Measuring inequality in eye care: the first step towards change

'Health inequalities' are differences in health between different subgroups of a population 1 , for example women/men, people with/without disabilities, and urban/rural dwellers. Many of us have insufficient information to understand the nature and extent of the inequalities that exist, and whether our services are effective. This lack of information restricts our ability to plan appropriate strategies to reduce inequality, and to track our progress towards equitable eye health. Fortunately, we can obtain this information by monitoring health inequality. Monitoring is a process that helps to determine whether policies and practices are working, and whether change is needed. There are two main sources of data we can use to monitor inequality – population-based surveys, and information collected from our clinics. Ideally, we would use information from both of these data sources. However, few of us have the time and money to implement population-based surveys, so this article will focus on monitoring inequality using clinic-based data. For example, you may have noticed that, compared to the community served by your hospital, most of the people undergoing cataract surgery are from the families of government employees (and very few are farmers) or from a 'wealthy' area in town (and very few from poorer areas, or rural areas), or from the most powerful ethnic, religious, or language group (and very few from minority groups). Or perhaps you have noticed that very few of your surgical patients are elderly widows. Collecting clinic-based information is a way to confirm or uncover these sorts of inequalities. To reduce inequality, we must identify which subgroup(s) of the population (e.g. farmers, people from poorer or urban areas, or minority groups) are less able to get access to, and benefit from, our services. Some of us work in settings where the Ministry of Health and/or hospital has already identified priority subgroups to monitor, so advice and resources may be available locally. For others, we will need to decide which subgroups are most relevant to monitor in our particular setting. The acronym 'PROGRESS' can help us to think about which subgroups to monitor, as it sets out a range of social factors that are often associated with health inequality (Figure 1.) 2 Some of these have obvious subgroup categories (e.g. age, gender, disability), but others require us to adopt clear and consistent definitions, e.g. socioeconomic status, education level, area of residence (rural vs urban) or occupation category. Figure 1. PROGRESS: …