In public health we often use buzzwords like equality, equity, and disparity and sometimes even mistakenly use them interchangeably. It's important to understand the difference between these catchphrases in order to establish a shared language to tell a complete health outcomes story and better explain what we're doing to improve them.
What is Health Equity?
Health 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 mean the same thing as health inequalities. They are simply 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.
Consider the following examples: Male babies are generally born at a heavier birth weight than female babies. This is a health disparity. We expect to see this difference in birth weight because it is rooted in genetics. Because this difference is unavoidable, it is considered a health disparity.
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 can be attributed to poverty – a higher percentage of Black mothers are poor and face hardships associated with poverty that can affect their health; however, we find differences in the health of Black and White mothers and babies even if we compare Blacks and Whites with the same income. Many scientists have shown links between the stress from racism experienced by Black women and negative health outcomes. This is a health inequity because the difference between the populations is unfair, avoidable and rooted in social injustice.
Health Equity vs. Health Equality
Oftentimes people use the words equity and equality interchangeably. To easily remember the difference, imagine that you're standing amongst a group of 30 people. Everyone in the group is given a size 9 pair of sneakers. While it's exciting to have been given free sneakers, there are only four people in group who are a size 9, therefore the majority of people won't be able to wear the sneakers. While the size 9 sneakers were equally distributed to everyone in the group, it wasn't equitable because not everyone wears that size.
The Social Determinants of Health
The places where we live, learn, work and play have a tremendous impact on our health. Receiving proper medical care and regular physicians' visits 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, transportation, access to healthy affordable food, and employment greatly influence the health and quality of life in communities. These social factors, generally referred to as the social determinants of health, determine whether individuals have parks and playgrounds to exercise, full-service supermarkets to buy fresh and affordable fruits and vegetables, living-wage paying job opportunities to support their families, and other, necessary resources that allow them to thrive. As public health advocates, educators, and leaders, we must encourage people to make healthy choices, but must also 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
People 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 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?
More than 100 studies now link experiences of racism to negative health outcomes. The experiences of racism over a lifetime can increase chronic stress levels. Increased levels of chronic stress are widely recognized as imposing serious health threats. 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.