Introduction
Methods
Identification of HEIA models, checklists, and reporting tools
Search strategies
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((“Health equity”) OR (“Health inequality”)) AND ((Assessment) OR (Measurement) OR (Evaluation)) AND ((Framework) OR (Tool) OR (toolkit) OR (Checklist)) AND ((Impact) OR (Effect)) AND (Reporting Checklist) AND (“Health system”).
Inclusion criteria
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Studies that dealt with health equity impact assessment and health impact assessment were included. Studies that provided conceptual tools and models were also included in the analysis. We also included studies that explained health equity, because they were likely to have discussed the dimensions and components of the tools and frameworks.
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Studies at the national, district, or regional scales or those with limited samples were included regardless of their design (longitudinal, cross-sectional, cohort, etc.).
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Considering the concept of equity, we included studies that used different aspects and methods of health equity impact assessment in their data analysis.
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Studies that were in the form of protocols or had introduced tools entered the final phase of the analysis.
Exclusion criteria
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In languages other than English.
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Merely addressing the importance of HEIA.
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Literature reviews.
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Assessed and measured health equity indicators.
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Provided frameworks for assessing equity indicators or introducing health equity indicators (we were interested in a framework to examine the impact of politics on health equity).
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Investigated the impact of policies related to health equity on health equity indicators.
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General expression and assessment output, without providing details of implementation steps.
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Addressing HIA obstacles and challenges.
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Provided insufficient information to be used in our research; and
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Provided solutions to promote health equity.
Data analysis
Title
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Study design
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Country
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Study Level
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Year of publication
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Approach
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Summary results
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Processes and procedures of implementing the tool
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Examined indicators and criteria
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The method of implementing the tool
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HEIA actors
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Initial design of HEIA reporting checklist
Validation of the HEIA reporting checklist
Dimension of face and content validity | Criteria |
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Analyses of face validity for each item through two options | It is Clear and expressive |
Not clear and expressive | |
Analyses of content validity index (CVI) for each item through five options: | Totally disproportionate |
Disproportionate | |
Somewhat proportionate | |
Proportionate | |
Totally proportionate | |
Analyses of content validity ratio (CVR) for each item through three options: | Necessary |
Useful but not necessary | |
Unnecessary |
Pilot implementation of the HEIA reporting checklist
Steps of HEIA | Methods used in this study |
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Screening | - Qualitative interview - Using algorithm screening (Additional file 1: Appendix 3) |
Scoping | - Rapid review - The scope of this HEIA was determined as below: ◦ Doing a Rapid assessment ◦ Management of HEIA” Health Equity Research Center (HERC), Tehran University of Medical Science (TUMS) ◦ Time duration: 5 weeks ◦ Thematic scope: The policy of Removing the subsidies from some basic food products - HEIA subject scope: According to the assessed policy and the studies conducted in this regard, the following health indicators and issues were considered and assessed: ◦ Growth trend of consumer price index (CPI) ◦ Food inflation rate trend ◦ Amount of food consumption ◦ Change the trend of calories consumed by people ◦ Prevalence of malnutrition ◦ Prevalence of underweight and short stature in children under 5 years old - Geographic Area: people of Iran - Duration of potential impacts: assessment of short-term and long-term impacts |
Impact Identification | - Comprehensive review - Qualitative interview |
Assessment of Impacts |
Using dynamic systems methods
Library review and qualitative interview methods were used to assess the required data. Then, the prospective analysis method of dynamic systems was applied to show the logical relationship between the studied variables and indicators, during which dynamic systems and loops as well as how they were affected and related were determined. The coefficients and intensity of the impacts of the variables on each other were extracted through the review of the studies, and/or the impact of policy implementation on the defined variables was evaluated and predicted for the coming years |
Decision-making and Recommendations | - Comprehensive review - Expert panel |
Results
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Section I: Policy introduction (eight subsections)
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Section II: Managing the HEIA of policy (seven subsections)
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Section III: Scope of affected population (three subsections)
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Section IV: HEIA Results (seven subsections)
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Section V: Recommendations (three subsections).
Section I
Policy introduction
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Policy: Policy means any document that is supposed to receive the approval of the parliament.
