Quantifying inequality and understanding inequity

In order to address inequity, we must first quantify the nature and extent of inequality that exists in a particular setting.
We recognise the importance of assessing inequality along PROGRESS+ axes such as gender, socioeconomic status, rurality and social support, and how they intersect with each other.

For example, we assessed the time taken for people at risk of cataract to travel to treatment in Kenya, Malawi and Rwanda, finding disparities in different locations and an unequal distribution of services, while demonstrating how this can be used as an indicator for physical access to services.

We have also demonstrated cumulative disadvantage in cataract blindness and service outcomes, with the likelihood of poor outcomes increasing with each additional axis along which disadvantage is experienced. Other research showed that in diverse settings, rural women without a spouse experience a disproportionate level of blindness from cataract due to lower access to good quality services.

Publications

Gender and eye health: overview of systematic reviews. (in preparation)

Rogers JT, Black J, Harwood M, Wilkinson B, Gordon I, Ramke J. Vision impairment and differential access to eye health services in Aotearoa New Zealand: protocol for a scoping review. BMJ Open. September 2021. https://doi.org/10.1136/bmjopen-2020-048215

Rogers JT, Kandel H, Harwood M, Vea T, Black J, Ramke J. Access to eye care among adults from an underserved community in Aotearoa New Zealand. Clin Exp Optom. November 2024. https://doi.org/10.1080/08164622.2023.2291527.

McCormick I, Nesemann JM, Zhao J. et al. Travel time to cataract surgical services in Kenya, Malawi and Rwanda: demonstrating a standardised indicator of physical access to cataract surgery. Eye. October 2023. https://doi.org/10.1038/s41433-023-02790-8

Ramke J, Zhao J, Wilson O, Lee A, Dakin S, Watene R, Cunningham W, Harwood M, Black J. Geographic access to eye health services in Aotearoa New Zealand: which communities are being left behind? Clin Exp Optom. March 2023. https://doi.org/10.1080/08164622.2022.2102410.

Ramke J, Kyari F, Mwangi N, Piyasena MMNP, Murthy GVS, Gilbert CE. Cataract services are leaving widows behind: examples from national cross-sectional surveys in Nigeria and Sri Lanka. Int J Environ Res Public Health. October 2019. https://www.mdpi.com/1660-4601/16/20/3854

Ramke J, Zwi AB, Lee AC, et al. Inequality in cataract blindness and services: moving beyond unidimensional analyses of social position. British Journal of Ophthalmology. February 2017. https://doi.org/10.1136/bjophthalmol-2016-309691