Addressing the data gap
Health inclusivity plays a critical role in improving people’s lives and bringing greater benefit to societies, yet it remains under-investigated and under-prioritised.
The Health Inclusivity Index is an independent research programme undertaken by Economist Enterprise, supported by Haleon. The objective is to assemble an international evidence base to help policymakers, regulators, academics and other professionals work towards greater health inclusivity for all.
What is health inclusivity?
Health inclusivity is the process of removing personal, social, cultural and political barriers that prevent individuals and communities from experiencing good physical and mental health.
Achieving inclusive health systems demands a Health in All Policies (HiAP) perspective. Core components include strong health literacy, community outreach programmes, equal access to healthcare services and inclusive delivery mechanisms.
About Economist Enterprise
Economist Enterprise is the arm of The Economist Group that provides services to businesses, government agencies and financial institutions. Its work is grounded in The Economist Group’s values of independence, integrity and progress. Economist Enterprise gives organisations the tools to make better decisions, take confident action and demonstrate leadership on a global stage.
Find out more about Economist Enterprise:
https://www.economistgroup.com/press-centre/the-economist-group/the-economist-group-launches-economist-enterprise
Effective March 2026, Economist Impact has been rebranded as Economist Enterprise. Some materials may still refer to Economist Impact; these references should be read as Economist Enterprise.
About Haleon
As a global leader in consumer health, Haleon’s purpose is to deliver better everyday health with humanity. At Haleon, we are working collectively towards a world where everyone is included in everyday health; to help people build the confidence and know-how to take more control of their everyday health, remove the barriers that hold people back, and make our products more accessible to everyone.
Haleon is supporting the Health Inclusivity Index to raise awareness of the barriers that limit truly inclusive healthcare, and highlight best practice examples that help policymakers across the world to develop inclusive policies, systems and practices that promote better health outcomes for all.
Only by understanding the barriers to good health for all people can we design a truly inclusive health system.
The Health Inclusivity Index:Measuring Progress Towards Good Health for Everyone, 2022.
The Health Inclusivity Index has undertaken three research phases so far
Phase 1 (2022)
The initial research phase analyses the policies, strategies, infrastructure and programmes of 40 countries to determine the extent to which they deliver health inclusivity.
Phase 2 (2023)
The second phase gathers the views of people within the 40 Index countries to understand their experiences of inclusion and exclusion when accessing healthcare services. It also identifies gaps between policy and practice, particularly among excluded and underserved population groups.
Phase 3 (2025)
The third phase examines the health and economic impact of improving inclusivity for specific population segments that are at risk from health exclusion.
Methodology
Structuring the research
The Health Inclusivity Index is the first research programme to examine the state of health inclusivity in 40 countries. To achieve a robust comparative snapshot of each country, we analysed data using three domains, each of which is split into three subdomains.
How strongly does the country advocate the right to health, and how firmly is it protected and promoted in national policy?
SubDomains- Right to health
- Wellbeing promotion
- Social determinants of health in policy
- Vulnerable population groups
- Health exclusion
- Health inequalities monitoring system
- Intersectoral cooperation policy
- Tobacco control
- Marketing of foods to children
- Dietary guidelines for healthy eating
- National policy on alcohol
- Taxes on alcohol and unhealthy food
- Food insecurity policies
- Oral health policy
- Implementation of SDGs
How developed is the country’s healthcare system and infrastructure, and how inclusive is it for people from all backgrounds?
SubDomains- Government health expenditure
- Population spending more than 10% on health
- Impoverishment due to out-of-pocket spending
- Migrant healthcare coverage
- Physicians
- Nursing and midwifery personnel
- Dentistry personnel
- Pharmacists
- Healthcare provider training
- Electronic health records
- Telehealth
- Public and private sector coordination
- Universal health coverage service coverage index
How accessible are the country’s healthcare services, and how easily can people manage their own health and wellbeing?
SubDomains- Person-centred healthcare
- Translation services
- Community companions
- Case management
- Health literacy programmes
- Health information for self-care
- Health outreach programmes
- Public/community participation in policy
- Human development index
Country selection
We selected 40 countries from the six World Health Organization regions, focusing on those with the largest populations that represent a breadth of income levels. This enables us to compare the challenges for similar countries and their efforts to improve health inclusivity.
Research indicators
The Index uses an extensive range of indicators across the three domains to examine many aspects of a country’s approach to health. For each domain, we also identified a ‘spirit of implementation’ indicator that characterises how a country implements other indicators within that domain (see Structuring the Research above).
