Health equity is a comprehensive field that challenges the idea that those individuals with greater access to healthy resources deserve to live a healthier life.
There are many naturally occurring and expected differences in health. Examples of these include factors such as age and genetics. Health equity instead seeks to account for pervasive structural factors that unjustly contribute to differences in health:
place (urban vs. rural location), race, ethnicity, gender, income, educational status, occupational status
Practitioners in this field seek to remove obstacles to health inequalities and their resultant consequences by promoting systematic changes to the healthcare system and greater access to social resources.
Dell Medical School has adopted the following definition of health equity:
"Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care."
More about Dell Medical School's commitment to and work in the health equity space may be found on the Office of Health Equity webpage.
Definitions of key terms may be found in the following report, as well as in the "Definitions" box below:
Healthy People 2030 defines health equity as “the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”
CDC defines health equity as "the state in which everyone has a fair and just opportunity to attain their highest level of health. Achieving this requires ongoing societal efforts to:
Health disparity is “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”
"Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations."
Case Western Reserve University's Center for Reducing Health Disparities describes health disparities as "differences in the presence of disease, health outcomes, quality of health care and access to health care services that exist across racial, ethnic, and socioeconomic groups." Health disparities are linked but not limited to the availability of and access to: "Nutritious food, affordable and reliable public transportation, decent and safe housing, health insurance, clean water and non-polluted air, and culturally sensitive health care providers."
NIH defines a health disparity as a "health difference that adversely affects disadvantaged populations, based on one or more of the following health outcomes:
According to WHO, health inequity is described as "avoidable inequalities in health between groups of people within countries and between countries. These inequities arise from inequalities within and between societies. Social and economic conditions and their effects on people’s lives determine their risk of illness and the actions taken to prevent them becoming ill or treat[ing] illness when it occurs".
Braveman et al (2017) defines health inequity as "a particular kind of health disparity that is not only of concern for being potentially unfair, but which is believed to reflect injustice. There will be different views of what constitutes adequate evidence. . . . Where there is reasonable (but not necessarily definitive) evidence that underlying inequities in opportunities and resources to be healthier have produced a health disparity, that disparity can be called a health inequity; it needs to be addressed through efforts to eliminate inequities in the opportunities and resources required for good health."
"Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks."
According to Healthy People 2030, SDOH can be categorized in five main areas: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, Social and Community Context.
World Health Organzation defines social determinants of health as those non-medical factors which will affect health outcomes. "They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems".
"Leading Health Indicators (LHIs) are a small subset of high-priority Healthy People 2030 objectives selected to drive action toward improving health and well-being. As a set, LHIs cover the life span. Most LHIs address important factors that impact major causes of death and disease in the United States, and they help organizations, communities, and states across the nation focus their resources and efforts to improve the health and well-being of all people."
In Healthy People 2030, there are 23 LHIs included.
According to Centers for Disease Control (CDC), culture compentence "is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations".
It is the "integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services; thereby producing better outcomes."
"Cultural competency in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet patients' social, cultural and linguistic needs. . . . Cultural competency is recognized as an essential means of reducing racial and ethnic disparities in health care."
The Child Welfare League of America defines cultural competency as "the ability of individuals and systems to respond respectfully and effectively to people of all cultures, classes, races, ethnic backgrounds, sexual orientations, and faiths or religions in a manner that recognizes, affirms, and values the worth of individuals, families, tribes, and communities, and protects and preserves the dignity of each."
Experts in the field stress the difference between "equity" and "equality" because they differ in their approaches to improving overall access to health.
Because of the country's and healthcare system's historical legacies of structural marginalization towards certain groups, a one-size-fits-all approach would not appropriately provide greater universal access to health care. An approach centered on "equality" would provide the same assistance to all members of society, but would not adequately account for different starting points. Instead, medical professionals seek to provide diverse patients with individualized care to bring everyone to the same level of health.
Visualizing Health Equity by the Robert Wood Johnson Foundation on RWJF.org - Infographics depicting the difference between equity and equality.
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