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.


11 Comments. Leave new

Thank you – Really good article. Equity is so important to our under served population.

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this is great, thank you for starting this discussion and the examination of how to work to achieve greater health equity. as a mental health counselor, I would like to be able to provide services to more BIPOC — I do think that telehealth is a good tool for that, as it allows therapists to serve a greater diversity of locations, as well as eliminate challenges in seeking transportation and child care to support office appointments. I hope that Beacon continues to reimburse for telehealth appointments after the covid crisis passes. I look forward to more health equity discussion and resources!

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Juanita Toney
June 30, 2020 9:15 pm

It’s goes beyond understanding of own biases and becoming educated how to overcome own biases. The key is to learn how to implement that understanding and education in daily living; to fully appreciate and accurately interpret other cultures as a means to identify individuals’ needs and to design and deliver services accordingly.

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Amie Mizzi, LMHC
June 30, 2020 9:48 pm

It is so important that these issues are front and center, both for the practitioner’s knowledge and for the practitioner to acknowledge the racial (and gender) issues and inequalities that exist within our patients’ lives and treatment Initially it may be uncomfortable and awkward to address these issues with our clients/patients. That is not an excuse. We are healthcare providers and we have the moral and professional responsibility to respond to and address our patients needs.These issues need to be addressed, acknowledged and incorporated into treatment as they are part and parcel or our patients’/clients’ everyday lives. If we don’t, we are not providing adequate treatment.

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Laura Bedard
July 1, 2020 12:54 am

This was very informative and useful. Thank You.

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This is one of the reasons I so desperately hope that Telehealth medicine/behavioral health will become a permanent thing for all members. No longer will geography, transportation or work shifts be a roadblock. This is a simple, profound, critical step that we can take to ensure equality in health care provision.

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Helpful to understand the difference in definition. I believe it will require much time and committment by all of us to create real equity in all areas of our society. The inequality has been present for our entire history and now is the time for us all to step up to making reparation and amends for the inequality. I do my part in all the areas I am aware.

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As a white mental health counselor during the current period of COVID stress and social unrest, I have found it important to ask minority clients how they are responding and to invite them to share any stories of discrimination. I do a bit of self disclosure about my own dismay over recent events and what I know to be a systemic problem, to communicate this is a safe place to tell their story and express their feelings as desired. I want to ease any fear of offending me by asking open-ended questions, validating them, and showing a desire to more deeply understand their experience if they are comfortable talking about it.

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Robert Serino
July 3, 2020 2:43 pm

Very good article, thank you. May we have the courage and grace to move forward toward true equity. Hopefully, as white practitioners we can learn to push through the discomfort of our white fragility, as Robin DiAngelo might say.

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Byron Greenberg
July 8, 2020 6:12 pm

Equality does not equal sameness. If two people inter a hospital ER with the same presenting problem, best practices medicine will precipitate the same treatment, regardless of racial, ethnic, or religious status. If one of those two people chooses not to use the ER, chooses to use a home remedy, or determines that they do not trust the system enough to fully disclose all relevant symptoms, they will not receive the same treatment. We can not mandate that all people make the same choices, but we can provide education as importantly, bolster those help seeking pathways that would allow greater simplicity of access to the many services that are already available. Some of these issues are cultural in nature and you must change the culture to change the behavior. At what point will we, in the interest of doing good, violate a persons cultural values, in the service of our (healthcare providers) value of wellness? Interesting article, Dr. Dubester. Thank you

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Ruth Cohen, M.D.
July 15, 2020 1:57 am

Excellent

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