15
quantitative indicators
Drawn from pre-existing datasets such as the WHO Global Health Observatory, WHO Global Health Expenditure Database, and the Migrant Integration Policy Index (MIPEX).
22
qualitative indicators
Designed specifically for the Index to analyse factors for which no cross-country datasets were readily available. These indicators are scored using detailed criteria.
14
supplementary indicators
Collected to provide further context, but are not part of the inclusivity score calculations. These indicators include measures of healthcare spending and outcome, and composite measures such as the EIU Democracy Index.
Index scores
Overall health inclusivity scores for each country were produced by normalising, weighting and combining the scores of the three domains and their indicators.
Indicator scores are presented on a normalised scale between zero and 100, where 100 is the most health inclusive.
Weightings reflect the importance attached to each element of the Index, with equal weighting attached to the three domains.
Expert engagement
Strategic guidance for phase 1 of the Health Inclusivity Index was provided by a Steering Committee consisting of 11 experts from across academia, civil society organisations and multilateral agencies. An Expert Panel of five additional experts reviewed and commented on the preliminary framework of the Index.
To interpret, understand and contextualise our findings from phase 1, we conducted 10 bilateral interviews with global experts.
Furthermore, our deep learning phase was supported by a team at University College London (UCL) led by Professor David Napier, Professor of Medical Anthropology. This guidance enabled us to understand the determinants that affect health and how they interact.
Structuring the research
The second research phase turns its attention to the views of people within the 40 Index countries. We conducted a survey of over 40,000 individuals to explore the extent to which they have experienced inclusion or exclusion when accessing healthcare services. These insights were added to the Index framework from phase 1 (indicated with an asterisk).
How strongly does the country advocate the right to health, and how firmly is it protected and promoted in national policy?
SubDomains- Right to health
- Wellbeing promotion
- Social determinants of health in policy
- Vulnerable population groups
- Health exclusion
- Health inequalities monitoring system
- Migrant healthcare coverage*
- Public and private sector coordination*
- Intersectoral cooperation policy
- Tobacco control
- Marketing of foods to children
- Dietary guidelines for healthy eating
- National policy on alcohol
- Taxes on alcohol and unhealthy food
- Food insecurity policies
- Oral health policy
- Basic living standards*
- Access to housing*
- Access to education*
- Climate change and health*
- Implementation of dietary guidelines*
- Level of food security*
How developed is the country’s healthcare system and infrastructure, and how inclusive is it for people from all backgrounds?
SubDomains- Government health expenditure
- Population spending more than 10% on health
- Impoverishment due to out-of-pocket spending
- Physicians
- Nursing and midwifery personnel
- Dentistry personnel
- Pharmacists
- Healthcare provider training
- Electronic health records
- Telehealth
- Barriers to accessing healthcare services*
- Access to women's health services*
- Denied access to care*
- Discrimination in quality of care*
- Access to affordable healthcare*
- Access to electronic health records*
- Access to telehealth*
- Availability of essential healthcare services*
- Accessibility of essential healthcare services*
How accessible are the country’s healthcare services, and how easily can people manage their own health and wellbeing?
SubDomains- Person-centred healthcare
- Translation services
- Community companions
- Case management
- Health literacy programmes
- Health information for self-care
- Health outreach programmes
- Public/community participation in policy
- Social cohesion in community*
- Quality of engagement with healthcare*
- Unfair treatment in receipt of services*
- Experiences of person-centred healthcare*
- Access to translation services*
- Features to support access to healthcare*
- Access to health information*
- Sources of health information*
- Awareness of person-specific health risks*
Country selection
We used the same country selection from phase 1, which spans 40 countries from the six World Health Organization regions. The selection focuses on those with the largest populations that represent a breadth of income levels, which enables us to compare the challenges for similar countries and their efforts to improve health inclusivity.
Research indicators
The Index uses an extensive range of indicators across the three domains to examine many aspects of a country’s approach to health. Supporting these are a broad spread of supplementary non-scoring indicators.
8
quantitative indicators
Drawn from pre-existing datasets such as the WHO Global Health Observatory, WHO Global Health Expenditure Database, and the Migrant Integration Policy Index (MIPEX).
26
qualitative indicators
Designed specifically for the Index to analyse factors for which no cross-country datasets were readily available. These indicators are scored using detailed criteria.
17
supplementary indicators
Collected to provide further context, but are not part of the inclusivity score calculations. These indicators include measures of healthcare spending and outcome, and composite measures such as the EIU Democracy Index.
24
survey indicators
Derived from our extensive survey of over 40,000 individuals across the 40 Index countries. These indicators explore a broad range of health inclusivity experiences.
