What Is Health Equity and How Do We Get There?

Three generations of women bonding outdoors
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In 2010, the U.S. government pinned down the definition of health equity as the “attainment of the highest level of health for all people.” That means everyone, regardless of race, socio-economic status, geography, or circumstance, has the same shot at living a healthy life. It is a lofty goal, and to achieve it will require some pretty big changes at all levels—from individuals to society as a whole.

What It Is

The phrase “health equity” is often thrown around in the context of reducing health disparities—that is, specific gaps in health among populations that are specifically linked to socio-economic or environmental disadvantages.

For example, black people in the United States are substantially more likely to die from cancer than any other race or ethnic group. Low-income individuals and racial minorities are less likely to have health insurance. And when they do have access to medical treatment, in many cases they receive inferior care compared to their white counterparts. Reducing health disparities is an important step to achieving health equity.

Efforts to reduce or eliminate these disparities have overwhelmingly focused on disease prevention or treatment. But as many doctors and public health professionals are quick to point out, not being sick isn’t the same as being healthy. A wide variety of factors are at play when we talk about health—diet, activity level, blood pressure, etc. Whether you have an infection or certain medical condition is only a part of the puzzle.

Attaining health equity, therefore, isn’t just controlling or eliminating diseases. It’s about looking at what’s holding some people back from achieving optimal health overall.

Health equity also isn’t the same as health equality. It’s not enough to make sure everyone has the exact same opportunities; they should have the opportunities that are appropriate for their situation. As an example, if you gave everyone in the room a pair of size 10 shoes, that would be equal as everyone would get the exact same thing—no more, no less—but it wouldn't be equitable because not everyone wears size 10. Some people will now be at an advantage because the shoes are a better fit, while others are no better off than they were before. It would have been more equitable for everyone to get a pair of shoes in an appropriate size.

Why It Matters

Being healthy largely depends on a lot of individual behaviors like your diet and exercise habits, whether you smoke or use drugs, or how quickly you’re able to address medical issues before they become serious. Taking personal responsibility for maintaining and improving your health is important, but what we choose to do for our health is dependent on the options available to us.

If you live in a neighborhood with broken sidewalks, no parks, and heavy vehicle traffic, getting outside to exercise might not be a viable option. Likewise, if the only places to buy food in your area offer low-quality, processed food and expensive yet limited options for fresh produce, it’s going to be tough to eat a healthy diet.

An old adage among public health professionals is: If you want people to make healthy decisions, you have to “make the right choice the easy choice.” But for some populations in the United States, the right choice isn’t even available, let alone easy. Health equity means removing or reducing the intense—but avoidable and unnecessary—barriers or biases holding people back from opportunities to improve their health and that of their families.

It’s not just a matter of social justice. Inequalities in health and healthcare are expensive. By one estimate, nearly a third of direct medical costs for blacks, Hispanics, and Asian-Americans were due to health inequalities, and the combined costs associated with these disparities (including premature death) was estimated to be $1.24 trillion between 2003 and 2006.

This is especially relevant when it comes to health gaps in children. If all kids had the same chances of health outcomes as wealthy children, the prevalence of certain conditions like low birth weight or unintentional injuries would drop by an estimated 60 to 70 percent. Unhealthy kids often grow up to be unhealthy adults, resulting in a vicious cycle that is intertwined with not just the physical health of families, but also their mental and financial health as well.

Achieving health equity in early childhood especially could have profound repercussions across society, including the potential to reduce the amount spent on medical care in the United States and boost the economy as a whole.

Achieving Health Equity

In order to get to health equity, the United States must first value everyone's physical well-being equally. That will take highly focused, persistent, and ongoing efforts to stop avoidable inequalities in health outcomes and health care access, correct injustices, and close the gaps in health disparities. It’s a monumental task and one that requires efforts at the individual, community, and national level.

Many organizations, professional associations, and individuals have set forth plans to get there, including Healthy People 2020, the American Academy of Pediatrics, and the American Public Health Association. While these plans vary slightly in terms of what needs to be done and by whom, there are some common themes throughout.

