HDG #020: What does “health equity” even mean?
Read time: 6 minutes
Greetings, Equity Advocates! As I was writing last week’s edition, I realized we skipped a fundamental topic somewhere around 19 issues ago: what does “health equity” even mean? And how do we articulate a concept so fundamental, yet so layered? It’s a real challenge since we all think about it a little differently, and I’ll just leave this right here: I think our lived experiences deeply shape much of what this personally means to us.
That’s not a bad thing. So our quest to define “health equity” today takes us on a historical tour through the perspectives of thought leaders—both past and present—their thoughts offering a richer understanding to help you decide what it really means to you and what it means in our industry as a whole.
Before understanding “health equity,” one must understand “equity”
This is where the subtle nuances of equity, equality, justice, liberation, inclusion, acceptance, and belonging come in. It is also why so many of these interesting graphics pop up in an attempt to explain what they all mean in practice.
You’ve probably seen at least one of these:
Equality is about giving everyone an equal chance, but equity is about recognizing that not everyone starts at the same place. Weaving these definitions together, these images attempt to communicate that equity is not merely about equal opportunities, but fair opportunities. They encourage us to acknowledge that not everyone starts at the same place and to create conditions where everyone can achieve their full potential.
(Note: I say “attempt” because they have come under discussion for being inadequate to demonstrate deep systemic barriers, instead making inequality seem more about physical conditions or the genetic lottery when there are so many more root constructs leading to disadvantage, such as structural racism, dysfunction of the healthcare system, etc., that these images don’t do a great job of depicting. More on this in a later edition)
Olden, golden wisdom about “health equity”
Building upon the concept of equity (images aside), the term "health equity" is a crucial concept in public health, healthcare, and social justice. It is colloquially used to describe the aspiration to eliminate health disparities and achieve optimal health for all. While there is a common underlying premise, different organizations and entities define "health equity" in various ways that reflect their specific contexts or perspectives.
In the 1980s, Margaret Whitehead, a prominent figure in the field of social medicine, defined health equity as "equal opportunity for everyone to enjoy the highest level of health." This focused on leveling the playing field, ensuring that everyone, regardless of their circumstances, had an equal shot at achieving optimal health.
Now, fast forward to the modern-day digital era. The Robert Wood Johnson Foundation describes health equity as everyone having a fair and just opportunity to be healthier, predicated on the removal of obstacles to health—obstacles such as poverty, discrimination, and their consequences.
Here are some additional definitions from well-known sources:
World Health Organization (WHO): The WHO defines health equity as "the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically."
Centers for Disease Control and Prevention (CDC): The CDC describes health equity as when "everyone has a fair opportunity to attain their highest level of health, with ongoing efforts to: address historical and contemporary injustices; overcome economic/social/other obstacles to health and care; and eliminate preventable health disparities."
Robert Wood Johnson Foundation (RWJF): As mentioned above, RWJF more specifically articulates health equity as "everyone has a fair and just opportunity to be healthier. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and healthcare."
American Public Health Association (APHA): The APHA defines health equity as "when everyone has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstances."
National Academy of Medicine (NAM): NAM explains health equity as "fairness and justice in health and healthcare." They specify that it entails "efforts to ensure that all people can reach their full health potential and should not be disadvantaged from attaining it because of their race, ethnicity, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, or physical disability, sexual orientation, geographic location, or other characteristics linked to discrimination or exclusion."
While these definitions vary in detail, they all emphasize fairness and justice in health outcomes, recognizing that social, economic, and environmental factors significantly influence individuals' health. They call for the removal of barriers that prevent certain populations from achieving their highest possible level of health.
What voices of today are saying
Equality is about giving everyone an equal chance, but equity is about recognizing that not everyone starts at the same place. There is also a lot of attention being drawn to the inefficiencies of the healthcare system that exacerbate these disparities. Weaving these definitions together, we understand that health equity is not merely about equal opportunities, but fair opportunities. It's about acknowledging that not everyone starts at the same place and creating conditions where everyone can achieve their full health potential.
By embedding these insights in our approach to health equity, we go beyond theoretical understanding. We transition into a practical reality where diversity is valued, obstacles are removed, and everyone can attain their fullest health potential.
This has become more discussed now than ever before, with some great thought leaders in the space posting regularly on Linkedin and other mediums. There are some common ties with the diversity, equity, and inclusion (DEI) renewed movement, as well—I’ll write more about how they overlap (or don’t) in a later edition, as well.
For now, some of my favorites on Linkedin to follow in the DEI and/or health equity space are:
Arthur Chan posts inspirational and thought-provoking DEI quotes and ideas
Paul Ladipo posts about DEI with an emphasis on anti-racism
Dr. Autumn BlackDeer is an Anti-colonial Scholar-Activist who centers on Indigenous voices
Dr. Ryan Paul talks about global public health with a common line of health equity and community issues
Kameron Matthews, MD, JD, FAAFP is the Chief Health Officer of Cityblock Health and a strong voice in health equity and policy
Dr. Deann Butler MHA, MBA talks about healthcare and structural racism, helping integrate equity into healthcare
Erin Gallagher is a woman’s advocate and amplifies women’s voices and issues wrapped with a bold bow of candor
This list goes on and on, but they are some of my favorites at the moment.
