Strengthening health information systems to address health

equity challenges
Lexi Bambas Nolen,1 Paula Braveman,2 J. Norberto W. Dachs,3 Iris Delgado,4 Emmanuela Gakidou,5 Kath Moser,6
Liz Rolfe,7 Jeanette Vega,8 & Christina Zarowsky 9

Abstract Special studies and isolated initiatives over the past several decades in low-, middle- and high-income countries have
consistently shown inequalities in health among socioeconomic groups and by gender, race or ethnicity, geographical area and other
measures associated with social advantage. Significant health inequalities linked to social (dis)advantage rather than to inherent
biological differences are generally considered unfair or inequitable. Such health inequities are the main object of health development
efforts, including global targets such as the Millennium Development Goals, which require monitoring to evaluate progress. However,
most national health information systems (HIS) lack key information needed to assess and address health inequities, namely, reliable,
longitudinal and representative data linking measures of health with measures of social status or advantage at the individual or
small-area level. Without empirical documentation and monitoring of such inequities, as well as country-level capacity to use this
information for effective planning and monitoring of progress in response to interventions, movement towards equity is unlikely to
occur.
This paper reviews core information requirements and potential databases and proposes short-term and longer term strategies
for strengthening the capabilities of HIS for the analysis of health equity and discusses HIS-related entry points for supporting a culture
of equity-oriented decision-making and policy development.

Keywords Information systems/organization and administration/standards; Delivery of health care; Social justice; Health status
indicators; Socioeconomic factors; Demography; Data collection; Databases, Factual; Policy making; Developing countries (source:
MeSH, NLM).
Mots clés Système information/organisation et administration/normes; Délivrance soins; Justice sociale; Indicateur état sanitaire;
Facteur socioéconomique; Démographie; Collecte données; Choix d’une politique; Pays en développement (source: MeSH, INSERM).
Palabras clave Sistemas de información/organización y administración/normas; Prestación de atención de salud; Justicia social;
Indicadores de salud; Factores socioeconómicos; Demografía; Recolección de datos; Bases de datos factuales; Formulación de políticas;
Países en desarrollo (fuente: DeCS, BIREME).

Bulletin of the World Health Organization 2005;83:597-603.

Voir page 602 le résumé en français. En la página 602 figura un resumen en español.

Introduction: why measure health equity? vantage come to be seen as natural and inevitable, while socially
disadvantaged groups and individuals generally lack the po-
Health equity is the absence of health differences between more
litical voice to challenge the status quo. Societies that wish to
and less socially advantaged groups (1). Sen (2) and others have increase equity in health must therefore be able to:
argued that health equity is a central dimension of overall social — identify health inequalities; and
equity or justice, as it conditions the capabilities of individuals — differentiate health inequalities reflecting random variation
and groups to participate in and benefit from social and eco- or immutable biological differences from those that could
nomic development. Without specific attention to equity issues, be decreased through medical, public health or social policy
societies tend towards inequity, as social advantage and disad- interventions feasible for a given context.

1
Consultant, Global Equity Gauge Alliance, PO Box 808, Durban, South Africa 4000. Correspondence should be sent to this author (email: lexibambas@hotmail.com).
2
Director, Center on Social Disparities in Health, Professor of Family and Community Medicine, University of California at San Francisco, San Francisco, California, USA.
3
Senior Researcher, Center for the Study of Public Policy, State University of Campinas, São Paulo, Brazil.
4
Chief, Department of Social Information, Ministry of Planning and Cooperation, Chile.
5
Research Associate, Center for Basic Research in the Social Sciences, Harvard University, Cambridge, MA, USA.
6
Lecturer, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England.
7
Statistics Adviser, UK Department for International Development (DFID), London, England.
8
Equity Team Leader, Office of the Assistant Director-General, Evidence and Information for Policy Cluster, World Health Organization, Geneva, Switzerland.
9
Team Leader – Governance, Equity and Health, Program and Partnership Branch, International Development Research Centre, Ottawa, Canada.
Ref. No. 04-019281
(Submitted: 3 November 2004 – Final revised version received: 9 March 2005 – Accepted: 9 May 2005)

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Health information systems and equity challenges Lexi Bambas Nolen et al.