Identify key health disparities and their root causes.

As with any public health approach to a problem, the first step is to figure out what is going on and why. A common strategy is to ask the question “why” five times.

Say, for example, you skinned your knee.

  • Why? Because you tripped on the sidewalk.
  • Why? Because your foot caught on an uneven surface.
  • Why? Because the sidewalk is in need of repair.
  • Why? Because the local government hasn’t repaired the sidewalk in that neighborhood for a long time.  
  • Why? Because it lacks adequate funding to repair damaged walkways in all the areas where it’s needed. 

You could just put a bandage on your knee and move on with life—but that won’t stop others from skinning their knees. A more permanent and comprehensive solution would be to encourage the local government to raise or request more sustained funding to cover the needed infrastructure improvement projects.

This is, of course, a gross oversimplification, but it demonstrates the need to really dig deep to figure out not just the problem but long-term solutions to fixing them. Community health issues tend to have complex causes.

Face some pretty uncomfortable realities head-on.

The United States has a long and complex history of favoring some economic, racial, and ethnic groups over others—be it through laws and policies or cultural norms. Not everyone is treated equally. Not everyone has the same opportunities. And not everyone faces the same challenges. To complicate things further, many biases are unconscious, and discrimination is being perpetuated by individuals who often have no clue they are doing it.

Unfortunately, this happens all the time in healthcare settings, where studies have shown providers to provide lower quality care and poorer communication to minority patients compared to their white patients.

An important step in healing these divides is by having an open and honest conversation about where we as a nation could do better to make things more equitable and what changes need to be made to get there. This means acknowledging and understanding the history of a given community, listening with an open mind to individuals experiencing inequities, and recognizing when and where we fall short of giving people equitable opportunities to be healthy.

Change or enact laws, policies, and programs at all levels of society to give everyone the same shot at being healthier.

The Affordable Care Act was passed in 2010 and fully implemented in 2014 in hopes of allowing more people to gain health insurance in the United States, and thus reducing disparities associated with access to health care. While it's had somewhat of a bumpy road politically, the law did make some progress in closing gaps. By 2016, the number of uninsured people in the United States had dropped by nearly half, greatly impacting previously disadvantaged groups like blacks, Hispanics, and those living in poverty.

Similarly, programs like Medicaid (for those living in poverty and/or with disabilities) and Medicare (for the elderly) help provide health insurance coverage to those who might not have been able to access it otherwise. While health insurance is but one piece of the health equity puzzle, legislation like these are an important step to helping close gaps in access. 

An oft-overlooked area that breeds health inequity is infrastructure. If a particular neighborhood has broken sidewalks, no parks, high crime, and few stores with fresh produce, it can be challenging for families in that area to follow daily exercise and nutrition recommendations to maintain a healthy lifestyle.

For example, food deserts (where full-service grocery stores selling fresh produce and healthy food options are scarce or absent) and food swamps (where unhealthy options like fast food are densely packed in a given area) could perhaps be mitigated through local-level interventions like zoning restrictions or government incentives or with health education programs implemented by local health departments, schools, or other organizations.

Build partnerships within a community.

A crucial step with any local, community, or national-level intervention is to first make sure everyone impacted is included in the discussion. Individuals and organizations who have a vested interest in a given change—known as "stakeholders"—must be engaged in the process if any intervention is to be successful, especially if it is depending on behavior change from a given group.

There's a public health parable that goes like this: An organization wanted to dig a well in a remote village where families had to walk miles every day to get water. It went in and dug the well and then left, believing they had solved an important problem. But when they came back to see how the village had been impacted, the well was left unused and in disrepair. When they inquired as to why the villagers weren't using the well, they discovered that women in the village actually liked the walk to the river because it was their time to socialize.

While the organization had asked the village elders for permission to build the well, no one thought to ask the women it would supposedly benefit. The moral of the story is simple: If you want to help people, you must involve them in the process. Building trust and getting buy-in from those involved is crucial to the success of any public health efforts.