The health equity movement only exists because health inequities and disparities are so blatant and persistent - at least, to marginalized and historically excluded communities. But they haven’t always been so obvious to others. Plus, there were those particular healthcare “pioneers” that perpetuated the racist and discriminatory stereotypes that continue to harm these communities today. Patients and providers across the country have to fight for health equity because harmful dogma and rhetoric have been ingrained into America’s healthcare policies and systems.
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What is health equity?
There are various definitions of health equity that exist, and you’ll find that it tends to depend on the perspective and priorities of the corresponding organization. Browse them below:
World Health Organization: Health equity is the absence of unfair and avoidable differences in health among populations or groups
United Nations: Health equity is a key component of sustainable development, recognizing that improving health outcomes for all populations is critical to achieving overall global development goals
National Institute of Health: Health equity is the principle underlying the continual process of assuring that all individuals or populations have optimal opportunities to attain the best health possible. Applying the principle of health equity requires that barriers to promoting good health are removed and resources are allocated among populations and/or communities proportional to their need(s). Integrating health equity in research and clinical practice applies frameworks that center on fairness, opportunity, quality, and social justice to promote well-being and health.
Center for Disease Prevention and Control: Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health. Achieving this requires ongoing societal efforts to (1) Address historical and contemporary injustices; (2) Overcome economic, social, and other obstacles to health and health care; and (3) Eliminate preventable health disparities.
IHI: Health equity is realized when each individual has a fair opportunity to achieve their full health potential. Differences in access, treatment, and outcomes between individuals and across populations that are systemic, avoidable, predictable, and unjust are particularly problematic for quality improvers. These types of differences are often referred to as inequities or disparities. Inequities are the worst type of unwanted variation in a system — variation linked to the complicated history and reality of racism, classism, sexism, ableism, ageism, and other forms of oppression
California Department of Public Health: Health equity refers to efforts to ensure that all people have full and equal access to opportunities that enable them to lead healthy lives. Determinants of equity are defined as the social, economic, geographic, political, and physical environmental conditions that lead to the creation of a fair and just society
Social Determinants of Health
Because the quality of neighborhoods and schools significantly shapes the life trajectory and the health of the adults and children, race- and class-differentiated access to clean, safe, resource-rich neighborhoods and schools is an important factor in producing health inequity. Such structural inequities give rise to large and preventable differences in health metrics such as life expectancy, with research indicating that one's zip code is more important to health than one's genetic code (RWJF, 2009).
Source: [National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States]
Other Causes of Health Inequity
“The social, environmental, economic, and cultural determinants of health are the terrain on which structural inequities produce health inequities. These multiple determinants are the conditions in which people live, including access to good food, water, and housing; the quality of schools, workplaces, and neighborhoods; and the composition of social networks and nature of social relations…And it is said, that the impact of these things follow us “from womb to tomb””.
Source: [National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States]
The Rise of Public Health
➡️ Affordable Care Act (also known as Obamacare) enabled many people to be insured, thus increasing access to healthcare services for populations that, historically, have been underserved.
The Affordable Care Act, formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010 (Wikipedia)
By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered.[5][6] The law also enacted a host of delivery system reforms intended to constrain healthcare costs and improve quality. After it went into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans (Wikipedia)
➡️ Upward trend in value-based care coincides with CMS’ (Medicare and Medicaid) trend of decreasing their reimbursement rates over time
According to CMS.gov, value based care includes programs that reward health care providers with incentive payments for the quality of care they give to people with Medicare. These programs are part of their larger quality strategy to reform how health care is delivered and paid for. (Source: CMS.gov, see below)
Impact on Societal Development
A study conducted by Deloitte (2022) states that the American economy loses over $320 billion to health inequities (which are preventable by the way).
This connects back to UN’s definition of health equity, where it was viewed as a vital component of sustainable development. This makes complete sense because the health, or lack thereof, of certain populations has ripple effects into businesses, the workforce, and availability of capital.
It has been proven that health inequities have a direct impact on Black people’s wealth by way of surmounting medical debt. You can read more about that here.
Conclusion
If you’re interested in learning more about health equity, be sure to follow me on IG @erynduhnay.
And if you listened to this podcast episode, please consider supporting me at my BUY ME A MATCHA page (here) which you can find linked in the description of this podcast or at the link in my bio. Thanks for listening and see you in the next one!
Sources
Affordable Care Act. (2023). In Wikipedia. https://en.wikipedia.org/w/index.php?title=Affordable_Care_Act&oldid=1137426980#cite_note-CBO_Subsidy2016-5
CMS’ Value-Based Programs | CMS. (n.d.). Retrieved March 14, 2023, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs
Haynes, B. (n.d.). The Racial Health and Wealth Gap: Impact of Medical Debt on Black Families. NCLC. Retrieved March 14, 2023, from https://www.nclc.org/resources/the-racial-health-and-wealth-gap/
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. 3, The Root Causes of Health Inequity. Available from: https://www.ncbi.nlm.nih.gov/books/NBK425845/]
Sector Brief “Communities in Action: Pathways to Health Equity” Exploring the Root Causes of Health Inequity. (n.d.). Retrieved March 14, 2023, from https://www.nap.edu/catalog/24624/
US health care can’t afford health inequities. (n.d.). Deloitte Insights. Retrieved March 14, 2023, from https://www2.deloitte.com/us/en/insights/industry/health-care/economic-cost-of-health-disparities.html