Equality in healthcare is an admirable goal, but it’s still not enough. Barriers to access and education create inequity in health outcomes. Removing those barriers is an essential step in achieving equity.
The terms “health equality,” “health equity,” and “health justice” may seem similar at first glance. After all, they all seem to deal with giving everyone the care they need to stay healthy and get better when they’re sick. Right?
Not so fast.
While they are related, these are three slightly different concepts.
While some advocate for healthcare equality, this doesn’t go far enough. There are social factors that can affect health outcomes. Treating everyone equally may not provide certain groups with the care they need.
In this article, we define each term and address the factors that lead to health inequity. We also discuss what you can do to help remove these barriers.
According to the Milken Institute School of Public Health, health equality means giving everyone the same resources, regardless of their background or circumstances.
In practice, this means everyone should receive the same access to care, health resources, health education, and so on. Health equality suggests everyone has the same opportunities for positive health outcomes. It assumes all people receive equal treatment.
Examples of health equality include:
- A doctor spends an equal amount of time with all their patients.
- A vaccine is available to all members of a community.
- A clinic provides the same informational brochure on a condition to all patients.
Why health equality matters
Inequality in healthcare can often lead to disparities in health outcomes.
For example, a 2020 report from the Center for American Progress found that 18% of transgender adults said a doctor had refused to see them because of their gender identity. This inequality of care and denial of access led to 28% of transgender respondents avoiding or postponing necessary medical care.
Black people often receive unequal treatment for managing pain. According to a
Equality can also pertain to resources. A 2020 study found that images of skin conditions, either online or in medical resources, often lack images of People of Color. This means that people, including medical professionals, may have difficulty recognizing skin conditions in various skin tones.
Why health equality is not enough
Health equality is a positive goal. Still, it does not consider that people have different needs, advantages, and circumstances that affect their access. For health equality to be a solution, everyone would need to start from the same place.
Consider the examples of health equality we addressed earlier. What if:
- A doctor spends equal time with all their patients, but some patients have more serious health concerns.
- A vaccine is available to all members of a community, but some people have a greater risk of infection.
- A clinic provides the same brochures to all patients, but some people have a different first language.
Equality might make sense if everyone had the same income, background, education, and access to health services. The problem is, they don’t.
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For example, antiretroviral therapies have become more widely available in recent years. Still, they have not reduced the rate of AIDS equally across all groups. According to the report, this shortfall may be due to healthcare access and education.
Equality: Helping you overcome barriers
Three people are standing behind a fence, trying to watch a parade as it passes by. One is tall, one is shorter, and one is a small child. The tall person can see over the fence, but the other two cannot.
Let’s help them.
Equality means giving all three spectators ladders of the same height. The tall person can now see well over the fence. The shorter person can now see over the fence. But the small child still cannot see at all.
The
Health equity involves providing care catered toward an individual or group to help them achieve the same health outcome as someone in another group. This could mean:
- A vaccine is available to at-risk people before it’s available to everyone.
- An organization provides free clinics for people in low income neighborhoods.
- A clinic has a translator available for people with a different first language.
- A doctor alters treatment for someone who does not have regular access to nutritious food.
In an equitable approach, a doctor would consider nonmedical factors that affect health outcomes. These are called
- Healthcare: What is your level of access to care? What is the quality of your care?
- Education: What is your education level? What is your access to information?
- Social and community life: What is your level of involvement and acceptance in your community? Do you face discrimination because of your status?
- Economic stability: What are your financial resources? Do you have employment, housing, and access to food?
- Neighborhood: Does where you live affect your health, safety, and access to vital resources?
The World Health Organization (WHO) says that social determinants of health account for
What are the social determinants of health?According to the
WHO andHHS , social determinants of health include:
- discrimination
- early childhood development
- education
- employment
- food security
- healthcare access
- housing and basic amenities
- income
- language and literacy skills
- physical activity opportunities
- pollution
- poverty
- social inclusion
- structural conflict
- transportation
- violence
- work-life conditions
Why health equity matters
Health inequity has a profound impact. According to the
The
- race or ethnicity
- religion
- socioeconomic status
- gender
- age
- mental health
- cognitive, sensory, or physical disabilities
- sexual orientation
- geographic location
According to the Brookings Institution, access to health insurance disproportionately affects People of Color. In the United States in 2020:
- About 30 million people were uninsured, and more than half were People of Color.
- More than 90% of people who didn’t have coverage because their state didn’t expand Medicaid live in the South.
- Based on 2016 data, Black babies died at more than twice the rate as white babies. Black mothers died at more than triple the rate of white mothers due to pregnancy- and childbirth-related complications.