Health Equity is the ultimate goal, but it’s not all kittens and rainbows
While the push toward health equity has garnered broad support, it has also met with criticism and skepticism from various corners. Some of these critiques often frame health equity as mere buzzwords, jargon, or marketing fodder. Here are a few common arguments put forth that threaten the advancement of the cause, some of which I can completely understand:
Overuse and Under-Definition: Some critics argue that "health equity" has become an overused buzzword, employed by organizations and policymakers without a clear understanding or consensus of what it entails. This ambiguity can dilute the concept's meaningfulness and lead to inconsistent application or manipulation for different agendas.
Marketing Fodder: There's a belief that the term health equity has become a fashionable phrase used to market services, initiatives, or programs, without a real commitment to the systematic changes needed. This can result in performative allyship where organizations use the language of health equity to appear progressive but don't implement substantive changes.
Diversion from Personal Responsibility: Some skeptics maintain that the focus on health equity shifts the conversation away from personal responsibility for health. They contend that overemphasis on systemic factors may discourage individuals from taking personal actions to improve their health.
Politicization: The concept of health equity can be politicized, with some critics suggesting it promotes a specific political or ideological agenda. For instance, it can be construed as a call for wealth redistribution or be framed as an attempt to promote "equality of outcomes" rather than "equality of opportunities."
Implementation Challenges: Critics also argue that achieving health equity is overly idealistic given the complexity of social determinants of health. They suggest that it may be practically impossible to control or equalize all the factors that influence health outcomes.
It's important to note that these critiques, while highlighting potential issues and challenges, do not negate the fundamental goal or merit of the strive for equity in healthcare— to address unfair and avoidable health disparities. Instead, they underline the necessity for more thoughtful, rigorous, and actionable approaches to health equity, moving beyond buzzwords to tangible change and tangible measures.
(another note: If you’re interested in reading more about the concept of “fakequity,” I recommend a blog by the same name (FAKEQUITY) that regularly publishes thought-provoking pieces about ways in which the equity conversation shows up as “all talk and no action”)
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Actionable Idea of the Week:
So, how do we bring these understandings into how we treat others, into our daily work, into our data analyses, or into crafting new programs?
The easiest first step is to embark on a self-reflective journey. What does health equity (or equity) mean to you personally?
Take time to question and deepen your understanding of this crucial concept. How does it resonate with your personal experiences, values, and aspirations? How have you supported its dismantling, or inadvertently contributed to its perpetuation?
Grappling with these questions isn't just an intellectual exercise – it's a stepping stone toward meaningful action. If you’re feeling particularly inspired, you can also try:
Reflect on your understanding of it in a broader sense: After beginning with some introspection of what it means to you personally, consider your current understanding of it in the broader sense. What do you think it means (or should mean) for an individual organization, an enterprise, a community, or an industry—and why? What are the principles behind it that you connect with most deeply? Is it purely how an organization acts internally through its people, processes, and projects, or is it also how it acts externally in the community or for the customers/patients/people it serves? What does that mean in context? What does it look like in action? When are actions incongruent with that mission?
Educate Yourself: Dedicate time to learning more about [health] equity. Dive into the literature, listen to podcasts, attend webinars or workshops. Look for a variety of perspectives to challenge and enrich your understanding. Use this newfound knowledge to refine your own definition of health equity. Challenge yourself to commit to learning and unlearning every day, as a core part of your journey towards promoting health equity.
Consider your role: Contemplate how health equity intersects with your work or life. How does it shape your approach to healthcare, research, or program development? How could you integrate it more thoroughly into your daily practices? Be wary of biases that could blind you to disparities and dilute your understanding or influence your assumptions. Take the time to analyze the programs and initiatives you're part of. Are they only serving those who are already well-positioned? Or are they reaching out to those burdened by systemic disparities?
Start Conversations: Share your insights with your colleagues, friends, or family. Foster an open dialogue where others can express their perspectives on health equity. These discussions can challenge your views, refine your understanding, and spark new ideas for action.
Take Action: This is where your understanding of health equity becomes a driving force. Whether you're a healthcare provider, a program developer, a policy maker, or a concerned citizen, there are ways to advocate for health equity. You might push for policy changes in your organization, develop more equitable programs, analyze data with an equity lens, or support community-led health initiatives. You might promote co-design and collaboration with communities, particularly marginalized ones. Allow their voices to inform the development, implementation, and evaluation of your initiatives. Every action, no matter how small, contributes to the larger goal of health equity.
And remember: the enemy of equity and justice is silence and neutrality
In the pursuit of equity, it is well-stated that silence is compliance. Break the silence. Voice your thoughts, ask the questions no one else is asking, and spark necessary conversations about fairness and the intentional dismantling of processes or assumptions that are deeply seated.
Understanding health equity isn't a destination – it's a journey. It calls for ongoing learning, reflection, dialogue, and action. As you move forward, remember that the power to effect change lies in your hands.
This is a call to help create a fair, equitable, and just world together, where everyone has the opportunity to be their best selves in health, work, education, and life.
Let your understanding of [health] equity be your compass, guiding your decisions, shaping your actions, and inspiring you to build a more equitable, fairer world—and hopefully, this edition helped grow that understanding just a bit more!
See you next week,
-Stefany
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