The Health Equity Assessment Tool

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

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Abstract

The Health Equity Assessment Tool (HEAT) is used for assessing the potential for health interventions to reduce health inequalities. The tool consists of a set of 10 questions that enable the assessment of policies, programs and service interventions for their current and future impact on health inequalities. It can be used by planners, funders and providers, and is part of the reporting requirements of District Health Boards. In 2008 a user guide to support HEAT has been published.

Purpose of health policy or idea

In New Zealand, inequalities in health are regarded as avoidable, unnecessary and unjust. Reducing inequalities is therefore one of the main objectives specified in the New Zealand Health Strategy. The challenge now is to develop and implement interventions that are effective in reducing inequalities. The Health Equity Assessment Tool (HEAT) has been developed to assist planners, funders and providers to assess the potential of policies, programs and service interventions for reducing inequalities. Ideally the tool is used prospectively for assessing new interventions. However, it can also be used retrospectively to assess existing programmes and services. The tool consists of the following ten questions:

1. What inequalities exist in relation to the health issue in question? 
2. Who is most advantaged and how? 
3. How did the inequalities occur? What are the mechanisms by which the inequalities were created, maintained or increased? 
4. Where/how will you intervene to tackle this issue?
5. How will the intervention improve Maori health outcomes and reduce health inequalities experienced by Maori?
6. How could this intervention affect health inequalities?
7. Who will benefit most?
8. What might the unintended consequences be? 
9. What will you do to make sure the intervention does reduce inequalities?
10. How will you know if inequalities have been reduced?

The tool has been a part of the District Health Boards' standard reporting procedures since 2004. This provides a clear incentive to focus on interventions that have the potential to reduce inequalities. Since 2008, HEAT is supported by a User Guide that provides guidelines to decision-makers about sources of information and methods for framing the answers to the 10 questions.

Main points

Main objectives

To ensure that funding is directed towards interventions that reduce health inequalities.

Type of incentives

The incentive is to direct money at services which reduce inequalities. However there are no financial incentives associated with application of this tool.

Groups affected

Disadvantaged groups, District Health Boards, Service providers

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

HEAT has been developed specifically for use in New Zealand. However the basic questions could easily be adapted for use in other countries.

Political and economic background

Since the publication of the New Zealand Health Strategy in 2000, health policy in New Zealand has increasingly focussed on policies and programs that reduce health inequalities. The gap in health status between Maori and Pacific people and other New Zealanders is of particular concern, but there are also socioeconomic and geographical inequalities. Although many of the causes of health inequalities (such as income, housing and education) lie outside of the health sector, the health sector has accepted a leadership role in initiating interventions for reducing these inequalities.  

Change based on an overall national health policy statement

The New Zealand Health Strategy

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

HEAT was adapted by academics and Ministry of Health staff in New Zealand from a health equity assessment tool developed in Wales. The tool was first trialled in 2002/2003 and amended for use in 2004. A review in 2005 led to further modifications and the development of a User Guide in 2008. Although many countries are now interested in interventions which reduce health inequalities, health equity assessment tools are not widely used internationally. Two exceptions are the Health Inequalities Impact Assessment (which was developed in the UK and which formed part of the basis for HEAT), and Four Steps Towards Equity, a health promotion equity tool developed in Australia.

In New Zealand HEAT is used most frequently by people making funding, planning and policy decisions, particularly the Ministry of Health and the District Health Boards (which are responsible for funding or providing health services for their geographic populations). Initially HEAT was used primarily for assessing public health programmes. However it can also be used for assessing other interventions including clinical services. Wider use by other groups including local government authorities, private providers, and community groups is also now being encouraged.

Initiators of idea/main actors

• Kostenträger: DHBs use the tool to evaluate new projects.

• Bürgergesellschaft: The Ministry of Health has been the main actor in developing and promoting the use of HEAT.

Approach of idea

The approach of the idea is described as:
renewed: Based on a tool developed in Wales and amended for use in New Zealand in 2002/03.

Stakeholder positions

At this stage, the Ministry of Health and District Health Boards (DHBs) have been the main users of HEAT. While other people within the sector (especially Maori providers) are aware of the tool, many are not using it as yet unless specially required to do so by DHBs. There has been no obvious opposition from any groups about the development and implementation of the tool. 

Actors and positions

Kostenträger
District Health Boards	sehr unterstützend		stark dagegen
Bürgergesellschaft
Ministry of Health	sehr unterstützend		stark dagegen

Actors and influence

Kostenträger
District Health Boards	sehr groß		kein
Bürgergesellschaft
Ministry of Health	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

The Ministry of Health has funded training courses in the use of HEAT for health sector personnel and this has been an important component in take-up of the tool. Publication of the User Guide has stimulated wider interest and there have been requests for further training.

Adoption of HEAT to date may have been constrained by confusion with other existing tools such as Health Impact Assessment (see "Health Impact Assessment", Survey No. 9/2007) or other guides which have been developed specifically for assessing the impact of health policies on the Maori population.

An important factor that should encourage wider adoption of HEAT will be the build-up of some case history which provides potential users with an understanding of its application in practice.

Expected outcome

The impact of HEAT on reducing inequalities depends on the breadth of its application, the validity of responses by users, and the extent to which resources actually flow towards those interventions which are expected to reduce inequalities. The breadth of application has been increasing over time as awareness and understanding of the tool has increased. The recent publication of a User Guide, together with workshops to assist users of the tool, should improve the validity of responses.

 

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

Recent research suggested that DHBs are focussing primarily on the distribution of new money as a means of addressing inequalities. HEAT is therefore generally being used to assess the impact of this new money, rather than the impact of existing expenditure on inequalities. The overall objective of reducing inequalities is only likely to be met if DHBs and others in the health sector are willing to extend the use of HEAT to assess the impact of existing expenditure on inequalities in health outcomes. 

References

Sources of Information

Signal, Louise, Jennifer Martin, Fiona Cram and Bridget Robson. The Health Equity Assessment Tool: A User's Guide. Wellington: Ministry of Health, 2008. www.moh.govt.nz/moh.nsf/pagesmh/8198/$File/health-equity-assessment-tool-guide.pdf

Bro Taf Authority. Planning for Positive Health Impact: Health Inequalities Impact Assessment Tool. Cardiff: Bro Taf Authority, 2000.

King, Annette. The New Zealand Health Strategy. Wellington: Ministry of Health, 2000.

Author/s and/or contributors to this survey

Cram, Fiona and Toni Ashton

Fiona Cram: Ngäti Kahungunu (indigenous tribe of New Zealand), mother of one son, PhD, is the Director of a small research, evaluation and training company, Katoa Ltd., Wellington.

Empfohlene Zitierweise für diesen Online-Artikel:

Cram, Fiona and Toni Ashton. "The Health Equity Assessment Tool". Health Policy Monitor, October 2008. Available at http://www.hpm.org/survey/nz/a12/4