The difference between “health equity” and “health equality”

Both health equity and health equality strive to improve outcomes and expand access to services, particularly for underserved and vulnerable communities. Nonetheless, these are two distinct techniques and philosophies with quite different outcomes.

Giving everyone the same opportunity, treatment, and services is what health equality entails. A doctor might perform the same test on everyone at the same time, regardless of risk factors, or give everyone the same information. The doctor may also assume that as long as everyone is treated equally, they are not being biased.

Ending structural and discriminatory barriers that lead to health inequity and inequality is what health equity entails. This covers both internal and external problems, such as racism and sexism in the healthcare system, as well as poverty and unequal distribution of resources.

On a policy level, health equality ensures that everyone has equal access to healthcare, whereas health equity places a greater emphasis on justice. Everyone would receive the same healthcare funds and services under an equality-based approach. In an equity-based approach, financing would be based on need, and the services available would be based on need. A Pap smear, for example, would be available to everybody with a cervix.

Gender and sex exist on a spectrum. This article will use the terms “male,” “female,” or both to refer to the sex assigned at birth. To learn more, visit here.

Health equity

Health equity

Fundamental justice is at the heart of health equity. The goal is to ensuring that everyone has equal access to high-quality healthcare and excellent health, even if that means providing additional support and resources to some people.

Different cultures, resources, and socioeconomic status are all taken into account when determining health equity. Poverty, for example, can have a negative impact on health by limiting access to adequate food, increasing stress and trauma, and causing people to live in dangerous environments.

Health professionals consider the influence of socioeconomic determinants of health and strategies for resolving them in a health equality framework.

A doctor who knows a person has limited access to good food, for example, may work with the person to devise strategies to overcome this obstacle and lower the chance of developing health problems. The doctor may also advocate for legislation to remedy the problem.

Health equity

The goal of health equality is to treat everyone equally and provide equal access to health care.

In some circumstances, health equality can help to eliminate gaps, particularly when those differences are caused by unequal treatment.

According to a 2016 study, medical students and residents believe racist stereotypes about Black people, such as thinking they are less in pain. Eliminating racist views and encouraging medical practitioners to evaluate people equally could help make Black people’s suffering more obvious and help close some health gaps.

Discrimination and poor care are also common complaints among transgender people. In a poll conducted by the National LGBTQ Task Force, half of trans respondents indicated they had to educate their doctors on trans healthcare. In addition, 28% stated they had been harassed in medical settings, and nearly one-fifth said they had been denied medical attention.

The goal of a health equality lens would be to eliminate discrimination and harassment towards trans people, but it wouldn’t be enough to fix the problem. Doctors would also know how to care for trans people if they used an equity-based approach.

Health disparity

A health difference is not the same as a health disparity. The term “difference” simply refers to the fact that distinct groups have different outcomes.

People who have a uterus, for example, are more likely to become pregnant. Rather than a gap, this is a biological difference. People over the age of 50 have a lower chance of becoming pregnant than those under the age of 30. Again, this is a distinction rather than a disparity.

A disparity is an inequitable and avoidable difference. Disparities are influenced by societal factors. Disparities in disease and health have varied but preventable consequences for various groups.

Prostate cancer, for example, is more common in black males than in white men. There was no significant difference in death rates between white and black males with prostate cancer when researchers controlled for socioeconomic and environmental variables, such as access to quality care, according to a 2019 study.

This shows that the high death rates of Black men with prostate cancer are due to avoidable factors rather than any inherent differences. These challenges include access to high-quality care, the sort of treatment a person receives, and health-related socioeconomic inequity.

Examples

Both health equality and health equity can aid in the reduction of health disparities, however the best strategy differs depending on the health issue.

Racism-related disparities

Melanoma, a highly aggressive skin cancer, affects black people at a lesser rate than white people. They are, however, more likely to succumb to the disease because doctors frequently identify cancer at a later stage.

A health equity lens would focus on providing equitable access to skin cancer screenings to both white and black people. Doctors would be educated on the reality that Black people can and do die from melanoma, and they would be encouraged to be vigilant about suspicious growths on both Black and white skin.

Researchers might use this approach to address scientific disparities, such as the exclusion of Black people from skin cancer research.

This may increase the number of Black people who receive cancer screenings, but it may not solve other issues. A more complete approach is taken with an equity focus. The emphasis in this system would be on ensuring equal access to screenings. However, healthcare professionals would consider other aspects as well, such as:

  • lobbying for funding for programs that ensure that Black people can access skin cancer screenings
  • reaching out to Black communities to overcome barriers to skin cancer screenings, such as lack of transportation or health insurance
  • identifying any cultural barriers to seeking or getting treatment
  • educating people about the risks of skin cancer

Disparities based on sexism

According to the research, people who are assigned female at birth have a hard time getting an accurate diagnosis for reproductive and gender-specific health issues. According to a 2020 study, the average time between the development of endometriosis symptoms and diagnosis and treatment is more than 6 years.

Some approaches to health equity would not solve the problem at all. Giving males and females equal access to the same screenings, for example, would rule out female health conditions like endometriosis.

Equal training in medical school and continuing education on male- and female-specific health issues could be an alternate equality-based strategy. This could ensure that doctors receive enough training, but it may not be enough to remedy the problem.

A health equality viewpoint can look at the unique challenges that people encounter when visiting the doctor. Several research demonstrate that people, especially doctors, are less concerned about their discomfort. In a study from 2021, for example, observers linked female discomfort to mental health difficulties but trusted males when it came to their pain. Females’ pain levels were frequently underestimated by observers.

Implicit bias training, information about how doctors tend to dismiss women’s pain perceptions, and other interventions may be beneficial. Public health advocates might create campaigns aimed specifically at health concerns that doctors frequently underdiagnose, and make sure the information was available in places where people could readily find it.

Here’s more on the effects of sexism on getting a diagnosis.

Conclusion

Some health inequalities can be resolved by achieving health equity, especially when the discrepancy is caused by poor treatment, discrimination, or a lack of proper screening.

A variety of social elements have an impact on one’s health. This involves aspects of the health-care system as well as societal challenges.

Medical professionals who care about equity must think about how socioeconomic determinants of health like access to a nutritious food, stress, and trauma affect outcomes. They must also think about how seemingly equal systems might result in inequitable and unjust consequences.

The use of an equity lens helps health systems get closer to eliminating inequities. It also pushes policymakers to consider the many ways in which social settings influence one’s health.

One way to understand equity is through a social-ecological model of health. Individuals have relationships, which exist in communities, which exist in wider social frameworks, according to this view.

Each layer of link has the potential to affect health outcomes. Individual prejudice may occur as a result of social conditioning, or a health system may yield inequitable outcomes as a result of societal difficulties, even if individual medical practitioners do not discriminate.

Sources

  • https://www.amwa-doc.org/health-equality-vs-health-equity/
  • https://onlinepublichealth.gwu.edu/resources/equity-vs-equality/
  • https://www.cdc.gov/healthyyouth/disparities/index.htm
  • https://www.medicalnewstoday.com/articles/health-equity-and-health-equality
  • http://collier.floridahealth.gov/programs-and-services/wellness-programs/health-equity/_documents/healthequityinfographic.pdf 
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/
  • https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncy.22229
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7089728/
  • https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html
  • https://www.jpain.org/article/S1526-5900(21)00035-3/fulltext