Often the terms “equity” and “equality” are used interchangeably, yet they represent very distinct concepts. In health, equality means everyone is treated the same and is given access to the same resources. However, equity means people have access to the resources they need to maintain a healthy life. An equity perspective recognizes the relative social advantages and disadvantages different populations face.
The role of public health professionals extends beyond offering the same solution to each individual or community. Gaining a deeper understanding of health equity and its applications can give those professionals the tools to address social and structural determinants.
“Everybody who studies public health should be studying public health equity”
Paul Farmer, Former Simmons Friars Leader and Partners in Health Co-Founder
Six Terms You Need to Know
Conversations about health equity often raise questions about these related topics.
Social and Structural Determinants
The social and structural determinants of health are the variety of factors that contribute to a person’s state of health. These determinants can include a person’s education, access to health care, economic stability, living environment, or social status, and they reflect differential power and access to resources.
Health disparity is the difference in health in a population, relative to other populations, that is closely linked with economic or social hardship. This disparity negatively affects those that experience racial, social, geographic, or gender-based discrimination.
Social justice emphasizes the fair distribution of economic growth and opportunities in a society. For health equity, the term is used to talk about the variety of ways a society can redress power imbalances that advantage some populations in health and disadvantage others.
Advocacy is the effort to influence policymakers to implement or support policies that improve health equity. Advocacy is accomplished by collaborating with community members to conduct research on the health issues of disadvantaged communities and to push for better policies.
Collective action is when a group of people or organizations works toward a common goal to improve the likelihood of succeeding. Local and global health organizations, and social movements, use collective action to advocate for structural changes that can advance health equity.
Institutional and Structural Racism
Racism is a system of advantage and disadvantage based on the socially constructed concept of race. Institutional racism reflects how this system functions within institutions, for instance, schools, criminal justice, transportation, and finance. Structural racism reflects how racism works across these institutions, at the broadest level of societal influence.
The Gardener’s Tale: A Lens to View Health Equity
Viewing health equity through a lens of structural racism can help us better understand the concept as a whole. Dr. Camara Jones, former president of the American Public Health Association, uses an allegory titled “The Gardener’s Tale”1 to help explain the role that racism plays in U.S. society, including its health system.
A gardener has two flower boxes, one that she knows is full of good soil and one that she knows is full of bad soil.
The gardener buys two packets of seeds for the same kind of flower — one packet for pink flowers and one for red flowers. She prefers the red over the pink, so she plants the red seeds in the good soil and leaves the pink flower seeds to be planted in the bad soil.
Of course, the red flowers flourish, but most of the pink flowers don’t grow very high.
Over a decade later, the gardener returns and believes that she was right to prefer the red flowers over the pink flowers. She fails to see that she doomed the pink flowers to a lifetime of poor growth by planting them in the bad soil.
The allegory illustrates the role that racism plays as one of the many factors preventing health equity in the United States. Racism has deep roots in society and continues to shape relative opportunity through many mechanisms, such as neighborhood segregation, discriminatory employment practices, and disciplinary gaps in educational settings. These factors compound health disparities and present major challenges to achieving health equity as an inclusive vision.
Public Health Careers With a Focus on Health Equity
Public health professionals work to evaluate and improve the health of entire populations and communities. A deeper understanding of health equity and its applications can help public health professionals meet the goals of the communities they serve. Since 1985, more than 40 states have established an office dedicated to health equity, minority health, and/or the elimination of health disparities, according to state health departments.
Professionals dedicated to achieving health equity may include:
Social and community service managers
Social movement leaders
Community health workers
State and local health department leaders
Organizations That Work to Solve Challenges of Health Equity
Achieving equity in health outcomes requires learning from both individuals and communities to understand their particular needs. Organizations committed to solving challenges related to health equity on a global and local scale include:
Partners in Health (PIH): Working with hospitals and other nonprofit health care groups globally, PIH supports impoverished communities by building medical facilities, delivering care, and addressing the social determinants that deter health care access.
People’s Health Movement (PHM): With chapters in more than 70 countries, PHM is a global network of health advocates and organizations dedicated to creating a more equitable and sustainable world.
World Health Organization (WHO): To create a healthier future for those around the world, the WHO explores all aspects of health equity and coordinates with international organizations to combat disease and hunger.
American Public Health Association (APHA): In order to fulfill its mission of achieving health equity in the United States, APHA advocates for federal health policy to advance community health across the country.
Robert Wood Johnson Foundation (RWJF): Dedicated to improving health standards and health equity in the United States, RWJF funds research and grant programs aimed at supporting disadvantaged communities.
Government Alliance on Race and Equity (GARE): GARE works with state and local governments, including health departments, to eliminate racism and its effects.
Health Care NOW: As part of a coalition of organizations — including health care providers, patients, and community members — this nonprofit organization is committed to supporting a single-payer health care system in the United States, to equalize access and opportunity for all.
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