In 2010, the U.S. government defined health equity as “the achievement of the highest level of health for all.” This means that everyone, regardless of race, socioeconomic status, geography or environment, can lead healthy lives. This is a noble goal, and achieving it will require some considerable change at every level – from individuals to society as a whole.
what is this
The term “health equity” is often used in the context of closing health disparities – specific health disparities between groups of people that are particularly associated with socioeconomic or environmental disadvantage.
Black Americans, for example, are far more likely to die from cancer than any other racial or ethnic group. Low-income individuals and minorities are less likely to have health insurance. And, when they do have access to health care, in many cases, they receive less quality care than their white counterparts. Closing health disparities is an important step towards achieving health equity.
Efforts to reduce or eliminate these disparities have focused on the prevention or treatment of disease. But as many doctors and public health professionals are quick to point out, not being sick does not equate to being healthy. When we talk about health, a variety of factors come into play – diet, activity level, blood pressure, etc. Whether you have an infection or certain medical conditions is only part of the puzzle.
Therefore, achieving health equity goes beyond controlling or eliminating disease. It’s about seeing what’s holding some people back from achieving optimal health overall.
Health equity is also not the same as health equity. It’s not enough to ensure that everyone has the exact same opportunity; they should have the opportunity that fits their situation.For example, if you gave everyone in the room a pair of size 10 shoes, that would be equal Because everyone will get the exact same thing – no more and no less – but not fair Because not everyone wears a size 10. Some people are at an advantage now because the shoes fit better, while others are no better than they used to be. It would be fairer to have everyone buy a pair of the right size shoes.
why it matters
Health depends largely on many personal behaviors, such as your diet and exercise habits, whether you smoke or use drugs, or how quickly you can address medical problems before they become serious. Taking personal responsibility for maintaining and improving your health is important, but what we choose to do for our health depends on the options available to us.
If you live in a neighborhood with broken sidewalks, no parks, and heavy vehicle traffic, exercising outside may not be a viable option. Likewise, eating healthy is going to be difficult if the only place to buy food in your area offers low-quality processed foods and expensive but limited fresh produce options.
For some demographics in America, there isn’t even the right choice, let alone easy. Health equity means removing or reducing strong (but avoidable and unnecessary) barriers or biases that hinder people’s opportunities to improve their own and their families’ health.
It’s not just a matter of social justice. Inequalities in health and healthcare are expensive. It is estimated that nearly one-third of direct health care costs for Black, Hispanic, and Asian Americans are due to health inequalities, and the combined costs associated with these disparities, including premature death, increased from 2003 to 2006. The annual period is estimated at $1.24 trillion.
This is especially important when it comes to children’s health disparities.if all Children have the same chances of achieving health outcomes as wealthy children, and the prevalence of certain diseases, such as low birth weight or unintentional injuries, will drop. Unhealthy children often grow up to become unhealthy adults, leading to a vicious cycle that is intertwined not only with the physical health of the family, but also with their mental and financial health.
Achieving health equity in early childhood in particular could have profound implications for society as a whole, including the potential to reduce U.S. health care spending and boost the overall economy.
Achieving Health Equity
To achieve health equity, the United States must first give equal importance to everyone’s physical health. This will require a highly focused, sustained and sustained effort to stop avoidable inequalities in health outcomes and access to health care, correct injustices, and close disparities in health disparities. This is a daunting task that requires individual, community and national efforts.
Many organizations, professional societies, and individuals have plans to achieve the goals, including Healthy People 2020, the American Academy of Pediatrics, and the American Public Health Association. While these plans differ slightly in what needs to be done and by whom, there are always some common themes.
Identify major health disparities and their underlying causes
As with any public health approach to a problem, the first step is to figure out what happened and why. A common strategy is to ask the “why” question five times.
Say, your knee is skinned.
- Why? Because you tripped on the sidewalk.
- Why? Because your foot is on an uneven surface.
- Why? Because the sidewalk needs repairs.
- Why? Because the local government hasn’t fixed the sidewalk in that block for a long time.
- Why? Because it lacks sufficient funds to repair damaged sidewalks in all areas where it is needed.
You can put a bandage on your knee and get on with your life – but that won’t stop other people’s knees from peeling. A more durable and comprehensive solution would be to encourage local governments to raise or require more sustained funding to pay for needed infrastructure improvement projects.
Of course, this is an oversimplification, but it shows the need to really dig deeper, not just to identify the problem, but to find a long-term solution to the problem. Community health problems often have complex causes.
Face some very uncomfortable realities
The United States has a long and complex history of favoring certain economic, racial and ethnic groups over others—whether through laws and policies or cultural norms. Not everyone is treated equally. Not everyone has the same opportunities. Not everyone faces the same challenges. To complicate matters further, many prejudices are unconscious, and discrimination is perpetuated by people who often don’t know what they’re doing.
Unfortunately, this happens all the time in healthcare settings, where research shows that providers deliver lower-quality care and poorer communication to minority patients compared to white patients.
An important step in bridging these divides is to have an open and honest conversation about what we can do better as a nation to make things fairer and what changes need to be made to make that happen. This means acknowledging and understanding the history of a particular community, listening with an open mind to individuals who experience inequality, and recognizing when and where we fail to provide people with equal opportunities for health.
Change or enact laws, policies and programs at all levels of society so that everyone becomes healthier in the same way
Passed in 2010 and fully implemented in 2014, the Affordable Care Act hopes to reduce disparities associated with access to health care by allowing more people to have health insurance in the United States. While it has been politically bumpy, the law has indeed made some progress in closing the gap. By 2016, the number of people who were uninsured in the U.S. had plummeted, disproportionately affecting previously disadvantaged groups such as blacks, Hispanics, and those living in poverty.
Likewise, programs like Medicaid (for those living in poverty and/or disability) and Medicare (for older adults) help provide health coverage to those who would otherwise not have access to it. While health insurance is only one piece of the health equity puzzle, legislation like this is an important step in helping close access gaps.
An often overlooked area of health inequalities is infrastructure. If a particular neighborhood has broken sidewalks, no parks, high crime rates, and few stores with little fresh produce, it can be difficult for families in the area to follow daily exercise and nutrition recommendations to maintain a healthy lifestyle.
For example, food deserts (full-service grocery stores selling fresh produce and healthy foods are scarce or non-existent) and food swamps (unhealthy foods such as fast food are packed densely in specific areas) may be mitigated by zoning restrictions or government incentives at the local level measures or interventions such as health education programs implemented by local health departments, schools, or other organizations.
Build partnerships within the community
A key step in any intervention at the local, community or national level is to first ensure that all affected people are involved in the discussion. If any intervention is to be successful, especially if the intervention depends on behavioral changes in specific groups, individuals and organizations (called “stakeholders”) with a vested interest in the specific change must be involved in the process.
There’s a public health fable that goes like this: An organization wants to dig a well in a remote village where families have to walk miles every day to get water. It went in and dug a well and left, thinking they had solved an important problem. But when they returned to see how the village was affected, the well was idle and in disrepair. When they asked the villagers why they didn’t use the well, they found that the women in the village actually liked to walk to the river because it was their time to socialize.
While the group has asked village elders for permission to build the well, no one thought to ask the women, which should be beneficial. The moral of the story is simple: if you want to help others, you have to involve them in the process. Building trust and gaining the support of those involved is critical to the success of any public health effort.