This paper proposes strategies to support a more systematic Kenya, documentation of (the existence as well as) the educa-
identification and understanding of health inequities through tional and health needs of the 60% of the population living
health information systems (HIS), particularly in low- and in slums led to the provision of city services for them (8). In
middle-income countries (LMIC), to support a culture of 1982, when the mortality rate in young girls in Bangladesh
equity-oriented decision-making and policy development. was found to be between 6.7 and 21.1 times higher than that
in young boys, depending on parental educational level, local
Current knowledge organizations campaigned for women’s rights, enrolled girls in
schools, and increased access to health care. By 1996, these and
For several decades, studies have consistently shown inequali-
other actions had reduced the gap significantly, with female
ties in health among socioeconomic groups and by gender, race
mortality rates between 1.8 and 2.3 times higher than male
or ethnicity, geographical area and other social categories (3–6);
rates (8) (see Fig. 2). The choice of which health measure and
these inequalities are widely recognized to be important chal-
equity stratifier to focus on in a particular context will depend
lenges both to health development and to the creation of a just
on priority health and human rights challenges, policy infor-
society. Strong HIS incorporating both population and facility-
mation needs and opportunities for effective action. Having a
based data are essential in helping governments to demonstrate
and address such inequalities, but HIS currently provide few range of health measures and equity stratifiers within the HIS
of the data needed. Because health inequities generally reflect facilitates timely recognition of emerging or hidden inequities,
imbalances in power and wealth in society, addressing them and improves accountability for protecting vulnerable popula-
requires strategic action. Better information alone is not suf- tions. Specific health measures and equity stratifiers that inform
ficient to resolve the problems; continuous monitoring of pro-equity policy are described below.
inequities, as well as country-level capacity to use this infor-
mation for effective planning are also required for progress Health measures
towards health equity and movement towards social justice in Ideally, core health indicators should cover a range of categories,
health to take place. including health status, health care and other determinants,
Studies have revealed health inequities such as higher and the social and economic consequences of ill health. Useful
mortality rates in poor children than in children from wealthier health status indicators for equity analyses include mortality,
families (7), as well as significant barriers to accessing quality morbidity, nutritional status, functional status/disability, and
health care faced by aboriginal populations or ethnic minorities suffering/quality of life. Health care indicators include access
(8). Such studies have proven invaluable in promoting pro- to and utilization of public health care facilities and preventive
equity policy, but only when the political will and technical and curative services, as well as quality of services, allocation
capacity to translate information into policy and action was of financial and human resources, and household financing
present. In countries with HIS that routinely incorporate equity and insurance. Access to safe water and sanitation tradition-
information, pro-equity decisions can be more readily translat- ally falls within the public health realm in developed countries
ed into health policy. For instance, Chile’s ongoing, nationwide and is increasingly recognized as a core public health service in
CASEN (Encuesta de Caracterización Socioeconómica Nacio- LMIC. Key health determinants that are currently measured
nal) household survey, which monitors living conditions was and addressed unevenly across countries include food security,
recently revised to include health data, led to broad, explicitly
pro-equity reforms of health and other social sector policies
(8) (see Fig. 1). Until equity-oriented information collection Fig. 1. Data such as these spurred health reform in Chile
and analysis have been institutionalized throughout the health explicitly focused on equity issues. Infant mortality rate
information system rather than through isolated initiatives, it according to maternal years of education in Chile, 1990–95
is unlikely that governments and health development agencies
will be able to secure comprehensive, long-term, and effective 40
Neonatal
reductions in health inequities.
Post-neonatal
35
Data required for equity analyses
Infant mortality rate (x 1000 LB)

30
Health equity is the absence of systematic health differences
between more and less socially advantaged groups; it is based
25
on principles of justice, reflecting equal opportunity for all
people (individuals and groups) to be as healthy as possible (1).
To document the existence or magnitude of health inequities, 20
data are required on:
— a measure of health; and 15
— a measure of social position or advantage (an “equity strati-
fier”) that defines strata in a social hierarchy. 10

The magnitude of health inequities across different social strata 5

can then be summarized using simple calculations such as rate
ratios and rate differences, or more complex calculations such 0
as the slope index of inequality (10–13). 0 1–3 4–6 7–9 10–12 13+ National
Maternal years of education average
Combining health measures and equity stratifiers in
particular ways can yield policy-relevant information that also LB = Live births.
reveals a basic injustice in society. For instance, in Nairobi, Source: ref. (9). Reproduced with permission of the author. WHO 05.96

598 Bulletin of the World Health Organization | August 2005, 83 (8)

 Special Theme – Health Information Systems
Lexi Bambas Nolen et al. Health information systems and equity challenges

Fig. 2. The gap in mortality rates between boys and girls for tendency for political power to be concentrated in urban areas
families of low, medium, and high educational levels in or particular regions. Comparing allocations of health mea-
Bangladesh fell significantly following monitoring and sures across different provinces and districts is useful, and such
equity-oriented interventions. Gender gap in child comparisons are easily understood by non-specialists.
mortality by head of household educational level in Bangladesh
in 1982 and 1996 Linking data
Monitoring health inequities is easiest if the data on health
CMR shortfall F minus M.

