social hierarchies.

 Health inequities put disadvantaged groups at further disadvantage with respect to
health, diminishing opportunities to be healthy.

 Health equity, an ethical concept based on the principle of distributive justice, is also
linked to human rights.

According to Culyer and Bombard, there are two domains of equity that are

particularly relevant for HTA. “One is fairness of the procedures used in the conduct of HTAs.

The other is equity as a decision criterion, like efficiency, for ranking health care
interventions” (Culyer and Bombard:2012; 148)

Going by the four key points mentioned in Box 1, there is a need to address multiple

determinants of equity for HTA like the choice and implementation of technology, the role of

the health service system to make it available, accessible, affordable and acceptable (4 As)
across social groups, the costs of the technology and its use. The organization of health

services is an important determinant of equity and therefore the four As of health services

as stated above need to be factored in as an important consideration. It is vital that the

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