Health Equity

Op-Ed: Federal and State Policymakers Must Do More for Patients with Sickle Cell Disease
Health Equity Explained

What is Health Equity?

Health equity is achieved when every person has the opportunity to “attain their full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment (CDC, 2022).

Watch a short video on Health Equity:

What are Health Inequalities? 

Health inequities are systematic differences in the opportunities groups have to achieve optimal health, leading to unfair and avoidable differences in health outcomes (Braveman, 2006; WHO, 2011). Social determinants of health have a substantial impact on the health of many Americans and are a key driver of health inequities. (AAFP, 2019)

What are the Social Determinants of Health?

Social determinants of health (SDoH) are the conditions under which people are born, grow, live, work, and age, and include factors such as socioeconomic status, education, employment, social support networks, and neighborhood characteristics. These have a greater impact on population health than factors like biology, behavior, and health care. SDoH, especially poverty, structural racism, and discrimination, are the primary drivers of health inequities. Reducing health inequities is important because they are pervasive; unfair and unjust; individuals affected have little control over the contributing circumstances; affect everyone; and can be avoided with existing policy solutions.

Watch Veronica Scott-Fulton's TEDx Talk on "How social determinants impact healthcare":

Healthcare's Role in Disparities

Looking at race- and ethnicity-related disparities, for example, differences in access to care, receipt of needed medical care, and receipt of life-saving technologies for certain populations “may be the result of system-level factors or may be due to individual physician behavior” according to an NCBI article. The article states that “patient race/ethnicity has been shown to influence physician interpretation of patients’ complaints and, ultimately, clinical decision making.”

The literature shows that clinicians have biases toward certain populations that impede their ability to provide effective care. Over time, these biases become institutionalized and harder to eliminate. Given that the perceived quality of healthcare (or lack thereof) can significantly impact health outcomes (e.g., adherence to medical advice, cancer screening recommendations, and medication regiments), many health systems find themselves in a self-perpetuating cycle of health inequities and poor health outcomes. Health systems exacerbate their health inequity problems when they don’t have the required data (e.g., socioeconomic) or healthcare delivery structure to discover and correct disparities. (Healthcatalyst, 2018)

Ways Health Systems Can Strive For Health Equity:

  1. Make health equity a leader-driven priority (healthcare leaders must articulate, act on, and build the vision into all decisions).
  2. Develop structures and processes that support equity (health systems must dedicate resources and establish a governance structure to oversee the health equity work).
  3. Take specific actions that address the social determinants of health (health systems must identify their health disparities and the needs and assets of people who face disparities, and then act to close the gaps). Some patient populations need additional support to achieve the same health outcomes as other patient populations (e.g., they need someone to drive them to appointments, they need home visits, etc.).
  4. Confront institutional racism within the organization (health systems must identify, address, and dismantle the structures, policies, and norms that perpetuate race-based advantage).
  5. Partner with community organizations. (Healthcatalyst, 2018)