Summary: One solution to addressing health inequities is understanding the difference between health disparities and health equities so that you can apply a health equity lens to your work.
CAI has been pursuing a mission of increasing equity in health and well-being for more than 40 years. But what does “health equity” mean, and how does it look different from what you are already doing?
As health and human services providers, of course you want all your clients to have the best health possible: a state of complete physical, mental, and social well-being, not just the absence of disease. Traditionally, achieving the goal of good health for clients has used an individualistic approach–taking the right prescriptions, getting more exercise, eating healthier, showing up to appointments, and other client-focused behavior changes.
And yet, despite decades of these kinds of interventions, some groups continually have worse health outcomes than others. Why is that, and what is the answer to this problem?
The answer to both of these questions is health equity. But what is health equity, and what does it mean for providers and clients?
Understanding the difference between health inequities and health disparities
Health disparities and health inequities are two terms you may have heard of that are often used interchangeably; however, they have quite different meanings. And using these terms incorrectly can lead to miscommunication and misdirection of resources.
- Health inequity: Differences in health outcomes that are socially determined, avoidable, and rooted in injustice. Poverty, race, segregation, and lack of educational and employment opportunities are a few contributors to inequities in health.
- Health disparity: Health differences between groups that are unavoidable. Examples of health disparities include women having higher rates of breast cancer than men because they have more breast cells, and younger people having better health than elderly people because of the natural aging process.
Knowing the difference between health disparities and inequities is the key to ensuing that our efforts effectively addressing health equity, and that no one is limited in achieving good health because of their social position or other social determinants of health.
Social determinants of health are a key focus of “Healthy People 2023,” which provides 10-year measurable public health objectives and tools to help progress toward achieving them.
An illustration of health inequities: meet Kahlil
Kahlil is a 26-year-old man who has sex with men. When he was born, he had a heavier birth weight than the average female baby. We expect to see this difference in birth weight because it’s rooted in genetics—male babies are generally born at a heavier birth weight than female babies. We call this a health disparity—which is when a difference in health outcomes between populations groups is unavoidable.
Kahlil plays street basketball for a few hours every day and has had more ankle sprains than the average person. This is also a health disparity because as a basketball player, his ankles are subject to much more wear and tear than the average person, and this is true for anyone who plays basketball regardless of things like their age, race, income, gender, or sexuality.
Kahlil was recently diagnosed with HIV.
His behaviors that put him at risk for HIV aren’t different than any other man. He’s not having riskier sex compared to other men who have sex with men. However, he is African American and therefore has been subject to racist and discriminatory laws, policies, and practices that have historically denied people of color the equal opportunity to earn income, own property, and accumulate wealth, leading to social inequities, such as poverty, segregation, lack of educational and employment opportunities, and ultimately, poorer health.
Kahlil doesn’t have a job or health insurance. He also doesn’t have a car, and the local clinic where he could get free resources and services, like condoms or PrEP, is an hour-long bus ride away. Besides, the last time he was there, he was treated unkindly by the front desk staff and the clinicians. Kahlil testing HIV positive is a health inequity—a difference in health outcomes rooted in social disadvantage arising from intentional or unintentional discrimination or marginalization.
If Kahlil had the access to care as other men who have sex with men in his community—if Kahlil had the resources and opportunities he needs to be successful at achieving optimal health—this health outcome could have been avoidable.
How to use a health equity lens
The answer to addressing health inequities is to apply a health equity approach to all our activities as health and helping professionals. This means:
- Recognizing that health equity is important because each of us, regardless of social class or status, is important and unique, and deserving of good health and quality of life. When we feel our best, we are better able to interact with our loved ones and contribute to our communities, and whenever there is health inequity, we are ultimately all affected.
- Seeing beyond individual characteristics and behaviors and recognizing the relationship between a person’s health and the social, historical, and cultural contexts in which we all live,
- Acknowledging that we as health and helping professionals can and do in fact play a role in facilitating health equity in the communities we serve.
Achieving health equity may seem overwhelming at first. But there are many interventions we know work, including developing anti-discrimination policies, extending healthy agency service hours, providing travel vouchers, and conducting client experience research that have the ripple effect of changing clients’ lives for the better.
Learn more
This article draws from the following websites and publications that provide additional information.
- Social Determinants of Health at CDC. An overview of xx
- “Healthy People 2030.” Details about this 10-year national initiative and resources to xx.
- AIDS Insititute training. [AIDS institute would be one resource: www.hivtraininny.org]
- Health Affairs Policy Brief: Achieving Equity in Health Bahls, C. (2011, Oct 6). Achieving equity in health. HealthAffairs. https://www.healthaffairs.org/do/10.1377/hpb20111006.957918/full/Understanding social determinants of health starts in the exam room. Phreesia. https://www.phreesia.com/2019/09/27/blog-understanding-social-determinants-of-health-starts-in-the-exam-room/
New York State Department of Health AIDS Institute. (2020, Jan). Health equity resources [PDF document]. Retrieved from https://health.ny.gov/diseases/aids/ending_the_epidemic/docs/health_equity.pdf
Noonan, A. S., Velasco-Mondragon, H. E., & Wagner, F. A. (2016). Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public health reviews, 37(1), 1-20.
Robert Wood Johnson Foundation. (2017, June 30). Visualizing Health Equity: One Size Does Not Fit All Infographic. Retrieved May 20, 2020, from https://www.rwjf.org/en/library/infographics/visualizing-health-equity.html
Michelle Hyland
CAI Vice President of Curriculum Development
Michelle Hyland has more than 20 years of experience in education and curriculum development. At CAI, she oversees the planning, development, and quality assurance of all public health care workforce training products, including training curricula, implementation manuals, toolkits, webinars, learning collaboratives, and e-learning modules.