FOCUS ON HEALTH EQUITY : A CALL TO ACTION
Health equity is a simple concept, but it is difficult to achieve. As racism is pervasive throughout industries and institutions so the Health equity is no difference. If health inequities are “inequalities that are deemed to be unfair, unjust, avoidable, or unnecessary, that can be reduced or remedied through policy action,” the state of health equity can be defined — as “the absence of avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease or mortality.”
Health equity exists, in other words, when everyone can be as healthy as they can be without abridgment of the means to achieve this goal. Yet the United States, the world’s richest country, has failed to achieve health equity.
Now, engulfed in the catastrophic pandemic maelstrom, we are reckoning with a deadly triad — health disparities, health inequity, and unequal health care access — quantified in a daily body count. We are obliged to acknowledge the lethal consequences of the cracks in our nation’s foundational tenets of equality, as Covid-19 exposes the cascading conglomeration of public policies reflecting toleration of underfunding of public health, undermining of equitable health care access, and the economic, educational, and judicial marginalization of minorities.
Do the Definitions really Matter?
In practice, different social, political, economic and cultural contexts, will undoubtedly suggest the need for different ways of defining and explaining equity. However, clarity is required to determine when different definitions represent substantially different paradigms, and the implications of adopting these different paradigms in particular contexts. As noted earlier, people often use the term health inequalities in what may be an effort to avoid the judgmental or moral connotations that may be associated with health inequities.
Health inequalities is less cumbersome than social inequalities in health, the latter term also often used as a more succinct way of referring to inequalities in health between more and less advantaged social groups. We believe that using these more concise terms will not be problematic so long as there is clarity as to how they are being used—that is, that both health inequalities and social inequalities in health mean inequalities in health or its social determinants, between more and less advantaged social groups, favouring the already more advantaged groups.
The World Health Organisation’s (WHO) World Health Report for the year 2000 made a welcome argument for the importance of assessing health not only by average levels but also by examining its distribution. However, the report examines the distribution of health by measuring what it refers to as “pure health inequalities,” disparities in health between ungrouped individuals, in contrast with examining differences between social groups. The total magnitude of health differences among all individuals is assessed, but there are no comparisons of health among different social groups. Thus, the WHO measure compares the health of healthier people with the health of sicker people within a country, but does not, for example, compare the health of wealthier people with the health of poorer ones, the health of different ethnic groups with each other, or health care for men and women with similar health conditions. Nevertheless, most audiences naturally assume that work on health inequalities is work on health equity.
Equity in health is an ethical value, inherently normative, grounded in the ethical principle of distributive justice and consonant with human rights principles. Like most concepts, equity in health cannot be directly measured, but we have proposed a definition of equity in health that can be operationalised based on meaningful and measurable criteria. In operational terms, and for the purposes of measurement, equity in health can be defined as the absence of disparities in health (and in its key social determinants) that are systematically associated with social advantage/disadvantage. Health inequities systematically put populations who are already socially disadvantaged (for example, by virtue of being poor, female, or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health.