This week I’ve chosen to evaluate the Wikipedia entry “Health Equity,” a subject area of great personal and professional interest. Below, I will assess the article through a framework of six domains: comprehensiveness, sourcing, neutrality, readability, formatting and illustrations. To give a brief overview, the article’s strong points are in breadth of information and overall quality of sourcing. Its weaknesses are predominantly in depth and contextual insight.
The article makes a good effort to cover a broad range of the different variables that are known to demonstrate inequity in health outcomes, covering race, ethnicity, sex, sexual orientation, age and at least an attempt at socioeconomic status, among others. What it fails to show in more than skeletal nature are the mechanisms of how these lead to inequitable outcomes. In fact, following the common misconception from the general public and even many within the medical profession, the article focuses almost exclusively on healthcare provision as the source of health disparities, rather than the wider determinants of health (Eg housing, sanitation, security, education and healthcare). A conceptual framework for the determinants of health is given by the WHO here. This is not to say that healthcare is not important, but that it is part of a complex tapestry of factors influencing our health. A good example is that of Rose and colleagues, who in their seminal work – the Whitehall study – showed there to be vast differences in health outcomes between different professions in the UK civil service, despite the fact that all of these professional groups had access to free healthcare under the British National Health Service.
Second, with further regard to the depth of the article, there is room for improvement. An example is seen Under “Ethnic and Racial disparities,” where there is one sentence at the end of the section dedicated to the role of slavery impacting on African American health in the US. While an in-depth account of slavery is beyond the scope of the Wikipedia article, the crucial mechanism that is crying out for explanation here is the generational effect of health inequity, where disadvantaged groups are likely to pass on health disadvantages to their children. The author might have focused on the higher rate of premature births and thus lower birth weights among African American women, which carries considerable health risks for the newborn in later life, who in turn is more likely to give birth prematurely, in a cyclical fashion unless disrupted.
Third, the contextual insight is lacking in several places; the use of study findings is presented in a way that does not show a basic understanding of epidemiology. For example, the finding that “African American men were 30% more likely than white men to die from heart disease” does not specify a time period (5-year, 10-year etc) or the measure used to calculate this (cumulative incidence, incidence rate etc).These measures should be specified to demonstrate better contextual insight. Taking off points for Sourcing (below), the reference for this particular statement was not found after searching with both Google and Harvard Library.
One the whole there are 107 references cited, with some additional resources provided. On the whole, the sources are from scientific journals, with a smaller proportion of books and several key publications from Intergovernmental Organizations like the WHO. I would say the authors should be commended for the number and source type, which are appropriate for a public health article, and abide by Wikipedia’s principle of Notability, in that the knowledge provided by the article is verifiable. The impact factor of the journals cited is variable, but this is to be expected with a list of references of greater than 100.
On a superficial level, the article successfully draws on examples from multiple locations throughout the globe to ensure that its application does not lie solely in, for example, the United States.
On a deeper level, the article does make a number of assumptions with regard to the intrinsic value of health equity. Coming from this background, it is easy to forget that this may not be obvious to every reader. Indeed, the value of health equity may even hold more weight if it is accompanied by an ethical discussion. To this end, a discourse in the different egalitarian perspectives in ethics would be warranted, such as those put forward by luck egalitarians. To discuss further whether health – in particular health equity -should be given special status, the authors might draw on Norman Daniels’ theory of social justice.
Apart from several long paragraphs, the article is easy to read with a good variability in sentence length and structure. Generally, the use of headings also aids the flow of the reading. Specialist terminology is, in many cases, explained.
Referring to the Wikipedia Manual of Style, the article contains an introductory lead section and the article is divided into headings, though more could be made of sub-headings. For example, the paragraph “Socioeconomic Status” uses only one subheading “Education,” whereas income and social capital as two other markers are described above without their own subheadings. There is no overuse of unexplained abbreviations.
While the article contains only one diagram – depicting the density of physicians per 100,000 population for each country – it might be an inappropriate use of resources to require more illustrative content for its own sake. I would argue, however, that for many of the variables giving rise to health inequity, further illustration would be beneficial. A simple graph depicting, for example, the infant mortality rate (number of deaths of infants under 1 year old per 1000 live births) for different racial groups would help to convey important information quickly to the reader.