Authors: Farah Husein
Equity is defined by the WHO as the “absence of unfair, avoidable, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other dimensions of inequality (e.g., social class, ethnicity, gender, age and disability).”1 Equity enables all people to participate, perform, and engage; it differs from equality, wherein everyone is treated equally, irrespective of their needs.2
Health is a fundamental human right. Health equity is achieved when everyone can attain their full potential for health and well-being.1 Inequity in health care can lead to disparities in health outcomes, with equity-deserving communities experiencing higher rates of illness, disability, and premature death.3,4 In addition, it can exacerbate social and economic inequalities that already exist.
Health Technology Assessment (HTA) has been described as a multidisciplinary process that uses explicit methods to determine the value of a drug, diagnostic test, medical device, or procedure (collectively referred to as health technologies) at different points in the life cycle. The purpose is to inform decision-making to promote an equitable, efficient, and high-quality health system.5-7 Considering equity in HTA can help ensure that health care interventions are evaluated and implemented fairly, and that health systems are aware of and can take measures to redress inequities where possible to achieve the best health outcomes for everyone. Equity-focused HTA aims to identify and address potential gaps in access, outcomes, and costs, and to help decision-makers promote equitable health care delivery.
Consideration of equity in HTA has the potential to:
address disparities: equity-focused HTA helps identify disparities in access, outcomes, and costs, particularly for marginalized or underserved populations, addressing health inequities
promote social justice: attending to equity in HTA aligns with the ethical principle of justice, ensuring that health care resources are distributed fairly across population groups and that equity-deserving groups have opportunities for access to health improvements that meet their needs
enhance decision-making: HTA that takes equity into account provides decision-makers with a more comprehensive understanding of the potential impact of an intervention on different population groups, enabling informed and ethical choices
optimize resource allocation: by examining the distribution of benefits and risks, equity-focused HTA helps allocate limited resources fairly, targeting interventions where they are most needed
improve trust: prioritizing equity in HTA enhances transparency, accountability, and public trust in our health care systems, as people see that their diverse needs and perspectives are considered in health care decision-making
prevent unintended consequences: without equity considerations, interventions could inadvertently widen health disparities or negatively affect certain groups, leading to unintended consequences.
CADTH has made a commitment to apply a lens of equity and inclusiveness throughout the organization, to foster health systems that include diverse persons across Canada and can better respond to their self-identified priorities and health needs.
1.World Health Organization. Health equity. 2023; https://www.who.int/health-topics/health-equity#tab=tab_1. Accessed 2023 Oct 5.
2.Canadian Centre for Diversity and Inclusion. Glossary of IDEA terms: a reference tool for inclusion, diversity, equity, and accessibility terminology. [Toronto]: Canadian Centre for Diversity and Inclusion; 2023 May: https://ccdi.ca/media/4005/20230509-glossary-of-idea-terms-en.pdf. Accessed 2023 Oct 10.
3.Statistics Canada. Determinants of health. Health of Canadians. Ottawa: Statistics Canada; 2023 Sep 13: https://www150.statcan.gc.ca/n1/pub/82-570-x/2023001/section4-eng.htm. Accessed 2023 Oct 5.
4.Public Health Agency of Canada. Key Health Inequalities in Canada: A National Portrait – Executive Summary. Ottawa: PHAC; 2018 May 28: https://www.canada.ca/en/public-health/services/publications/science-research-data/key-health-inequalities-canada-national-portrait-executive-summary.html. Accessed 2023 Oct 5.
5.CADTH Framework for Patient Engagement in Health Technology Assessment: Introduction. 2022 Jan 19; https://www.cadth.ca/cadth-framework-patient-engagement-health-technology-assessment. Accessed 2023 Oct 5.
6.Goodman C. HTA 101: Essential Information for Newcomers. [Place unknown]: [Publisher unknown]; [2023]: https://htai.org/wp-content/uploads/2023/06/The-Newcomers-Guide-HTA101-1.pdf. Accessed 2023 Oct 5.
7.O'Rourke B, Oortwijn W, Schuller T. The new definition of health technology assessment: A milestone in international collaboration. Int J Technol Assess Health Care. 2020;36(3):187-190. PubMed