Creating health gains or widening gaps:The role of health outcomes

Issue addressed: Health policy in Australia, including that related to illness prevention and health promotion is increasingly focussed on evidence of health outcomes. Although there is evidence of gains in the health status of the Australian population, these have not been shared evenly by all population groups, leading to increased inequalities in health. To date, the health outcomes approach and the research used to inform that approach has given little consideration to variations in outcomes among populations and the implications for equity. Methods: A literature review and critical analysis were undertaken. Results: Although the health outcomes approach has not addressed the issue of equity goals explicitly, there is an implicit endorsement of the position that all health gains should be valued equally, irrespective of who gains. The pursuit of maximum health outcomes may lead to widening gaps between the advantaged and disadvantaged in our society. Conclusion: There is a need for all health outcomes initiatives to explicitly address equity considerations. This requires monitoring health staus differentials within populations and analysing variations in the effectiveness of interventions. A new program of research focussed on what works to improve health specifically in disadvantaged groups, rather than considering the effectiveness of interventions in isolation from their context, would provide the evidence-base for health policy concerned with inequalities in health.