IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v379y2025ics0277953625005234.html
   My bibliography  Save this article

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
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953625005234
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2025.118193?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. Lucas Chancel, 2022. "Global carbon inequality over 1990–2019," Post-Print halshs-04157767, HAL.
    6. Richard G. Wilkinson & Kate E. Pickett, 2024. "Why the world cannot afford the rich," Nature, Nature, vol. 627(8003), pages 268-270, March.
    7. Pickett, Kate E. & Wilkinson, Richard G., 2015. "Income inequality and health: A causal review," Social Science & Medicine, Elsevier, vol. 128(C), pages 316-326.
    8. Lucas Chancel, 2022. "Global carbon inequality over 1990–2019," PSE-Ecole d'économie de Paris (Postprint) halshs-04157767, HAL.
    9. 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.
    10. United Nations UN, 2015. "Transforming our World: the 2030 Agenda for Sustainable Development," Working Papers id:7559, eSocialSciences.
    11. 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.
    12. Lucas Chancel, 2022. "Global carbon inequality over 1990–2019," Nature Sustainability, Nature, vol. 5(11), pages 931-938, November.
    13. repec:plo:pone00:0221250 is not listed on IDEAS
    14. 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.
    15. 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.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Mundaca, Luis & Wamsler, Christine, 2025. "Engaging high-income earners in climate action: Policy insights from survey experiments," Ecological Economics, Elsevier, vol. 227(C).
    2. Okushima, Shinichiro, 2024. "Measuring energy sufficiency: A state of being neither in energy poverty nor energy extravagance," Applied Energy, Elsevier, vol. 354(PA).
    3. Dong, Kangyin & Zhao, Congyu & Nepal, Rabindra & Zander, Kerstin K., 2025. "Are natural disasters stumbling blocks to carbon inequality mitigation? A global perspective," Ecological Economics, Elsevier, vol. 227(C).
    4. Tobias Angel & Alexandre Berthe & Valeria Costantini & Mariagrazia D’Angeli, 2024. "How the nature of inequality reduction matters for CO2 emissions," Working Papers 2024.14, Fondazione Eni Enrico Mattei.
    5. El Tinay, Hassan & Schor, Juliet B., 2025. "Do economists think about climate change and inequality? Semantic analysis and topic modeling of top five economics journals," Ecological Economics, Elsevier, vol. 232(C).
    6. Nicolli, Francesco & Gilli, Marianna & Vona, Francesco, 2025. "Inequality and climate change: Two problems, one solution?," Energy Economics, Elsevier, vol. 145(C).
    7. Francisco Estrada & Veronica Lupi & W. J. Wouter Botzen & Richard S. J. Tol, 2025. "Urban and non-urban contributions to the social cost of carbon," Nature Communications, Nature, vol. 16(1), pages 1-11, December.
    8. Wang, P.P. & Huang, G.H. & Li, Y.P. & Luo, B. & Li, Y.F., 2025. "Unveiling China's household CO2 emissions with disaggregated energy sectors: An affinity-propagation multi-regional input-output model," Renewable Energy, Elsevier, vol. 238(C).
    9. Zhao, Congyu & Jia, Rongwen & Dong, Kangyin, 2023. "Does financial inclusion achieve the dual dividends of narrowing carbon inequality within cities and between cities? Empirical evidence from China," Technological Forecasting and Social Change, Elsevier, vol. 195(C).
    10. Oskar Lindgren & Erik Elwing & Mikael Karlsson & Sverker C. Jagers, 2024. "Public acceptability of climate-motivated rationing," Palgrave Communications, Palgrave Macmillan, vol. 11(1), pages 1-9, December.
    11. Robert Istrate & Victor Tulus & Robert N. Grass & Laurent Vanbever & Wendelin J. Stark & Gonzalo Guillén-Gosálbez, 2024. "The environmental sustainability of digital content consumption," Nature Communications, Nature, vol. 15(1), pages 1-11, December.
    12. Sager, Lutz, 2025. "Global air quality inequality over 2000–2020," Journal of Environmental Economics and Management, Elsevier, vol. 130(C).
    13. Córcoles, Carmen & López, Luis Antonio & Osorio, Pilar & Zafrilla, Jorge, 2024. "The carbon footprint of the empty Castilla-La Mancha," Energy Policy, Elsevier, vol. 184(C).
    14. Ollier, Maxime & De Cara, Stéphane, 2024. "Give and take: An analysis of the distributional consequences of emission tax-and-rebate schemes with an application to greenhouse gas emissions from European agriculture," Ecological Economics, Elsevier, vol. 219(C).
    15. Zhang, Zhao & Zhang, Feipeng & Ma, Caoyuan, 2024. "Does carbon emission trading scheme inhibit corporate executives' pursuit of excess compensation? Evidence from a quasi-natural experiment in China," Energy Economics, Elsevier, vol. 139(C).
    16. Jared Starr & Craig Nicolson & Michael Ash & Ezra M Markowitz & Daniel Moran, 2023. "Income-based U.S. household carbon footprints (1990–2019) offer new insights on emissions inequality and climate finance," PLOS Climate, Public Library of Science, vol. 2(8), pages 1-24, August.
    17. Cappelli, Federica & Di Bucchianico, Stefano, 2025. "What is the role of profit and luxury consumption in the ecological transition?," Economic Modelling, Elsevier, vol. 147(C).
    18. Veríssimo, Diogo & Blake, Katie & Flint, Hilary Byerly & Doughty, Hunter & Espelosin, Dulce & Gregg, Emily A. & Kubo, Takahiro & Mann-Lang, Judy & Perry, Laura R. & Selinske, Matthew J. & Shreedhar, G, 2024. "Changing human behavior to conserve biodiversity," LSE Research Online Documents on Economics 126106, London School of Economics and Political Science, LSE Library.
    19. Cappelli, Federica & Di Bucchianico, Stefano, 2024. "What role for profits and luxury consumption in the ecological transition?," IPE Working Papers 245/2024, Berlin School of Economics and Law, Institute for International Political Economy (IPE).
    20. Teaghan L. Hogg & Samantha K. Stanley & Léan V. O’Brien, 2024. "Validation of the Hogg Climate Anxiety Scale," Climatic Change, Springer, vol. 177(6), pages 1-17, June.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:379:y:2025:i:c:s0277953625005234. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.