Developing an Ideal Health Equity Index: characteristics, challenges and perspectives from three Southeast Asian countries

Health disparities are a multi-faceted issue, with the accessibility of healthcare services accounting for only a part of human well-being. Health equity – the opportunity for everyone to attain their highest level of health – involves considerations of healthcare systems, health outcomes and contextual factors such as Social Determinants of Health. There is a growing recognition of the role of contextual, structural and social factors in shaping population health – as well as the need to measure inequities in health to guide systems-level interventions. However, no global consensus exists on measuring health equity within and beyond health systems. Limited data collection practices also pose challenges to cross-sectoral, holistic measurements of health equity, especially in low- and middle-income countries. We propose some key ideal characteristics for Health Equity Indices (HEI): (1) a comprehensive perspective, (2) appropriate data formatting and quality, (3) adaptability, (4) consensus-based mechanisms, (5) transparency and (6) practicability. Based on focus group interviews with expert stakeholders in three Southeast Asian countries (Cambodia, Thailand and Vietnam) common challenges in collecting data for health equity were identified. This research highlights the gap between the development of aspirational, cross-sectoral HEI to measure health equity and the data collection and feasibility challenges present in Southeast Asian LMICs.