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

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dc.contributor.authorCarrad, A.
dc.contributor.authorSchram, A.
dc.contributor.authorTownsend, B.
dc.contributor.authorHarris, P.
dc.contributor.authorBaum, F.
dc.contributor.authorRychetnik, L.
dc.contributor.authorAllender, S.
dc.contributor.authorPescud, M.
dc.contributor.authorFriel, S.
dc.date.issued2025
dc.description.abstractThe 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.
dc.description.statementofresponsibilityAmy Carrad, Ashley Schram, Belinda Townsend, Patrick Harris, Fran Baum, Lucie Rychetnik, Steven Allender, Melanie Pescud, Sharon Friel
dc.identifier.citationSocial Science and Medicine, 2025; 379:118193-1-118193-9
dc.identifier.doi10.1016/j.socscimed.2025.118193
dc.identifier.issn0277-9536
dc.identifier.issn1873-5347
dc.identifier.orcidBaum, F. [0000-0002-2294-1368]
dc.identifier.urihttps://hdl.handle.net/2440/147738
dc.language.isoen
dc.publisherElsevier
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/2013563
dc.rights© 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
dc.source.urihttps://doi.org/10.1016/j.socscimed.2025.118193
dc.subjectSocioeconomic advantage; Privilege; Health equity; Delphi; Indicator; Monitoring; Determinants of health
dc.subject.meshHumans
dc.subject.meshConsensus
dc.subject.meshSocioeconomic Factors
dc.subject.meshDelphi Technique
dc.subject.meshAustralia
dc.subject.meshHealth Status Disparities
dc.subject.meshSocial Determinants of Health
dc.subject.meshSurveys and Questionnaires
dc.subject.meshHealth Equity
dc.titleMonitoring privilege for health equity: building consensus on indicators to monitor socioeconomic advantage through a modified Delphi survey
dc.typeJournal article
pubs.publication-statusPublished

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