New PHSR Study Reveals Strong Public Support for Reducing Health Inequality in the U.S.

Dr. Julia Slejko’s research reveals that Americans value fairness in health outcomes, emphasizing the importance of equity in health care decision-making.

By Pam Carder
December 1, 2025

A new study led by Julia Slejko, PhD, associate professor in the Department of Practice, Sciences, and Health Outcomes Research (P-SHOR) at the University of Maryland School of Pharmacy (UMSOP), suggests that a large majority of Americans may be willing to prioritize improving health outcomes for socially disadvantaged groups – even if it means forgoing some gains in overall population health, based on the data from their study sample.

Published in Value in Health, the open-access study titled “Health Inequality Aversion in the United States” offers new insight into how the U.S. public values equity in health care decision-making.

Understanding Inequality Aversion

Health inequality aversion reflects the degree to which people are willing to sacrifice total population health to reduce disparities between those who are better and worse off. Slejko and her collaborators adapted a survey instrument originally used in the United Kingdom to elicit what is known as the health inequality aversion parameter (IAP) among a nationally representative sample of U.S. adults.

Participants were asked to make hypothetical trade-offs in health improvements between different segments of the population – defined by social vulnerability indicators such as income, race/ethnicity, and overall health status.

Key Findings

Results from 1,290 participants showed that:

• 88 percent of respondents preferred prioritizing health gains for those in the worse-off population quintile.
• On average, participants weighted improvements for the most disadvantaged groups six to seven times more than gains for the better-off groups.
• Inequality aversion was relatively consistent across age and geographic region, though participants from lower-income and ethnic minority groups expressed slightly stronger preferences for equity.

“These findings suggest that the American public places substantial value on reducing health disparities,” said Slejko, who also serves as program director for UMSOP’s Graduate Program in Pharmaceutical Health Services Research (PHSR). “Our results highlight a clear societal preference for integrating equity considerations into how we evaluate health interventions and technologies.”

Implications for Policy and Health Technology Assessment

The study underscores the need to incorporate equity more systematically into U.S. health policy areas that have traditionally focused on overall efficiency and cost-effectiveness.

“Our research supports more robust and routine integration of equity concerns into health care decisions,” said Slejko. “Distributional cost-effectiveness analysis provides a way to ensure that both total health improvement and fairness are considered in policymaking.”

“Dr. Slejko’s research highlights how our faculty are advancing methods that not only evaluate the effectiveness of health care interventions, but also examine who benefits from them,” said Jill Morgan, PharmD, BCPS, BCPPS, professor and chair of P-SHOR. “Her work exemplifies our department’s commitment to promoting health equity and ensuring that research translates into meaningful policy change.”

This research was conducted as part of the Patient-Driven Values in Healthcare Evaluation (PAVE) Center at UMSOP.

Co-authors on the paper include Salomé Ricci, PharmD, MS; Susan dosReis, PhD (both of UMSOP); Richard Cookson, PhD (University of York, UK); and Stacey Kowal, MSc (Genentech, Inc.).

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