Health Equity

What is Health Equity?

The term "health equity" is often used to describe the services, situations, and environments that focus on health outcomes being equal for all individuals.  Health equity is defined as the “attainment of the highest level of health for all people.” ^[1] In order to achieve health equity, the focus should be on equal outcomes instead of equal inputs; this often requires providers, planners, community leaders, and workers in the public health system to focus on equity rather than equality and fairness.

Equality vs. Equity:

Equality places an emphasis on treating everyone the same, no matter their differences.  Equity places an emphasis on ensuring everyone has the same opportunities which might require additional effort or mean providing different services in order to obtain similar outcomes.

What are Health Disparities/Inequalities?

When talking about "achieving health equity," it is important to address "health inequities."  Health inequities are differences in the health status of different groups of people – differences that are unnecessary and avoidable as well as unjust and unfair^. [2] Equity is “an ethical concept, grounded in principles of distributive justice.” ^[3] This means equity is concerned with the proportional distribution of goods and services with the intent of avoiding inequalities in outcomes.

Disparities and Inequities are often used interchangeably, however, there are differences between them. Health disparities and health inequalities are synonymous while health inequity has a clear difference.

Health disparities “refer to differences in the health status of different groups of people.  Some groups of people have higher rates of certain diseases compared to others.” ^[2], [4] These groups may be based on race, ethnicity, immigration status, age, gender or sexual identity, sexual orientation, income, geography, or disability.  All health inequities are health disparities, however, not all health disparities are health inequities. Examples of health disparities that are not health inequities are:

• 81% of people living with Alzheimer’s are age 75 or older. An estimated 4% are under the age of 65. ^[5]
• Men are about 100 times less likely to develop breast cancer than women. ^[6] 

These disparities are attributed to biological variations that are unavoidable and, for the most part, impossible, ethically, or ideologically unacceptable to change.  A health disparity becomes a health inequity when it is “attributed to the external environment and conditions mainly outside the control of the individual concerned.” ^[2] Examples of health disparities that are health inequities are:

• Infant mortality rates for infants of non-Hispanic black mothers are more than double the rates for infants of non-Hispanic white mothers. ^[7]
• During 2008-2010, death rates due to heart disease were highest in Southern states and lowest in Western states. ^[8]

These disparities are preventable and can be changed which makes them inequities.

Taking a Health Equity Approach with HIV:

To achieve health equity with HIV means to eliminate health inequities by decreasing HIV rates so they are proportionate to the demographic make-up of an area.  For example, if African American’s are 11% of the overall population, an equitable distribution of HIV would see African Americans making up 11% of all new HIV acquisitions. 

In order to achieve this reality, efforts to address HIV cannot be equal and must place emphasis on communities with the greatest prevalence.

For example, if gay and bisexual men account for 70% of all new HIV acquisitions, then 70% of resources devoted to HIV prevention should be devoted to this community.

This includes “implementing structural approaches to HIV prevention and care that address conditions such as housing, education, employment, and food security; and reducing stigma and eliminating discrimination associated with HIV acquisition.” ^[18] Implementing structural approaches to address HIV would involve addressing social determinants of health and equity and creating programs and services that work to eliminate conditions contributing to HIV acquisition.  These conditions include, but are not limited to; poverty, insufficient sex education, and joblessness. Efforts addressing HIV health inequities would also address anti-gay discrimination and the effects of discrimination on already marginalized communities. ^[19]

References