Inequalities will be monitored for all three levels of the GPW13 impact framework: the 46 outcome indicators and milestones, the Triple Billion targets and healthy life expectancy (HALE).
For the 46 outcome indicators, disaggregated data will be used to monitor within-country inequalities (i.e. differences in health that exist between population subgroups within a country). For global-level monitoring, disaggregation will be tailored to each indicator and the same inequality dimensions will be applied across countries. For regional-, national- and subnational-level monitoring, the inequality dimensions most relevant to each WHO Region or Member State will be used for disaggregation.
For HALE and the Triple Billion targets that are measured using composite indices, data availability is generally insufficient for data disaggregation and within-country inequality monitoring. The focus will therefore be on monitoring between-country inequalities (i.e. differences in health that exist between countries).
Wherever possible, data disaggregation should be used to monitor within-country inequalities. For example, HALE can be calculated separately for men and women, allowing monitoring of within-country sex-related inequalities. For countries where disaggregated data are available, case studies can be undertaken.
WHO headquarters is responsible for global-level monitoring, Regional Offices for regional-level monitoring, and Member States (in collaboration with country offices) for national-level and subnational-level monitoring. Results from global-level monitoring will be presented as part of progress reports and dashboards. All reporting will depend on data availability.
To monitor within-country inequalities for the 46 outcome indicators, each indicator will be disaggregated by at least one dimension of inequality (e.g. demographic, socioeconomic or geographic factor, such as economic status). For each indicator and inequality dimension, at least one priority subgroup will be identified – typically the most-disadvantaged or most-vulnerable subgroup or the subgroup with the highest burden. The situation in the priority subgroup(s) will be monitored alongside the national average to show how priority subgroup(s) are performing compared to the population overall.
At the global level, inequality dimensions and priority subgroups were identified through a consultative process with domain experts at WHO headquarters. For each indicator, the most relevant inequality dimension(s) and priority subgroup(s) were selected. These may differ from indicator to indicator but are consistently applied across all countries to enable global monitoring and benchmarking.
One example of this is indicator SDG 3.6.1, “Death rate due to road traffic injuries”, where “place of residence” (urban/rural) was identified as the most important inequality dimension and “rural” as the priority subgroup. For this indicator, the progress in rural areas will be monitored alongside national average for all countries. A few other considerations:
Indicators- Disaggregation may not be possible for all indicators. Due to their inherent nature, some indicators may only be monitored at the national level. For example, indicator SDG 1.a.2, “Proportion of total government spending on essential services (education, health and social protection)”, is a national-level indicator that cannot be disaggregated. In this case, no disaggregation applies.
- Disaggregation may already be an inherent part of some indicators. For example, by definition indicator SDG 3.3.1, “Number of new HIV infections per 1000 uninfected population, by sex, age and key populations”, should be disaggregated by sex, age and key populations. In this case, indicators should be disaggregated by the pre-defined dimensions. And for each pre-defined dimension, a priority subgroup should be identified. Additional inequality dimensions and priority subgroups can also be selected.
- Double disaggregation may be considered for some indicators in order to assess intersections between two different inequality dimensions. For example, with indicator SDG 3.3.2, “Tuberculosis incidence per 100 000 population”, it may be useful to disaggregate by both age and sex.
- Indicators should be disaggregated by sex, wherever relevant and possible.
- For the same inequality dimension, the priority subgroup may be different for different indicators. For example, although the poorest quintile is often the priority subgroup when indicators are disaggregated by economic status, the richest quintile may be identified as a priority subgroup in some cases.
- For some indicators and inequality dimensions, more than one priority subgroup may be identified; however, one group will be identified as the top-priority group for the purpose of monitoring. An example of this is indicator WHA67.25/WHA68.7, “Percentage of bloodstream infections due to antimicrobial resistant organisms” disaggregated by age. Both children <5 years and elderly people ≥65 years may be priority subgroups, but for the purpose of monitoring children <5 years may be selected as the top-priority subgroup.
Inequality monitoring depends on the availability of disaggregated data by relevant dimensions such as demographic, socioeconomic or geographical factors. Possible data sources with this level of data include population representative health surveys, administrative data, civil registration and vital statistics and censuses. If disaggregated data are not available, within-country inequalities cannot be monitored.
Data availability is variable for global-level monitoring of the 46 outcome indicators. While disaggregated data for some indicators and dimensions are available for many countries, for other indicators and dimensions they are only available for a few countries. Data availability for global-level monitoring of HALE and the Triple Billion targets is generally insufficient to allow for data disaggregation and within-country inequality monitoring.
