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 What is Health Equity?

Photo of BostonHealth equity means that everyone has a fair opportunity to live a long, healthy life.  It implies that health should not be compromised or disadvantaged because of an individual or population group’s race, ethnicity, gender, income, sexual orientation, neighborhood or other social condition.  Achieving health equity requires creating fair opportunities for health and eliminating gaps in health outcomes between different social groups.   It also requires that public health professionals look for solutions outside of the health care system, such as in the transportation or housing sectors, to improve the opportunities for health in communities.

 Health Disparities vs. Health Inequities

Health disparities, or health inequalities, are differences in the presence of disease, health outcomes, or access to health care between population groups.  Health inequities, on the other hand, are differences in health that are not only unnecessary and avoidable but, in addition, are considered unfair and unjust.  Health inequities are rooted in social injustices that make some population groups more vulnerable to poor health than other groups. 

Photo of a pregnant womanConsider the following example.  Male babies are generally born at a heavier birth weight than female babies.  This is a health disparity.  While there may be a difference in the birth weight between male babies and female babies, the difference is unavoidable and rooted in genetics.  On the other hand, babies born to Black women are more likely to die in their first year of life than babies born to White women.  Some of this difference is due to poverty – a higher percentage of Black mothers are poor and face hardships associated with poverty that can affect their health.  But we find differences in the health of Black and White mothers and babies even if we compare Blacks and White with the same income. Many scientists believe that it is racism experienced by Black women that explains this extra difference.  Racism creates stress, and too much stress creates a risk for mothers and babies.  This is a health inequity because the difference between the groups is unfair, avoidable and rooted in social injustice.

 The Social Determinants of Health

Photo of a liquor storeWhere we live, learn, work and play has a tremendous impact on our health.  While going to the doctor and receiving medical care are essential for detecting and curing illness, access to health care can only account for 10 to 15 percent of preventable deaths.  Social factors such as housing, education, income and employment greatly influence the health and quality of life in neighborhoods and communities.  These social factors, generally referred to as the social determinants of health, determine whether or not individuals have parks and playgrounds to exercise, supermarkets to buy fresh and affordable fruits and vegetables, job opportunities to support their families, and other resources that allow them to be healthy.  While it is definitely important for us to encourage people to make healthy choices, we must remember that people can only make healthy choices if they have healthy options. 

(Robert Wood Johnson Commission to Build a Healthier America)

 Why Racism Matters

Photo of a city streetPeople of color experience worse health outcomes than Whites across a wide spectrum of diseases and conditions, including heart disease and stroke, diabetes, cancer and HIV/AIDS.  Racial and ethnic health disparities exist even when we control for other factors, such as socioeconomic status, education, individual behavior and health insurance status.  For example, babies born to Black women with a college degree are more likely to die in their first year of life than babies born to White women who did not finish high school.  While class, education and other social factors are important, they do not account for the whole picture. 

Racial and ethnic health disparities are also not the result of genetics.  In fact, race does not exist biologically.  There is not a single gene, trait or characteristic that distinguishes members of one race from another.  Instead, race is a social construct.

 

So what is at the root of racial and ethnic health disparities?

Racism-Health Outcomes Chart

More than 100 studies now link experiences of racism to worse health.  The experiences of racism over a lifetime can increase chronic stress levels, which is widely recognized as a health threat.  The anxiety, anger, and frustration that result from experiences of racism trigger the body's stress response, which over time, creates wear and tear on the body. Racism can take many forms.  Whether internalized, interpersonal, or institutional, racism influences how people are treated, what resources and jobs are available, where people are likely to live, and what chances communities have to reach their full potential.

(Unnatural Causes Background Primer)