Health equity: When equality is not good enough
When discussing public health, we often hear the terms “health equity”, “health equality” and “health inequality”, but what do they really mean? What are the subtle variances in meaning, and why is it important to understand those differences?
With the current COVID-19 pandemic and social unrest, it is now more important than ever to understand these terms as these two scenarios can exacerbate already existing health disparities between Whites and minority Americans. For example, more than half of Black American adults experience stress and hypertension and report feeling sad and hopeless at twice the rate of Whites.
Small variances in meaning make a big difference
As we recognize July as Minority Mental Health Awareness Month, understanding the three terms’ different meanings will help us figure out our path to reduce health disparities. “Health equality” means that everyone is at the same level of health. It seeks to promote fairness, but it can only work if everyone starts from the same place and needs the same help.
“Health inequality” refers to unfair health differences that are closely linked with social or economic disadvantage.
Finally, “health equity” is the attainment of the highest level of health for all people. Achieving that standard requires valuing everyone equally by focusing on those factors that lead to “health inequity” — avoidable inequalities, past and current injustices and healthcare disparities.
Let’s look at real-life examples of the difference between “equality” and “equity” to help us understand how we can address health inequality.
Equality: All public schools in a community have computer labs with the same number of computers and hours of operation during school hours, open to all students.
Equity: Computer labs in lower income neighborhoods have more computers and printers, as well as longer hours of operation, as some students do not have access to computers or the internet at home.
In other words, to achieve equity, adjustments may need to be made to bring all people to the same level, whether it’s adding computers to labs and extending their hours or, by way of example in healthcare, ensuring that there are adequate translation services. All adjustments enable the individuals — students and non-English speaking patients — to take full advantage of the services provided.
The time is now for health equity among minorities
Health disparities among minorities are well-documented. Minorities “bear a disproportionate burden of disease, injury, premature death and disability”, according to the Centers for Disease Control and Prevention. Further, it is estimated that racial/ethnic minorities will account for nearly 50 percent of the total US population by 2050; the implications for public health are even more devastating if health inequities are not addressed.
So how do we make health equity a reality?
The solution is multi-faceted and some efforts include:
- Improving educational and economic opportunities, as well as neighborhood and work conditions
- Closing critical gaps in care, including access to clinical preventive services
- Focusing on social determinants of health
As we work on these systemic changes, healthcare providers and social service organizations can take steps today to address health inequities in their routine activities. It starts with understanding one’s own biases — often unintended — and becoming educated on how to overcome these biases through cultural competency awareness and training.
In brief, cultural competency means the ability to appreciate and accurately interpret other cultures as a means to understand individuals’ needs and to design and deliver services accordingly. At the core of cultural competency is effective communication. Next week, Beacon Health Options will provide tips on how you and your organization can improve your communication skills to help reduce health disparities.
As we seek to improve health for all people, it is important to remember that health equity is not the same as health equality. We all experience the world differently, depending on ethnicity, age, gender, sexual orientation and more; what works for one person may not work for another.