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Title: The exact title of the policy to be approved and is supposed to be evaluated from the perspective of health equity.
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Main goal: The general goal of the policy under review.
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Type of policy: Checklist aimed to ensure that all government approvals considered equity. In this section, the type of proposal and its level were checked.
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Policy level: Determining whether the policy was national, provincial, or local (local meant one or more districts or one or more specific cities (smaller than the province level).
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Department(s) and Institution(s) Proposing a Policy: In this section, the main government department(s) and institution(s) that proposed policy for parliamentary approval were introduced.
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Department(s) Affected by the Policy: Defining the beneficiaries of a policy that might be directly or indirectly affected by its implementation.
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Trustee of policy implementation: The main custodian(s) of implementing the proposed policy.
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Date of policy proposal in the parliament: The time for proposing policy to the parliament.
Section II
Managing the HEIA of policy
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Assessment type: Different types of HEIA could be typologically divided into four categories: desk-based HEIA, rapid HEIA, middle HEIA, and comprehensive HEIA (Table 5).
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Credit for conducting the assessment (Iranian Rial): Funding HEIA at different scales, the amount of financial aid, depending on the scope and extent of the assessment.
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Research team & authors: The name and affiliation of the main assessors.
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Number of team members: The number of policy assessment team members involved in field and report compilation.
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Assessment duration: The time spent on HEIA.
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Type of reporting and dissemination: The way that HEIA reports might be presented, i.e., formal reports, executive summaries, community reports, or briefing reports [17].
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Does the checklist have any attachments? Whether the completed checklist has any attachments; as well as the number and title of each attachment.
desk-based HEIA | rapid HEIA | middle HEIA | comprehensive HEIA |
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✓ Taking 2 days to 1 week ✓ Providing an overview of potential health impacts | ✓ Very fast (1 week to 6 weeks) | ✓ 4 weeks to several months | ✓ Several months to several years |
✓ Based on available documents | ✓ Requiring few resources | ✓ Requiring a moderate amount of resources | ✓ Requiring significant resources |
✓ Without beneficiaries’ participation | ✓ Without beneficiaries’ participation | ✓ Participation of some beneficiaries | ✓ Significant participation of beneficiaries |
✓ No need to collect new data | ✓ Collecting some new data often relies less on the existing data bank | ✓ usually including the collection of primary data |
Section III
Scope of affected populations
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Introducing the affected population: The affected population could include ordinary people of a region, a specific group of patients, a specific category of jobs, a specific age group, and/or those with any other characteristics. The section specifies whether the population was affected by the positive or negative impacts of the policy.
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The number of affected populations: The number of affected people for each of the aforementioned groups.
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Distribution of affected population: Distribution of the affected populations by age, sex, education level, economic quintile, vulnerable groups, and geographical region.
Section IV
HEIA results
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Type: This section deals with the “types” of health equity impacts, referring to the effects of policy implementation on inequalities in health impacts (mortality rates, incidence and prevalence of diseases, etc.).
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Direction: To indicate whether the impact was beneficial or harmful to health equity.
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Affected population: To specify the affected population separately for each of the specified impacts.
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Duration of impact1: When or how long does the exposure often occur? The time interval between the implementation of the policy and its effect on each health equity impact was determined and recorded:
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✓ One to two years: short-term
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✓ Two to five years: medium-term
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✓ Over five years: long-term.
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Likelihood of impact: This refers to the likelihood of exposure or impact. Likelihood refers to the strength of the research/evidence, showing causal relationships between policy impacts and health equity impacts: limited evidence, limited but strong evidence, and a causal relationship established. A causal impact meant that the impact was likely to occur regardless of its severity or magnitude.
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Impact severity: This part showed how severe potential health impacts might be:
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✓ Low: The effect was not noticeable.
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✓ Moderate: The impact results were discomfort, minor injuries, or illnesses that did not require interventions.
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✓ High: The impact led to moderate injury or illness that might require interventions.
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✓ Very high: The impact led to loss of life, serious injuries, or chronic diseases that required interventions.
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Overall assessment of the impact of policy on health equity: In this part, according to the aforementioned information, the assessor gave his overall judgment about the impact of the policy under review on health equity: low, medium, high, and very high.