Opinion: Health inclusivity is now a viable — and measurable — goal

Combating disparities in health has been on the global health agenda for decades — and most recently the COVID-19 pandemic has put an immense spotlight on the realities we face globally. But simply assessing inequities in how health resources are distributed cannot explain why these gaps continue, or more importantly show us how to tackle them. Enter the notion of health inclusivity.

Health inclusivity means removing the personal, social, cultural, and political barriers that prevent individuals and communities from experiencing good physical and mental health. But until as recently as last month, health inclusivity was a concept with no single mechanism to measure it and no objective for governments to strive for.

This is why we embarked on developing the first-of-its-kind Health Inclusivity Index, supported by Haleon. The index measures the degree of health inclusivity within a country, through a set of 37 indicators that assess the country’s progress toward the provision of good physical, mental, and social health for all.

Our goal is to help policymakers improve health inclusivity, benchmark progress, and deliver greater health equity to society. While undoubtedly there will be debate with our framework and results, we are confident that our transparent approach to defining and quantifying health inclusivity will enrich policy conversations and, ultimately, drive action.

Defining the levers to address health inequity

Through the process of establishing the index, we found that wealth alone is not enough for good health. Though unsurprisingly the index highlighted that countries with a higher GDP per capita tend to be more inclusive, many countries with lower economic wealth perform well despite this limitation, including Colombia, Kazakhstan, the Philippines, Poland, and South Africa. We also saw that higher government health spending does not necessarily translate into more inclusive health care.

Instead, we confirmed that health is predominantly influenced outside of the formal health system. The best predicator of a country’s overall health inclusivity score stemmed from factors that enable individuals to take charge of their own health and provide them with the core tools to do so.

Key levers in this area include good housing within a health-promoting environment, access to good education, economic opportunities, opportunities to be physically active within an environment that facilitates this, and access to a balanced and health-promoting diet.

While top results centered on elements related to social determinants of health, there were key and relevant findings for health systems and policies. In particular, we found that universal health coverage is necessary, but not sufficient, for health inclusivity. Inclusivity in health requires that services are accessible, easy to navigate, affordable, and of decent quality for all.

It follows, therefore, that the provision of health care services must also be coordinated and appropriate for the individual, and provided in the community. Identifying and prioritizing marginalized populations with health care delivery are also important factors, though it is worrying that 1 in 5 countries studied were found to have practices that restrict access to health care for parts of society.

The path forward

Like many of the experts engaged to help guide our work, we believe the Health Inclusivity Index fills a critical void in the global drive for better health equity. The framework and objective policy measures provide a concrete, quantitative way to think about health inclusivity, or a clear path for action.

The tool also begins to connect the dots between health outcomes and economic consequences. We found a moderate positive relationship between healthy life expectancy and index scores, indicating that supporting health inclusivity may be a way to drive better health outcomes and higher productivity as a result.  

Armed with these insights, countries can start to identify opportunities to improve and ultimately achieve better health for all. And while this first iteration is a positive step in the right direction, our journey with health inclusivity has just begun.

Over the next two years, we intend to double the number of countries included in the index to provide a more comprehensive picture of health inclusivity around the world. We will also leverage the results to interact with key partners in a range of locations and with key thematic areas in order to encourage engagement and dialogue, and spur action on health inclusivity.

The recent World Health Summit reminded us that better health for all is not just a priority for the health community but is also a societal imperative as a healthy population underpins strong economies and thriving communities. While putting that into practice is easier said than done, the results of the index clearly lay out an argument that a holistic, cross-sectoral approach is the best and most logical path forward.