While the term health equity is used widely, a common understanding of what it means is lacking.
What is health equity?
In a report designed to increase consensus around meaning of health equity, the Robert Wood Johnson Foundation (RWJF) provides the following definition: “Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”
The definitional concepts presented in the report are based on widely recognized ethical and human rights principles and supported by knowledge from health sciences.
Consensus around definitions for an issue such as health equity can help bridge divides and foster productive dialogue among diverse stakeholder groups. Conversely, a lack of clarity can lead to detours, and pose a barrier to effective engagement and action.
Also included in the report are examples of specific terms related to health equity that often arise in discussions around the concept.
Health equity surrounds and underpins RWJF’s vision of a society in which everyone has an equal opportunity to live the healthiest life possible. The authors, including RWJF staff members, put forth these four key steps to achieve health equity:
Identify important health disparities. Many disparities in health are rooted in inequities in the opportunities and resources needed to be as healthy as possible. The determinants of health include living and working conditions, education, income, neighborhood characteristic, social inclusion, and medical care. An increase in opportunities to be healthier will benefit everyone but more focus should be placed on groups that have been excluded or marginalized in the past.
Change and implement policies, laws, systems, environments, and practices to reduce inequities in the opportunities and resources needed to be as healthy as possible. Eliminate the unfair individual and institutional social conditions that give rise to the inequities.
Evaluate and monitor efforts using short- and long-term measures as it may take decades or generations to reduce some health disparities. In order not to underestimate the size of the gap between advantaged and disadvantaged, disadvantaged groups should not be compared to the general population but to advantaged groups.
Reassess strategies in light of process and outcomes and plan next steps. Actively engage those most affected by disparities in the identification, design, implementation, and evaluation of promising solutions
The authors note that equity is not the same as equality. To equalize opportunities, those with worse health and fewer resources need more efforts expended to improve their health.
Health Equity: Everyone Counts
The effects of policies that make data unavailable on excluded or marginalized groups can put those populations at further disadvantage that may reflect systemic racism.
Systemic racism is so embedded in systems and structures that it often is viewed as the natural, inevitable order of things. Addressing it is crucial to advancing health equity and achieving a more just society.