The American Public Health Association estimates that more than 30% of the medical costs for Black, Hispanic, and Asian Americans are related to health inequities, such as unequal access to care and other health resources.
An equitable approach is not the same as an equal approach. Equality provides the same level of care to everyone. Equity means that doctors can cater care so that people from historically marginalized groups can achieve their best possible health outcomes.
Equity would mean finding out why there are disparities in health outcomes and addressing the obstacles that created them.
Discover more Healthline resources on health equity.
Equity: Ensuring positive outcomes for everyone
Equality gave our spectators ladders of the same height. But still, not everyone can see over the fence.
Equity means giving all three spectators what they need to see over the fence. The tall person does not need anything. The shorter person needs a short ladder. But the small child needs a taller ladder.
Equity provides each person with what they need so they can achieve similar outcomes. It’s not equality because some people receive more than others. But the outcome is equal.
Different people and groups define health justice differently. But most definitions involve removing systemic and discriminatory barriers to equal access to healthcare and health education.
Health justice is a path to health equity. While there are things health professionals and organizations can do to overcome barriers, health justice seeks to remove the barriers entirely. It rights the injustices and inequalities that affect healthcare access, education, and outcomes.
But while individual doctors or healthcare centers can take steps on their own to promote health equity, justice often requires change at higher levels. Justice requires an approach that includes personal, community, and political efforts.
Efforts to achieve health justice may not be related to healthcare at all. Instead, they may try to erase the negative effects of those social determinants of health. According to a 2014 WHO bulletin,
According to the American Hospital Association, examples of such efforts include:
- building grocery stores in food deserts
- investments in affordable housing
- supporting higher wages or equal pay
- investing in early childhood education
- improving ride-share and transportation services
Health justice also entails researching and addressing how poverty, racism, ableism, sexism, and other forms of oppression can make people sick or create barriers to care.
Why health justice matters
Health justice advocates seek to remove barriers to equal access to establish equity. Health justice has to do with finding a way to right systemic wrongs, including discrimination against certain social groups. This discrimination is often rooted in law.
A 2015 paper in the American University of Law Review notes that health inequities are often due to:
- court systems and laws that unfairly treat certain populations, such as eviction laws
- laws that perpetuate poor health
- lack of laws to help prevent conditions before they occur, such as lead poisoning
So, what are some policy changes that can help improve health outcomes?
A 2020 study found that about 930,000 people in the United States lacked sustained access to basic sanitation. About 610,000 people lacked basic water access. Lack of clean water and sanitation significantly increases the chances of contracting serious diseases. People who were homeless or in temporary housing were at the greatest risk.
A just approach to improving health outcomes would be to ensure clean water access for everyone. This could involve policy changes, legal action, or investing in specific resources.
The lack of affordable housing also has a profound effect on health outcomes. When families spend most of their income on housing, they have less to spend on food and healthcare. It can also cause undue stress.
By contrast, stable, affordable housing can positively affect physical and mental health. According to a
Disparities exist on a global level, too. The life expectancy gap between low and high income countries is
These global problems highlight the need for international cooperation. Such measures can provide essential healthcare, such as insulin, vaccines, and other medications, to people in low income countries.
Justice: Removing barriers
Equality gave our spectators ladders of the same height. But still, not everyone could see over the fence.
Equity gave our spectators what each needed to see over the fence. Now they can all see, using the support we gave them.
Justice means taking the fence away altogether. Justice removes the barrier so everyone can benefit on their own terms.
There are a few ways you can get involved in advocating for health equity. You can:
- become more educated about health inequities and public policy
- raise awareness among your family, friends, and organizations of which you might be a part
- volunteer at healthcare advocacy associations and organizations
While you can make personal changes, such as recognizing bias, to achieve health justice, you’ll need to work with others. The
- Respect the community’s diversity.
- Work toward equitable access to healthcare, education, housing, transportation, and child care.
- Engage trusted leaders who represent affected groups.
- Work to correct myths, stereotypes, and misinformation.
- Build trust and partnerships with public health entities.
- Share information with clear, easy-to-read, culturally conscious language.
The Robert Wood Johnson Foundation, a charitable nonprofit dedicated to health and health equity, also has ideas on how you can help, depending on your industry.
Health equality, health equity, and health justice may seem to mean the same thing, but they don’t.
Health equality means giving everyone the same thing. Health equity means giving each person what they need so they can access the same level of care. Health justice advocates act to identify and remove obstacles to health equity.
Several nonmedical factors can influence health outcomes. These are called social determinants of health. They include factors like your race, gender identity, socioeconomic status, or even where you live.
You can help work toward health justice by educating yourself, raising awareness among others, and volunteering for an advocacy group.