30
1982 and stratifiers are derived from the same data source. If this is
1996 not possible, a mechanism is needed for linking health data
20
from one database to stratifiers in another. Furthermore, the
10
data must be assessed at the same unit of analysis, be it at the
individual, household, or small-area level. The feasibility of
0
linking data between sources varies between and within coun-
0 year 1–6 years 7+years tries, for reasons that include technical coordination, resource
Schooling of household head constraints and legal restrictions. The easiest scenario for
CMR = Child mortality rate. linking records is simply to match a unique identifier in both
F = Female. databases. This may be an individual’s unique identity number
M = Male.
(e.g. a social security number) or an identifier for a small area
Source: Bhuiya et al., 2001 (14). Reproduced with permission of the author. WHO 05.97
(e.g. a census tract, postal code or village name).
Although unique identifiers for individuals are the most
useful, to avoid complex legal and ethical issues related to the
environmental conditions, war and other types of violence,
confidentiality of data on individuals, and to move forward
social networks, and individual risk factors such as tobacco use,
quickly, a feasible short-term recommendation is to incorpo-
excessive alcohol use and sedentary lifestyle. Finally, acute and
rate small-area identifiers into all sources. For the longer term,
chronic ill health have different social and economic conse-
national and international institutions should develop legal
quences for different social strata, e.g. catastrophic illness can frameworks for incorporating unique identifiers and sharing
cause or exacerbate household poverty among disadvantaged disaggregated data while preserving anonymity and privacy.
groups where there is no social protection. Finally, individual and institutional technical capacity for data
source linkage must be developed as part of the tool kit of
Equity stratifiers equity work (21–34).
Virtually everywhere in the world, social advantage varies by
four general equity stratifiers — socioeconomic status, gender,
ethnicity and geographical area (6, 7, 15–20). These stratifiers Potential of common databases to provide
interact in complex ways, and subgroups defined by several data on equity
characteristics of these equity stratifiers are at a particular dis- The databases that show the most promise for sustainability
advantage, e.g. poor women in a marginalized ethnic group. and maximum impact on equity include censuses, vital registra-
Socioeconomic position can be reflected by economic tion systems, household surveys, small-area data and adminis-
resources, education, and/or occupation. Household wealth or trative data. Factors to consider for each database include which
assets is a particularly meaningful measure of economic resources health measures and equity stratifiers are currently available, how
because accumulated assets can be used (e.g. when income is the information can be used, and what changes could improve
temporarily low) to cover health care expenses and maintain a the potential for equity analysis.
standard of living that promotes health. Schooling (educational
attainment) and occupation are important indicators of social Censuses
status in their own right, but should not be viewed as proxies In many countries censuses are often the only available source
for wealth or income. of socioeconomic information, and censuses and vital registra-
Sex or gender are meaningful equity stratifiers for many, tion systems that cover the entire population provide essential
but not all, health measures. For example, low birth weight denominator data. Although some censuses focus only on
according to sex of the infant is not meaningful for equity population size by age and sex, many provide information on
analysis because it is not amenable to social policy, but ana- socioeconomic status, ethnicity and geographical area. Informa-
lysing differences in prevalence rates of malnutrition between tion on health status is, however, limited. Disaggregating census
boys and girls is meaningful because it indicates discriminatory data is difficult, and linking data at the individual level is often
treatment (4). impossible because records generally do not include unique
Discrimination against ethnic or racial groups can have identifiers. Recommendations for improving the contribu-
serious health and social effects (4, 6). Indicators for charac- tion of censuses to equity analyses include conducting censuses
terizing ethnicity include self-identification, social perception regularly and transparently, and including small-area identifiers.
of race or ethnicity, religion, language spoken at home, tribal Standardizing identifiers for all sources in a country according
affiliation, or status as an immigrant or native-born citizen. to census measures would facilitate the linking of databases.
Finally, groups can be advantaged according to the geo-
graphical area (e.g. urban versus rural, or better- and worse-off Vital registration systems
provinces or districts) where they live or work. Resources are Vital registration systems can reveal, for instance, inequities
often allocated on a geographical basis, reflecting both logistic between genders related to child mortality or differences in life
issues such as distance, topography and transport as well as the expectancy according to socioeconomic status. Information on

