New research shows that assessing people’s capabilities to transform resources and living conditions into health choices can be useful in research on health equity. A researcher says that considering this is necessary to assess how various interventions promote or reduce health equity.
Many countries have a political goal of attaining or at least improving equity in health.
Everyone should have the same opportunities to be and become healthy, including consulting healthcare professionals, receiving treatment and getting well, whether they are rich or poor, male or female and live in urban or rural areas.
But equity in health can be measured in many ways, and determining whether political interventions have the intended effect can therefore be difficult.
In a new study, researchers introduce new theoretical perspectives to this field.
They argue that assessing health equity should include the concept of capabilities – people’s ability to flourish and lead lives they have reason to value.
Nobel Prize winner Amartya Sen developed the concept of capabilities, which is not yet widely used in health but may soon be.
“With this concept, we are expanding how we can assess equity in health. Then we do not solely focus on resources, genetics or social conditions but also on people’s capabilities to transform health and other services into something that makes sense for them and their perception of the world,” explains an author behind the study, Karsten Vrangbæk, Professor, Department of Public Health, University of Copenhagen.
The research, with PhD student Ina Tapager as first author, has been published in Health Economics, Policy and Law.
Empirical tools required
Karsten Vrangbæk says that the concept of capabilities has attracted interest from the health authorities in the United Kingdom, including the National Institute for Health and Care Excellence, but that researchers are still struggling with using the concept empirically to study health equity.
To clarify whether the concept of capabilities is useful in health research, the researchers wanted to map potential ways to use the concept in empirical health research. They did this by focusing on chronic disease management programmes in Denmark as an empirical case to investigate the dimensions of health equity and capabilities.
Karsten Vrangbæk says that these chronic disease management programmes are interesting because they are an early and ambitious attempt to structure the collaboration across public authorities and treatment levels for the growing number of people in Denmark needing treatment for chronic diseases.
“However, investigating this intervention is very challenging because the pace and scope of implementation has differed across Denmark and because how this type of structural policy initiative influences the participants is transformed through many stages in a system in which many parameters also change,” says Karsten Vrangbæk.
Capabilities useful in studying health equity
In the article in Health Economics, Policy and Law, the researchers present and discuss the concept of capabilities in the context of health equity.
They then analyse whether Denmark’s chronic disease management programmes include aspects that demonstrate the relevance of applying capabilities in studies of health equity. This part of the research shows that several aspects of the chronic disease management programmes have formulations that are close to the thinking behind the concept of capabilities: considering the differences in people’s capacity to transform goods and services to benefit their health.
Finally, the researchers discuss various proposed empirical tools to use capabilities to analyse interventions. According to Karsten Vrangbæk, the question is how to get from an abstract theoretical concept to a questionnaire that can be used in studying health equity. The researchers review some proposed tools in the article.
Overall, the article indicates that the concept of capabilities may be useful.
“We conclude that the concept of capabilities is relevant, although quite abstract, to use in studying health equity. We also conclude that the chronic disease management programmes can be interpreted in a capabilities perspective and that various existing measurement tools can be used in discussing capabilities in relation to health equity,” explains Karsten Vrangbæk.
Karsten Vrangbæk explains that, based on their conclusions, the researchers are taking the next step in mapping how capabilities can be included in practice for studying health equity.
The goal is to be able to carry out targeted studies, including how individual people’s capabilities will determine how an intervention will affect their health.
The researchers have already carried out studies empirically investigating how people with different capabilities manage chronic disease and transform their available resources to reduce the likelihood of experiencing problems related to illness and improve well-being.
The researchers did this with diabetes and COVID-19 as cases, and in both scenarios, they found that the more capable people are in transforming their resources to manage illness and health, the less likely they will experience challenges and the more likely their health will improve.
“This qualifies the ability to measure people’s capabilities and use them in the context of complex chronic disease management programmes,” concludes Karsten Vrangbæk.