Prioritizing the Determinants of Social-health Inequality in Iran: A Multiple Attribute Decision Making Application

BACKGROUND: One of the main challenges of healthcare systems of developing countries is health inequality. Health inequality means inequality in individuals’ ability and proper functioning, resulting in inequality in social status and living conditions, which thwarts social interventions implemented by the government. OBJECTIVES: This study aimed to determine and prioritize the social determinants of health inequality in Iran. MATERIALS AND METHODS: This was a mixed method study with two phases of qualitative and quantitative research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect qualitative data along with a multiple attribute decision making method for the quantitative phase of the research in which the TOPSIS technique was employed for prioritization. The qualitative findings were entered into NVivo for analysis, as were the quantitative data entered into MATLAB software. RESULTS: The results approved the suitability of the conceptual framework of social determinants of health suggested by the WHO (world health organization) for studying social determinants of health inequality; however, this framework general and theoretical rather than a guideline for practice. Thus, in this study, 15 themes and 31 sub-themes were determined as social determinants of social health inequality in Iran. Based on the findings of the quantitative phase of our research, socioeconomic status, living facilities such as housing, and social integrity had the greatest effect on decreasing health inequality. CONCLUSIONS: A major part of the inequality in health distribution is avoidable because they are mostly caused by adjustable factors like economic conditions, educational conditions, employment, living facilities, etc. As in the majority of developing countries the living and health conditions are the same as Iran, the findings of this study may be applicable for other developing countries.