What is Health Equity?

Health Equity is the principle of, and commitment to incorporating fairness into health by reducing health inequalities (1). Health equity is a social justice goal.

Promoting health equity means creating the conditions where individuals and communities have what they need to enjoy full, healthy lives. 

Health equity implies that all people can reach their full health potential and should not be disadvantaged from attaining it because of their race, ethnicity, religion, gender, sexual orientation, age, disability, social class, where they live, socioeconomic status or other socially determined circumstances.

“Equitable care does not mean treating every patient exactly the same. Instead, equitable care ensures optimal outcomes for all patients regardless of their background or circumstances.”

Source: The Roadmap to Reduce Disparities, Robert Wood Johnson Foundation (2014)

Before we talk more about Health Equity, what is ‘Equity’?

Equity is often confused with the equality, but they are not the same. 

equality ≠ equity

Equity and equality are two strategies we can use in an effort to produce fairness. 

Equity means providing each person with what they need to be successful. Equality means treating each person the same. 

Equality aims to promote fairness, but it can only work if everyone starts from the same place and needs the same help. Unfortunately, in our society not everyone begins with the same amount of advantage.

If you start from a place of disadvantage and are then treated equally as a person with advantage, you perpetuate and ultimately grow the gap between the two of you. Equitable measures must first close that gap, so that everyone can participate in the available opportunities equally.

Equality is providing everyone the same support. Equity is providing each person the amount of support needed to access the same opportunity.

A health equity approach recognizes that health is not distributed equally and some people may need more or different services than others in order to be healthy.” (4)

What are health inequities?

Health Inequities are defined as “differences which are unnecessary and avoidable and which are also considered unfair and unjust” (3). 

People are heavily influenced by the communities they work and live in, which can be powerful producers of health and well-being. Health inequities represent differences in opportunity for different populations which result in unfair and unequal life chances and access to services.

Health inequities arise from gaps related to the social determinants of health, which are the socially determined circumstances in which people are born, grow, live, work and age, including the health care system. Addressing the root causes of health inequities, such as the social determinants of health, is important not simply equitable access to health services, but equitable access to health.

The gap in life expectancy between those living in areas of most advantage and those in areas of least advantage had a difference 8.4 years in Saskatoon, as determined by the Saskatoon Health Region in 2012 (5). See the full report here.

“Health equity focuses on ensuring and treating those who require care in ways that are appropriate to what they need to enjoy full, healthy lives. It aims to remove unjust and unnecessary differences, requiring us to consider the possibility of making different arrangements for resource allocation, or social institutions or policies.” (6)

What are the consequences of health inequity during COVID-19?

COVID-19 is painfully exposing the existing and persisting health inequalities in our societies. This pandemic will have the heaviest impact on the lives of people who are already vulnerable or marginalized. These existent inequalities are often unfair and avoidable, and can be considered inequities. These health inequities contribute to the spread and deadliness of this new virus, COVID-19. It is more clear than ever that existing health inequities harm everyone in our communities, not just those that they affect directly.

We need be concerned about flattening the curve but also considering who is under the curve. Without equity, we are all at increased risk.

Why do we need health equity during COVID-19?

If we are to collectively flatten the curve of COVID-19, we need to ensure that the most vulnerable groups are considered in all of our policy decisions, guidance and practice at the frontlines and that they receive equitable access to health care and the needed support to follow public health orders. 

Marie-Claude Landry, Chief Commissioner of the Canadian Human Right Commission recognizes:

“While social distancing, self-isolation, and quarantining are essential to flattening the curve, we must recognize that these measures create unintended and disproportionate consequences for people living in vulnerable circumstances. As the current situation evolves, the number of people put in vulnerable circumstances will grow. The rights and needs of these people cannot be forgotten or ignored.” 

The most vulnerable and marginalized members of our society will be at highest risk of both infection and the distress caused by the pandemic response. These people are an integral part of the community, the health service and the service economy, and our collective health depends upon their personal ability to limit the spread of COVID-19. Our collective health is linked to each other.

Research demonstrates that worsening social, economic, and environmental factors affect health in ways that compromise opportunity for all” (7,8,9)

What can we do?

Health equity requires focused and sustained societal efforts to confront historical and contemporary inequities and eliminate health disparities. In order to flatten the curve, governments and public health must support the most vulnerable people in our communities to stay safe, reduce transmission of the virus and decrease the burden and risk experienced by all frontline workers.

We must collectively recognize that:

  • Every individual is worthy of being healthy and having the supports to achieve health;
  • The COVID-19 crisis has amplified existing inequities and those who are already marginalized will suffer more heavily;
  • The health of our most vulnerable community members will impact the collective health of our society;
  • Our community is healthier and more resilient when we support each other and there is equity embedded in our public policy and community responses.

As we build health policy that works for a diverse population, we must consider: 

  • The realities of inequitable access to information
  • The disparate abilities of community members to use public health advice and information
  • The existing barriers to access for social supports and healthcare
  • The increasing stress on existing community services and healthcare

We recognize the tremendous efforts of governments, public health, front-line workers, community organizations and community members during this pandemic. In order to create health for our entire communities, we must all ensure that those living in vulnerable circumstances are front and centre in our minds, our actions and our policies.

What equity-informed approaches or promising practices have inspired you during the response to COVID-19?

12 + 10 =

“Advancing health equity is the right thing to do, the fair thing to do, and ultimately, something that we need to do to achieve better health for all.”

