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Abstract
Indices of population ‘health need’ are often used to distribute health resources or assess equity in service provision. This article describes a spatial structural equation model incorporating multiple indicators of need and multiple population health risks that affect need (analogous to multiple indicators–multiple causes models). More specifically, the multiple indicator component of the model involves health outcomes such as hospital admissions or mortality, whereas the multiple risk component models the impact on the need for area social and demographic indicators, which proxy population-level risk factors for different diseases. The latent need construct is allowed (under a Bayesian approach) to be spatially correlated, though the prior assumed for need allows a mix of spatially structured and unstructured influences. A case study considers variations in need for coronary heart disease (CHD) care over 625 small areas in London, using recent mortality and hospitalization data (the ‘indicators’) and measures of general ill-health, income and unemployment, which proxy variations in population risk for CHD.