An analysis of the concept of equity and its application to health visiting

The aim of this paper is to provide an in-depth analysis of the concept of equity in the British health visiting service and thus facilitate understanding of the term. An attempt has been made to apply the analytical process to the context of health visiting.

Equity has been discussed at some length in the health literature. Much of this including the health visiting literature discusses inequality and inequalities in health at the same time as discussing equity. Increasingly, poverty and inequalities have become accepted as determinants in poor health. It seemed appropriate therefore to analyse these topical and seemingly related concepts.

A well established method of concept analysis has been utilized to facilitate the process of analysis.

Confusion between the meaning and application of the concepts of equity and equality was found. Much of the health visiting and health care literature related to addressing the needs of groups who experience inequality in terms of service provision, and access to services. Following an in-depth critical analysis of the literature three critical attributes of the concept were identified: equal opportunity of access to services; a high standard of service for everyone; and unequal distribution of services to meet unequal need. These relate to two distinct forms of equity: horizontal and vertical equity. A definition of equity has been proposed. Maxwell's (1992) framework is suggested as a means to evaluate equity in service provision and uptake.

Most of the literature examines equity at a macro level, that is service level. Nurses and health visitors are urged to examine the services that they are involved in to determine the level of equity that is achieved or not attained. Suggestions have been offered as to how this task may be undertaken. A definition has been proposed to stimulate debate and discussion about the concept within nursing contexts.