Index scores
Overall health inclusivity scores for each country are produced by normalising, weighting and combining the scores of the three domains and their indicators.
Indicator scores are presented on a normalised scale between zero and 100, where 100 is the most health inclusive.
Weightings reflect the importance attached to each element of the Index, with equal weighting attached to the three domains.
Expert engagement
Strategic guidance for phase 2 was provided by two advisory groups. Our Expert Steering Committee was composed of five members of the phase 1 Steering Committee. Our multidisciplinary Expert Advisory Group was composed of 17 members from across academia, civil society organisations and multilateral agencies.
Structuring the research
The third research phase examines the health and economic impacts of removing barriers that prevent good health for underserved population segments. It focuses on seven health topics across four demographic groups.
Phase 3 also includes forcefield analysis and stakeholder mapping to create health inclusivity roadmaps for five countries. These outline the steps that countries can take, and which stakeholders would be best placed to implement them.
Country selection
We used the same country selection from phase 1, which spans 40 countries from the six World Health Organization regions. The selection focuses on those with the largest populations that represent a breadth of income levels, which enables us to compare the challenges for similar countries and their efforts to improve health inclusivity.
Economic impact modelling
Phase 3 includes a series of economic impact assessment models to measure the effects of improving inclusivity for seven health topics.
Each of the seven models investigates a specific health topic for a specific underserved population group (summarised below). For detailed information about model construction, visit the Data and Reports page and download the phase 3 method statement.
| Model | Scenario | Target population |
|---|---|---|
| Air Pollution (PM2.5) | Reducing annual PM2.5 concentration in line with WHO Targets (5 ug/m3) | Lower-income groups |
| Tooth decay | Reducing the progression rate of dental caries by 30% | Lower-income groups |
| Gum disease and type 2 diabetes | Reducing the risk of developing type 2 diabetes among people with gum disease | Lower-income groups |
| Health literacy | Reducing inadequate health literacy by 25% | People with low health literacy |
| Micronutrient deficiency (anaemia) | Reducing the prevalence of anaemia by 50% by 2030 (in line with SDG goals) | Women of reproductive age (15-49 years old) |
| Musculoskeletal conditions | Reducing the incidence or recurrence of musculoskeletal conditions through various forms of primary and secondary prevention | Older adults (aged 50+) and women (aged 18+) |
| Osteoporosis | Reducing spinal and hip fractures due to osteoporosis by 30% and 20%, respectively | Older adults (aged 50+) |
Country roadmaps
The phase 3 roadmaps leverage two types of analysis: forcefield analysis and stakeholder mapping.
FORCEFIELD ANALYSIS
Forcefield analysis is a methodology that enables us to assess and score factors that support or hinder health inclusivity in five countries.
We chose three factors: health literacy, healthcare access, and empowering people and communities. For each factor, we identified three enablers and three barriers.
After an extensive literature review, we conducted interviews with experts from the five countries, who were asked to score the factors from 1 to 4 depending on their level of impact (see table below). The interview results were analysed and triangulated with the literature review to finalise scores for each country, which identified the most significant gaps and opportunities for change.
| Scoring | Enablers | Barriers |
|---|---|---|
| 1 = Weak impact | Force exists but has little impact on health inclusivity | Force exists but has little impact on health inclusivity or can be addressed easily |
| 2 = Some impact | Force has some impact on health inclusivity, but is still developing, is not widely utilised or implemented, or only certain groups may take it into consideration | Force poses some resistance to health inclusivity but can be eliminated with planning and resources |
| 3 = Considerable impact | Force has some impact, but is not being followed or utilised enough to achieve optimal health inclusivity | Force poses considerable resistance to health inclusivity, but the impact can be minimised with extensive planning and resources |
| 4 = Strong impact | Force is a high-quality, generally accepted standard of practice and/or provides optimal health inclusivity | Force poses strong resistance to optimising health inclusivity |
STAKEHOLDER MAPPING
Stakeholder mapping enables us to identify leaders and organisations that are best placed to drive change, either by strengthening the enablers or removing the barriers discovered in our forcefield analysis.
Based on the literature review and interviews for the five countries, we identified the key stakeholders and the actions that would have greatest impact. These are displayed as part of the stakeholder map in each roadmap.
Expert engagement
Phase 3 consisted of bilateral interviews with more than 40 experts from across the Index countries. They contributed subject matter, geographic and methodological expertise for different aspects of the research programme, with expertise spanning academia, clinical medicine, civil society organisations and multilateral agencies.
Health drives wealth: the economic impact of health inclusivity
Take a closer look at the phase 3 modelling methodology, including an overview of how the economic impact assessments were defined, developed and carried out.