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 Special Theme – Health Information Systems
Health information systems and equity challenges Lexi Bambas Nolen et al.

several stratifiers is generally available, including geographical and denominator data are available, information such as health
areas, gender and, in some cases, educational level or occupa- service delivery data at the sub-district level is useful for pro-
tion. If geographical areas are closely related to socioeconomic gramme planning. Administrative data could be improved by
status or ethnicity, those stratifiers might be inferred. Health reducing bias resulting from non-random sampling, expanding
measures usually include age at death and sometimes include population coverage to ensure coverage of marginalized groups
cause of death and age of mothers at times of delivery. and including a small-area identifier.
The primary barrier to equity analysis is coverage, be-
cause the poorest countries, and the poorest population groups
within countries, tend to have lowest registration coverage (35,
Building a culture for equity-oriented
36). Improvements would aim at expanding registries to all decision-making
countries (they currently function well in only 57 countries); Improved data collection alone is unlikely to result in the de-
ensuring full (or at least unbiased) population coverage; and velopment of equity-oriented policy, as barriers to change are
including causes of death, birth weight and gestational age, related to underlying conditions ranging from lack of awareness
individual or small-area identifiers, and at least one additional of and capacity to address inequities, to entrenched interests
socioeconomic stratifier. that are served in an unjust system. Health stakeholders could
strengthen capacity and political will to effect policy changes,
Household surveys interventions, and measurable reductions in health inequali-
Household surveys are especially useful in revealing health in- ties through increased research, training, accountability and
equities, and are the primary source of health information for demand for equity data, and public participation.
most of sub-Saharan Africa. Surveys usually include a number Important areas of research include: pathways of health
of equity stratifiers and more health measures than censuses. inequities; the impact of interventions; and systemic, political
Household surveys generally collect data on child morbidity and social factors that affect the development of pro-equity
and mortality, satisfaction with health services, access and policy, implementation of changes, and social action. Such
distance to health care facilities, financial access and cost of research would help translate data into policy, increase demand
care, and other data. Surveys can provide information on the for equity data and provide direction for the development of
quality of housing and access to water, and whether water, interventions.
sanitation and electricity as well as access to education, have Currently there are few opportunities for training in
been fairly distributed within a society. Finally, they can be a equity analysis and interpretation. Priority areas for training
rare source of information on issues such as poverty resulting include quantitative analysis and how to strengthen policy
from family illness.
relevance of HIS, as well as equity-oriented policy analysis, use
Possible improvements include regular repetition of sur-
of qualitative information and development of interventions.
veys to track changes over time, harmonization of questions
Training should target high-level decision-makers, statisticians,
across countries to support comparisons between them, in-
researchers and civil society, and would create a critical mass
clusion of additional health outcomes, increased sample sizes
to allow more extensive analyses of inequities, and proactive of people and institutions familiar with the issues and the pos-
strategies to increase use of Demographic and Health Survey sible solutions.
(DHS) data within LMIC (37–39). Increased accountability and demand for equity data
would create pressure to collect information and spur policy
Small-area databases development. Accountability and demand could be increased
Small-area data can be useful in the absence of micro-data, by sensitizing the public, civil society, donors and other insti-
which provide information on individual persons and house- tutions to health inequities; organizational requests for routine
holds. Small-area data usually include population, death rate, reporting of data disaggregated by equity stratifiers; and inte-
and socioeconomic or demographic covariates for a county, grating and monitoring explicit equity goals in global initiatives,
municipality or postcode. Ideally, small areas correspond to a such as the Millennium Development Goals.
governmental level at which health care decisions are made. Civil society plays an important role in supporting public
Small-area data are often derived from census data, but another participation, providing feedback on which to base improve-
source is demographic surveillance sites (DSS). Each DSS is a ments and intervention efforts. An informed and active civic
geographically-defined population under continuous demo- engagement can be supported by strategies aimed at ensuring
graphic monitoring, and includes data on all births, deaths, and broad public access to data, together with transparent and fair
migrations as well as socioeconomic information on individuals processes for ensuring dialogue about policy among all stake-
and households. Although not nationally representative, the holders.
longitudinal data are extensive, complement survey data, allow Although different organizations, such as donors, govern-
streamlining of facility-based HIS, and can reveal erroneous ment, civil society and inter-governmental organizations may
denominator data in HIS. DSS have also provided informa- be best situated to address these issues, a coordinated effort
tion for the first life tables for Africa based on African data. led by international or global institutions could galvanize
Twenty-nine DSS currently operate in Africa and Asia; a fea- improvements in technical capacity, political will and public
sible improvement would be to expand the size and number participation.
of DSS to include additional low-income countries.
Conclusions and standards for an equity-
Administrative data
Administrative data from various governmental sectors, such oriented health information system
as primary school enrolment or immunization coverage, is This paper has proposed immediate possibilities as well as lon-
rarely used in equity analyses. However, if equity stratifiers ger term strategies for strengthening the potential of HIS to

