Re-engineering health policy research to measure equity impacts

The determinants of health inequality have become increasingly well understood, but policy makers have repeatedly failed to address the issue effectively, and many public health interventions unintentionally worsen inequalities because they disproportionately benefit those with greater resources. This is a policy failure, but it is also a scientific failure. Although policy makers often understand that their decisions have differential impacts across society, the analytical tools used to inform policy lack a substantial perspective on equity, focusing on averages rather than social distributions, leading to inequitable solutions. In an age of social division driven by rising inequality, rigorous new methods for precisely measuring the equity impacts of health and social policy interventions are required, drawing on new partnerships between researchers across disciplines. By developing these methods, and using them to assess the effectiveness of major public health and healthcare initiatives, researchers can improve understanding of the structural, behavioural and organizational barriers to delivering equitable health outcomes. Policy makers will then have the necessary information to judge who gains and who loses from their decisions.