Abstract
The 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.
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.
| Original language | English |
|---|---|
| Article number | 118193 |
| Pages (from-to) | 1-9 |
| Number of pages | 9 |
| Journal | Social Science and Medicine |
| Volume | 379 |
| Issue number | 2025 |
| DOIs | |
| Publication status | Published - Aug 2025 |