With discussions of health equity and health justice in the news, you may be hearing terms like “social determinants of health” and “health disparities” in frequent conversation. What do health equity, health literacy, health disparities, and social determinants of health mean, and what do they have to do with one another?
What is health equity?
Health equity is a broad term; in short, it is the goal that every person is equally able to live a healthy life regardless of their background or circumstance. According to the CDC, health equity is when each person has the chance to reach “his or her full health potential,” without facing obstacles from “social position or other socially determined circumstances.” This includes equitable (fair) access to healthcare professionals, healthy food, a safe living environment, and the ability to be well across all aspects of life, from work to home life to medical care.
In addition to health equity, some other important terms in this discussion include:
Social determinants of health – these are factors that can influence a person’s health but that typically fall outside the scope of a healthcare professional. This can include education, socioeconomic status, and even the zip code where a person lives and works. A person’s health can be affected deeply by the neighborhood in which they live. The air they breathe, the ability to safely play and exercise outside, and the ability to access healthy food all vary greatly from one area to another. The same can be said of education and income – even today, the greatest predictor of a child’s A1C is their parents’ education level and socioeconomic status. Watch this video to learn more about social determinants of health.
Health literacy – this is a person’s ability to understand important health and medical information. This term also speaks to their ability to use that information to get the best care for themselves. A person with higher health literacy can more easily understand what options they have for medical treatment, as well as the consequences of the choices they make; they can also communicate about their decisions about health and healthcare. People with lower health literacy levels have a harder time understanding their diagnoses and treatment plans, as well as communicating their needs and preferences to their healthcare professional. Health literacy is an essential component of health equity; individuals need to be able to understand the information they are given, in order to best advocate for their own health.
Health disparities – these are the differences in health outcomes that vary by population. For example, certain racial minorities experience higher rates of chronic illnesses, disabilities, and mortality when compared to other populations. Disparity – meaning more problems facing one group of people than the general population – results in health inequity. Disparities are not just affected by race: as you will see below, they are also influenced by factors including gender, geographic region, age, sexual identity and orientation, and immigration status.
What are the major barriers to health equity?
We have a very unequal system of healthcare in the United States. For a number of reasons, not every person has access to equal care or equitable outcomes. This has become especially visible during the COVID-19 pandemic; the health crisis is disproportionately affecting certain communities, which is highlighting the lack of health equity in our country. Some reasons for these disparities include:
Socioeconomic status: Healthcare in the United States is extremely expensive (both for insurance costs and for costs of care). Medications, clinical visits, and other aspects of taking care of one’s health can be unaffordable for people based on their income level. Additionally, choices that will benefit overall wellness, such as healthy eating or visiting a gym, may be inaccessible due to cost. As a result, socioeconomic status is often a major predictor of overall health.
Lack of insurance or underinsurance: Not everyone in the United States is able to afford health insurance. In some cases, people have health insurance, but their deductible is so high that they are unable to use the insurance in any meaningful way. As the costs associated with having insurance increase, fewer people will be able to afford consistent access to medical care. Learn more about insurance and affording medical treatment here.
Race and ethnicity: A major barrier to health equity is systemic racism present in our current healthcare system. Studies show that race and ethnicity are still major factors in determining the quality and type of care that a person receives. This has to do with unintentional biases in healthcare professionals, among other things. Historically, people of color were not equally included in clinical trials, which affects treatment and standards of care even today. One way to resolve this has been an increase in cultural humility training, which encourages healthcare professionals to develop more honest, trustworthy, and culturally sensitive relationships with the people they help.
Age: Another barrier to equal care is age discrimination. Healthcare professionals may assume someone’s medical issues are a result of aging, instead of looking for a different explanation based on their symptoms. Additionally, elderly people are not always trusted to accurately report their symptoms. Even further, elderly people are often excluded from clinical trials, which means that many medications are not tested in older populations.
Geographic region: There are more healthcare professionals in and around cities. In one study of over 6,500 healthcare professionals, 95.4% of the endocrinologists were located in urban areas, with less than 2% located in rural areas. This means that accessing care is much harder for people in rural regions, so disparities arise based on where people live.
Why do we care?
Chronic conditions (like diabetes and obesity) are disproportionately seen in communities of color and build on additional factors to put these communities at greater risk for health challenges. Although race and ethnicity are not the only factors that drive health disparities, they are major factors. We all have a responsibility to work to address the inequities and disparities in our country.
How can we continue these conversations?
Many of the inequities in our health system in the United States are systemic, meaning that they are built into greater systems of inequality in our country. There is no easy way to “solve” this crisis. However, once we are able to identify the problem, it becomes possible to address it. There are many ways to work toward equity in health, from increasing access to health insurance to reducing the stigma associated with seeking care. A major step toward health equity is through education, for people, policy makers, and healthcare professionals.
It’s important that we pursue this conversation about health equity further. Here are some ways that you can become involved:
Start a conversation about this topic. Ask your friends and family what they know about health equity, and where they see places that we can work toward change. Helpful conversation starters can include, “How can we work toward a fairer health system?” View this extensive guide for more tips.
Support organizations that are doing work in this important area. Donate, volunteer, and help others learn more.
Karen Washington, a “food justice warrior,” has made it her life’s work to bring healthy food to the Bronx in New York. Karen noticed that her neighborhood lacked access to healthy food and was also ranked as the least healthy county in New York. Because of this, she set out to make changes to help her community.
In a similar vein, Dr. Valarie Bluebird Jernigan noticed health patterns in Native American communities that indicated a lack of equity. You can read about her journey toward health equity in indigenous communities here.
Many powerful efforts are underway to achieve health equity. However, work is needed to advocate for more equitable outcomes, so that we can create a more just health system that helps all people in the United States.