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Lexi Bambas Nolen et al. Health information systems and equity challenges

Box 1. Recommendations for integrating equity into health information systems

Technical recommendations related to specific databases

• Regularly repeat transparent censuses; incorporate socioeconomic information
• Establish functioning vital registration systems with unbiased, even if incomplete, coverage; include individual or small-area identifiers and at
least one socioeconomic stratifier; record cause of death
• Regularly repeat household surveys to increase availability of trend data; increase sample size to improve robustness of equity analyses; include
adult morbidity/mortality and quality-of-life data as well as stratifiers
• Expand the size and number of demographic surveillance sites to additional low-income countries
• Improve administrative data by reducing bias, expanding population coverage, and including a small-area identifier

Systems-wide recommendations that would improve potential for equity analysis and pro-equity policy
• Support information audits to help countries determine the most appropriate stratifiers to integrate into their databases and consider how best
to support policy-making and monitoring
• Promote, through appropriate existing channels, the development of international legal standards that protect privacy for record identification,
including a geographical code indicator (according to census tract) and the sharing of disaggregated data
• Work with existing databases (vital registration, censuses, major household surveys and disease surveillance) to include a unique identifier and
a geographical code indicator that would enable linking of databases
• Support intersectoral coordination and sharing of data from databases maintained by different institutions or sectors; improve the collaborative
processes and strengthen the voice of ministries of health in discourses with all those who collect the data needed for health equity, e.g.
ministries of planning, finance and statistics
• Support research in key areas of health equity, including pathways of health inequities, effective interventions, and the systemic, political and
social factors that hinder or foster development of pro-equity policy, policy implementation and social action
• Support training in quantitative analysis and strengthening policy relevance of HIS, as well as equity-oriented policy analysis, use of qualitative
information, and development and implementation of interventions; support training at various levels (e.g. policy-makers, statisticians and civil
society groups) to support both political will and capacity throughout society
• Support increased accountability and demand for equity data through sensitization to health inequities, organizational requests for routine
reporting of data disaggregated by equity stratifiers (especially gender), and integrating and monitoring equity goals in global initiatives
• Support the participation of civil society, donors and others in public discussion; support open-membership networks for interventions and
knowledge sharing

support equity analysis. Ideally, all countries would have a a few low-income countries with a high disease burden that
wide range of health measures and equity stratifiers in each have sufficient data and capacity for analysis, thus allowing a
population-based database, or the ability to link records, as more modest investment to “tip the balance” and demonstrate
well as the technical and political ability to use information success.
to implement pro-equity interventions. The short-term goals It is also vital to plan a long-term strategy for improving
are more modest, because the ideal is distant even in countries the support that HIS can provide to societies in addressing
with strong HIS and there remain daunting challenges in health equity challenges. Several of the specific recommenda-
regard to the technical and political prerequisites for change. tions listed in Box 1 involve technical and political processes,
However, every country could achieve important improve- and countries will be able to undertake some sooner than
ments within the next few years while developing longer term others. It is to be hoped that these recommendations would
plans for tracking and addressing health inequities within and be initiated by countries themselves, with support from other
between countries. institutions. Champions of improved HIS and health equity
At present, only 39 of the 192 WHO Member States, would need to play a strong role in initiating these improve-
mostly industrialized countries, have a vital registration system ments, particularly because equity has not been a traditional
coupled with a major household survey (or record linkage ca- focus for HIS in most countries.
pacity), which are prerequisite for a basic health equity analysis. Although countries could address these recommenda-
Ninety countries have data from only one census or an old tions themselves in isolation, an international effort that
household survey (10 years old), or no data at all. The priority coordinates activities to maximize progress in data collection,
for HIS development should be to ensure that every country training, sharing of experiences, policy development and imple-
has a basic capability for health equity analysis. This means mentation could be invaluable in supporting the rapid devel-
that both countries and donors must recognize the importance opment of strong equity-oriented HIS, especially in LMIC.
of, and increase financial and technical support for, routine Although there are challenges ahead, there are also strategic
and widespread collection, analysis and application of equity- opportunities to improve the contributions of HIS to equity
sensitive health data. The countries with the fewest data and data, and to narrow the gaps in equity-relevant information
least human resource capability for equity analysis should re- among countries. O
ceive the greatest and earliest support, as they face the longest
road. A secondary strategy would be to identify and work with Competing interests: none declared.