– Saskatoon Health Authority

Definitions

Health Equity

Health Equity is the principle of and commitment to incorporating fairness into health by reducing health inequalities. It implies that all people can reach their full health potential and should not be disadvantaged from attaining it because of their race, ethnicity, religion, gender, sexual orientation, age, disability, social class, where they live, socioeconomic status or other socially determined circumstances. (5)

Health Inequities

Health Inequities are defined as “differences which are unnecessary and avoidable and which are also considered unfair and unjust” (3). Health inequities represent differences in opportunity for different populations which result in unfair and unequal life chances and access to services.(5)

Health Inequalities

Health inequalities represent differences in health experiences and health outcomes between different populations. Health inequalities may be health inequities if they are due to socially determined circumstances. (5)

Social & Structural Determinants of Health

The Social Determinants of Health (SDH) are the social and economic factors that influence people’s health. They include factors such as education, income, race, gender, etc. Structural determinants of health affect whether the resources necessary for health are distributed equally or whether they are unjustly distributed according to race, gender, social class, geography, sexual identity, or other socially defined group of people.

Vulnerable Populations

Who may be considered vulnerable during the COVID-19 pandemic? See this document for a list of who may be considered vulnerable during the COVID-19 pandemic.

What are some of the emerging challenges impacting people living – or put – in vulnerable circumstances? View explanation.

Discrimination

Discrimination is a broad term that includes but is not limited to racism. Prejudicial treatment has been based on a wide range of characteristics, including not only racial or ethnic group but also low income, disability, religion, LGBTQ status, gender, and other characteristics associated with social exclusion or marginalization. Discrimination is not necessarily conscious, intentional or personal; often it is built into institutional policies and practices. 

Racism

Racism refers to prejudicial treatment based on racial or ethnic group and the societal institutions or structures that perpetuate this unfair treatment. Racism can be expressed on interpersonal, structural/institutional, or internalized levels.

Social exclusion or marginalization

Social exclusion or marginalization refers to barring or deterring particular social groups–based, for example, on skin color, national origin, religion, wealth, disability, sexual orientation, gender identity, or gender—from full participation in society. Excluded or marginalized groups are those who have often suffered discrimination or been excluded or marginalized from society and the health-promoting resources it has to offer.

Resources

What is Equity? Fact Sheet

From the Saskatoon Health Region

Key Dimensions of Equity-Oriented Care

EQUIP Health Care presents three key dimensions of equity-oriented health care (EOHC) and ten strategies to guide organizations in enhancing capacity for equity-oriented health care.

Closing the gap in a generation: Health equity through action on the social determinants of health

Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health is the final report of the WHO Commission on Social Determinants of Health.

What is Health Equity? And What Difference Does a Definition Make?

This report from the Robert Wood Johnson Foundation aims to increase consensus and promote discussion around the meaning of health equity and the implications for acting on it.

Let's Talk: Health Equity

Explores the concepts of health equity and promotes discussion and understanding designed to spark dialogue, reflection, and action to address the social determinants of health. 

Tenfold Podcast

Tenfold is a podcast about community engagement and public health.

Dr. Camara Jones Explains the Cliff of Good Health

Everyone should have the opportunity to achieve good health. But, as Dr. Camara Phyllis Jones explains through her cliff analogy, that’s often not the case.

References

  1. Braveman P. (2014). What are health disparities and health equity? We need to be clear. Public health reports (Washington, D.C. : 1974), 129 Suppl 2(Suppl 2), 5–8. https://doi.org/10.1177/00333549141291S203
  2. Chin, M. H., Clarke, A. R., Nocon, R. S., Casey, A. A., Goddu, A. P., Keesecker, N. M., & Cook, S. C. (2012). A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care. Journal of general internal medicine, 27(8), 992–1000. https://doi.org/10.1007/s11606-012-2082-9
  3. World Health Organization. https://www.who.int/hia/about/glos/en/index1.html
  4. Health Quality Ontario’s Health Equity Plan. (2016) Government of Ontario. Retrieved from: http://www.hqontario.ca/Portals/0/documents/health-quality/Health_Equity_Plan_Report_En.pdf
  5. Advancing Health Equity in Health Care. What is Health Equity? A Primer for the Health Care System. (2014). Saskatchewan Health Region. 
  6. https://equiphealthcare.ca/equip/wp-content/uploads/2018/04/HEQ-Mar-26-2018.pdf
  7. Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., Bergeron, A., & Cutler, D. (2016). The Association Between Income and Life Expectancy in the United States, 2001-2014. JAMA, 315(16), 1750–1766. https://doi.org/10.1001/jama.2016.4226
  8. Rudolph L, Gould S, Berko J. (2015). Climate Change, Health, and Equity: Opportunities for Action. Public Health Institute, Oakland, CA
  9. Woolf SH., Aron L., Dubay L., Simon SM., Zimmerman E., Luk KX. (2015). How are income and wealth linked to health and longevity? Urban Institute and Virginia Commonwealth University, Washington, DC.
  10. Coronavirus Disease (Covid-19) Vulnerable Populations And Covid-19. (2020). Government of Canada. Retrieved from: https://www.canada.ca/content/dam/phac-aspc/documents/services/diseases-maladies/vulnerable-populations-covid-19/vulnerable-groups-eng.pdf
  11. (Braveman P, Arkin E, Orleans T, Proctor D, and Plough A.  (2017). What Is Health Equity? And What Difference Does a Definition Make? Princeton, NJ: Robert Wood Johnson Foundation. Retrieved from: https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html)