Why Health Equity Matters

Health equity is a key concept that is receiving increased attention, with a focus on how to improve population health. However, it is not uncommon for this concept to be misconstrued or poorly understood when attempting to adopt team approaches and reach agreement on priorities, whether in individual offices, large health care facilities, or in other professional groups. This article provides an overview of the current state of health equity, as well as ways you can support this mission in your own practice.

WHAT IS HEALTH EQUITY?

Health equity is an important public bridge to the diversity of health care stakeholders for building consensus, supporting dialogue, and implementing actions towards improving the overall health of people, independent of who they are or where they live. The American Public Health Association (APHA) demonstrates health inequity effectively by showing that certain groups of people are more at risk for certain diseases but have less ability to get treatment, so they are more likely to have severe health consequences or to die from treatable, preventable diseases. The APHA also explains how equity does not mean equality or simply equalizing opportunities; rather, those with worse health and fewer resources require a range of patient-specific efforts in order to achieve optimal health.

The APHA provides a wealth of resources and information on health equity on its website (www.apha.org), including an excellent educational video.¹ The Robert Wood Johnson Foundation defines health equity as a state in which “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 jobs with fair pay, quality education and housing, safe environments, and health care.”²

RECOGNIZING HEALTH DISPARITIES

Health disparities were at the forefront of a groundbreaking 2003 Institute of Medicine Report titled, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare,” which found that people of color (POC) receive lower-quality medical care than do White people.³ Since that time, a multitude of national initiatives and programs focused on health disparities and health equity have emerged. In 2005, the Centers for Disease Control and Prevention (CDC) expanded its Office of Minority Health to become the Office of Minority Health & Health Disparities, and in 2011, the title changed again to the Office of Minority Health and Health Equity.⁴ The CDC states that health equity is achieved when everyone has the opportunity to attain their full health potential (see Additional Reading for more on this).⁵ Another example is The Commonwealth Fund’s Advancing Health Equity program, which was established in 2021 and that aims to eliminate unequal treatment, experience, and outcomes in health and health care for POC by reducing systemic racism in health care policy and practice.”⁶

Additional Reading

The Robert Wood Johnson Foundation launched the Finding Answers initiative in 2005, which focused on moving beyond merely documenting racial and ethnic differences in health care to supporting efforts to eliminate them, and by 2018, the initiative had gathered data from 33 organizations focusing on cardiovascular disease, diabetes, and depression—diseases for which the evidence of racial and ethnic disparities is strong. These findings culminated in the development of the Roadmap to Advance Health Equity.⁷ In addition, the Centers for Medicare and Medicaid Services (CMS) adopted health equity as a 2022 Pillar in the CMS Strategic Plan.⁸ (For more examples of initiatives, see Resources for Information on Health Equity.)

Since 2020, a substantial number of health care stakeholders and related professional organizations have adopted similar aims through initiatives involving inclusion, diversity, antiracism, and equity. Many organizations include achieving health equity as a primary objective and focus on how we can help achieve optimal health for all. These include reducing disparities in a broad range of areas, including workforce, care delivery protocols, funded scientific research, publications, and access to health care. It also includes increasing awareness of the effects of determinants of health, systemic racism and discrimination, and of the existing educational and professional training protocols on these topics.⁸

MOVING FORWARD

Universal health equity does not yet exist, but a large body of knowledge continues to evolve on how this can be achieved. Strategies to improve health equity include identifying key health disparities and understanding important determinants of health, such as having health insurance, education and income status, and living and working conditions, as well as how these determinants affect the overall health of patients and specific patient populations.

Many advocacy groups have begun to focus on reducing inequities in the resources needed to be healthy by working to implement laws, environments, and practices that eliminate unfair conditions for disadvantaged groups.^1,8 In order to achieve health equity, providers, payors, and constituents must also be committed to the mission of improving health and eliminating discriminations regardless of race, ethnicity, gender, sexual identity, age, disability status, preferred language, religion, employment status, income, migrant status, and other factors.⁸ Learn what you can do to forward this mission in Support Health Equity in Your Own Practice.

GOAL TO IMPROVE POPULATION HEALTH

Your efforts to educate yourself and implement change will help others to realize the importance of health equity. Ultimately, reducing health disparities leads to decreased morbidity and mortality. As the mission for health equity becomes a more widely adopted priority among health care stakeholders, it is important to translate such efforts into our patients’ communities across the country to achieve optimal US population health.