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Résumé
Renforcement des systèmes d’information sanitaire pour combattre les injustices en matière de santé
Des études spécifiques et des initiatives isolées, menées au matière de santé, à savoir des données fiables, longitudinales et
cours des dernières décennies dans des pays ayant des niveaux représentatives, reliant les mesures de l’état de santé aux mesures
de revenus très divers, ont régulièrement mis en évidence des du statut ou des avantages sociaux au niveau individuel ou à petite
inégalités face à la santé entre les groupes socioéconomiques échelle. En l’absence de documentation factuelle et de surveillance
d’une part et en fonction du sexe, de la race et de l’origine de ces injustices, ainsi que de moyens à l’échelon national pour
ethnique ou géographique, ou autre paramètre associé à des exploiter ces informations en vue d’une planification efficace
avantages sociaux encore, d’autre part. Les inégalités importantes et d’un suivi des progrès résultant des interventions, il est peu
en matière de santé liées à des avantages ou des désavantages probable qu’une évolution plus favorable à l’équité s’opère.
sur le plan social plutôt qu’à des différences biologiques propres Le présent article examine les besoins essentiels en matière
aux individus sont généralement considérées comme injustes ou d’information et les bases de données susceptibles d’être utilisées.
inéquitables. Ces injustices touchant à la santé sont la principale Il propose des stratégies à court et long termes pour renforcer la
cible des efforts de développement sanitaire, parmi lesquels les capacité des SIS à analyser les questions d’équité face à la santé et
Objectifs de développement pour le Millénaire, qui exigent un suivi évoque les points d’entrée liés aux SIS qui permettraient d’appuyer
pour évaluer les progrès accomplis. Cependant, il manque à la l’intégration d’une culture de recherche de l’équité dans la prise
plupart des systèmes d’information sanitaire (SIS) les informations de décisions et le développement de politiques.
clés permettant d’évaluer et de combattre les injustices en

Resumen
Refuerzo de los sistemas de información sanitaria para afrontar los retos que plantea la equidad en
materia de salud
Estudios especiales e iniciativas aisladas llevadas a cabo durante longitudinales fiables y representativos que relacionen indicadores
los últimos decenios en países de ingresos bajos, medios y altos de salud con indicadores del estatus o las ventajas sociales a nivel
han mostrado sistemáticamente desigualdades en salud entre individual o en zonas reducidas. Sin documentación empírica y
grupos socioeconómicos, así como por género, raza o grupo sin actividades de monitoreo de esas inequidades, y si los países
étnico, zona geográfica y otros indicadores de ventajas sociales. carecen de capacidad para usar esa información para planificar y
Las desigualdades en salud significativas ligadas a (des)ventajas vigilar eficazmente los progresos en respuesta a las intervenciones,
sociales en lugar de a diferencias biológicas se consideran en es improbable que se logre avanzar hacia la equidad.
general injustas o inequitativas. Esas desigualdades son el principal En este artículo se consideran los requisitos de información
objeto de las iniciativas de desarrollo sanitario, incluidas metas básica y las posibles bases de datos, se proponen estrategias a
mundiales tales como los Objetivos de Desarrollo del Milenio, que corto y largo plazo que pueden fortalecer la capacidad de los
requieren actividades de vigilancia para evaluar los progresos. Sin SIS para analizar la equidad sanitaria y se examinan los puntos
embargo, la mayor parte de los sistemas de información sanitaria de acceso relacionados con los SIS en apoyo de una cultura de
(SIS) nacionales carecen de la información básica requerida para adopción de decisiones y desarrollo de políticas orientada a la
evaluar y corregir las inequidades en salud, esto es, de datos equidad.

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