The use of health inequity indicators for policy formulation, monitoring, and evaluation

Abstract

This critical and propositional essay aims to reframe the role of health inequality indicators within the policy cycle of formulation, monitoring, evaluation, and auditing of public health policies, arguing that such indicators should be understood as core instruments of substantive auditing and democratic accountability. The method consists of a conceptual and normative analysis grounded in a critical review of national and international literature on health inequalities, public policy evaluation, and distributive justice, complemented by strategically selected empirical evidence for illustrative purposes. It argues that evaluations predominantly based on average indicators tend to produce institutional blindness to persistent inequalities, thereby limiting the capacity of the State to identify distributive failures and to guide redistributive corrective action. It further argues that the systematic incorporation of inequality indicators into auditing processes enables a shift from procedural control toward an equity-oriented approach focused on policy improvement and the generation of public value. The conclusion emphasizes that, in contexts marked by structural inequalities and low social mobility, the absence of such indicators in auditing systems constitutes a significant institutional limitation, supporting their adoption as a substantive criterion of quality in public health policy evaluation.