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Health Equity Audit: guidance on methodology

Key guidance documents on HEA methodology are:

Health Development Agency/Association of Public Health Observatories: Health Equity Audit Made Simple: A briefing for Primary Care Trusts and Local Strategic Partnerships (2003)

Department of Health: Health Equity Audit - A Guide for the NHS (2003)

Health Development Agency: Making the Case – Health Equity Audit (2005)

Health Development Agency: Clarifying approaches to: health needs assessment, health impact assessment, integrated impact assessment, health equity audit, and race equality impact assessment (2005)

These documents were published over the period 2003-2006 when HEA practice was evolving. While there are some differences in emphasis, all have in common the six-stage cycle below.

Stages of HEA

  1. Agree partners to work with and choose issues with highest impact, eg cancer, coronary heart disease, primary care and the dimension of inequality to be audited, eg age, area etc.
  2. Identify any gap in service provision, service need, access, use or outcome, using collected information, and construct need/equity profiles
  3. Agree high-impact local action to narrow the gap – consider provision, access, use, and quantity and quality of services
  4. Agree priorities for action – identify highest-impact intervention for effective local action
  5. Secure changes in investment and service delivery, and embed the outcome in mainstream planning, eg in NHS local delivery plans and service and financial frameworks; move resources to match need
  6. Conduct ongoing review of progress to assess impact on how the gap is narrowing – ensure effective evaluation is occurring through indicators being in place, and identify local areas or groups where more action is required

In February 2006 the National Institute for Health and Clinical Excellence published Health Equity Audit – Learning from Practice Briefing which provides a summary of learning from three workshops on HEA, and examples of completed or near-completed HEAs to illustrate these learning points.