Ensuring there are sustainable
services to promote and protect
the public health will be of limited
use if – as a result of some
oversight or unintentional action
– these services exclude some
group within society or a specific section of the
population. Services need to be sustainable and
equitable if they are to be truly effective.
Equity audit is a way of looking at how health
services are organised to meet the needs of
different people. The aim is twofold:
To identify areas of concern where it is apparent
that there are differences in health experience
and outcome for certain groups as compared
to the rest of the population, which may be
amenable to intervention; and
To recommend practical solutions, where
possible, to resolve these issues.
Equity audit is therefore an examination or
assessment (audit) of how fairly (equitably) health
resources are distributed. It is important to note
that equity is not the same thing as equality, since
the provision of extra resources may be necessary
to make sure some groups have the same
capacity to benefit from care as everyone else.
An example would be the provision of transport to
and from clinic for people with disabilities.
The proces of equity audit
Equity audit considers the delivery of services and
people’s experience of them. However, the specific
issue under investigation depends upon where on
the patient ‘pathway’, from diagnosis through to
treatment and outcome, the problem is perceived
to be located. The focus may, for example, be on
groups that appear to suffer disadvantage due to
their inability to access and/or make effective use
of services. Alternatively, it may arise as the result
of data that highlights apparent inequities, such as
higher rates for a particular clinical procedure in
some areas, with no obvious explanation.
Equity audit can be described as a six stage
process. These are outlined in Box 1.
Principles and priorities
A key principle underpinning equity audit is the
need to focus on areas where inequalities are
already known or suspected to exist. The priority
areas for equity audit in Lothian for the current
year are coronary heart disease (CHD), diabetes
and breast cancer. These have been selected for a
number of reasons, including the following:
Data shows that there are disparities between
more and less affluent groups in prevalence and
health outcomes for diabetes and CHD
(Case Study 1);
Diabetes is a long-term condition requiring
regular review and self-management by patients,
and certain groups are less likely to access
health services and information to help them
manage their condition (Case Study 2); and
Breast cancer is the most common type of cancer
for women in Scotland and there is lower uptake
of screening services by some groups of women.
Recommending interventions designed to
address the inequality issues that are identified
through equity audit is also an important part of
the process. The intervention may not be major
in terms of resources (Case Study 3), but it is
vital that whatever changes are implemented are
followed up and monitored to make sure that the
desired effect is achieved.
Equity audit assesses how fairly health resource
and services are distributed. It focuses on
where inequalities are known or suspected,
recommends interventions and monitors the
resultant impact on service provision.
Equity audit plays an important part in
addressing health inequalities in Lothian and
is a key component in ensuring sustainable
services for all Lothian people.