Monitoring inequality: an emerging priority for health post-2015

Editorials 591 The Millennium Development Goals focused on poverty and development and reducing inequalities between countries. 1 Progress was monitored through national averages without adequate attention to within-country inequality. The post-2015 sustainable development goals (SDG) stress " leaving no one behind " – with goal 10 specifically calling for the reduction of inequality, within and among countries. 2 Monitoring of inequalities within countries focuses on indicators and dimensions of inequality that are particularly relevant to each country. Drawing upon the outputs of within-country inequality monitoring, policies can be tailored to be maximally effective in reducing inequalities. 3 At the same time, having comparable disaggregated data across countries is important to track within-country inequality at a regional or global level. One of the SDG targets specifically addresses the importance of disaggregated data, calling on countries to increase " …the availability of high-quality, timely and reliable data disaggregated by income, gender, age, race, ethnicity, migratory status, disability, geographic location and other characteristics relevant in national contexts. " 2 Such disaggregated data are vital to identify where and why inequalities exist and ensure that policies, programmes and practices are successful in reaching the most vulnerable. Many countries have made major progress in monitoring health inequalities through household surveys such as Demographic and Health Surveys. However, currently, many basic indicators of health and well-being are not consistently available in a form that permits disaggregation by sociodemographic factors and subna-tional regions. For instance, relatively few studies have provided the global situation of within-country inequality in risk factors of noncommunicable diseases by socioeconomic status. Household health surveys now need to be extended to include more emphasis on noncommunicable diseases and injuries. Investments should be made across different data sources, including birth and death registration (with cause of death), health facility and community information systems and administrative data on health infrastructure, workforce and financing. Countries should develop technical capacity to conduct health inequality analysis and establish reporting practices that effectively communicate clear messages facilitating action. Global standards are now required to enable better international comparisons of within-country health inequality. A coordinated effort to support standardized data collection, analysis and reporting in all countries will strengthen global and regional monitoring of inequality in health. The World Health Organization (WHO) Health Equity Monitor contains comparable disaggregated data from 94 countries on the topic of reproductive, maternal, newborn and child health. 6 Using these data, a flagship report was developed …