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Monitoring privilege for health equity: building consensus on indicators to monitor socioeconomic advantage through a modified Delphi survey

Author

Listed:
  • Carrad, Amy
  • Schram, Ashley
  • Townsend, Belinda
  • Harris, Patrick
  • Baum, Fran
  • Rychetnik, Lucie
  • Allender, Steven
  • Pescud, Melanie
  • Friel, Sharon

Abstract

The World Health Organization's Commission on Social Determinants of Health highlighted the need to measure and monitor the inequitable distribution of power, money, and resources across society. Efforts to monitor health inequity focus on disadvantage rather than advantage or privilege, and on proximal health outcomes rather than distal social and structural determinants of health. This study aimed to identify a comprehensive set of key indicators to measure and monitor socioeconomic advantage. Following a literature review to establish an initial set of indicators (n = 79), we used a three-round, online Delphi survey to build consensus among a panel of participants with diverse disciplinary backgrounds and with expertise related to socioeconomic inequity. Participants rated indicators for relevance to the concept of socioeconomic advantage using a seven-point Likert scale and ranked priority indicators among selected indicator categories. Thirty-one, 21 and 15 experts—predominantly from Australia— participated in the first, second and third round, respectively. Sixty-four of 76 indicators reached consensus, including all indicators within the ‘Wealth’ and ‘Income/wealth inequality’ categories. Priority rankings of economic indicators were clear: gross income and disposable income were the highest ranked income indicators; net wealth was the highest ranked wealth indicator. Ranking of ‘Connections and signalling indicators’ was less distinct; however, elite secondary schooling, and attendance at exclusive events received the highest mean ranks. Monitoring of these socioeconomic advantage indicators is crucial for identifying whether policy and governance is ultimately shifting the dial on equitably distributing resources for improving health equity outcomes.

Suggested Citation

  • Carrad, Amy & Schram, Ashley & Townsend, Belinda & Harris, Patrick & Baum, Fran & Rychetnik, Lucie & Allender, Steven & Pescud, Melanie & Friel, Sharon, 2025. "Monitoring privilege for health equity: building consensus on indicators to monitor socioeconomic advantage through a modified Delphi survey," Social Science & Medicine, Elsevier, vol. 379(C).
    • Handle: RePEc:eee:socmed:v:379:y:2025:i:c:s0277953625005234
    DOI: 10.1016/j.socscimed.2025.118193
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    References listed on IDEAS

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    1. Lucas Chancel, 2022. "Global carbon inequality over 1990–2019," Nature Sustainability, Nature, vol. 5(11), pages 931-938, November.
    2. Lucas Chancel, 2022. "Global carbon inequality over 1990–2019," PSE-Ecole d'économie de Paris (Postprint) halshs-04157767, HAL.
    3. Anthony B. Atkinson & Thomas Piketty & Emmanuel Saez, 2011. "Top Incomes in the Long Run of History," Journal of Economic Literature, American Economic Association, vol. 49(1), pages 3-71, March.
    4. Weijters, Bert & Cabooter, Elke & Schillewaert, Niels, 2010. "The effect of rating scale format on response styles: The number of response categories and response category labels," International Journal of Research in Marketing, Elsevier, vol. 27(3), pages 236-247.
    5. repec:plo:pone00:0221250 is not listed on IDEAS
    6. Belton, Ian & MacDonald, Alice & Wright, George & Hamlin, Iain, 2019. "Improving the practical application of the Delphi method in group-based judgment: A six-step prescription for a well-founded and defensible process," Technological Forecasting and Social Change, Elsevier, vol. 147(C), pages 72-82.
    7. Yonatan Berman & Branko Milanovic, 2024. "Homoploutia: Top Labor and Capital Incomes in the United States, 1950–2020," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 70(3), pages 766-784, September.
    8. Lucas Chancel, 2022. "Global carbon inequality over 1990–2019," Post-Print halshs-04157767, HAL.
    9. Ingrid Robeyns, 2019. "What, if Anything, is Wrong with Extreme Wealth?," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 20(3), pages 251-266, July.
    10. Thomas McGregor & Brock Smith & Samuel Wills, 2019. "Measuring inequality," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 35(3), pages 368-395.
    11. Ka Ching Chan & Christopher T. Lenard & Terence M. Mills & Ruth F. G. Williams, 2019. "Measuring inequality in society," Communications in Statistics - Theory and Methods, Taylor & Francis Journals, vol. 48(1), pages 88-99, January.
    12. United Nations UN, 2015. "Transforming our World: the 2030 Agenda for Sustainable Development," Working Papers id:7559, eSocialSciences.
    13. Richard G. Wilkinson & Kate E. Pickett, 2024. "Why the world cannot afford the rich," Nature, Nature, vol. 627(8003), pages 268-270, March.
    14. Bana e Costa, Carlos A. & Oliveira, Mónica D. & Vieira, Ana C.L. & Freitas, Liliana & Rodrigues, Teresa C. & Bana e Costa, João & Freitas, Ângela & Santana, Paula, 2023. "Collaborative development of composite indices from qualitative value judgements: The EURO-HEALTHY Population Health Index model," European Journal of Operational Research, Elsevier, vol. 305(1), pages 475-492.
    15. Pickett, Kate E. & Wilkinson, Richard G., 2015. "Income inequality and health: A causal review," Social Science & Medicine, Elsevier, vol. 128(C), pages 316-326.
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