Tag Archive for: equity

Moving from Equality to Equity

Health equality means giving everyone the same opportunities, care, and services.  This has been the focus for laws, polices, procedures, and medical training. This focuses on elimination of differences in health diagnoses and treatments. Health equity focuses on fundamental justice. The goal is to ensure equal access to quality healthcare and good health, even if this requires giving some people more support and resources. Health equity considers different cultures, access to resources, and socioeconomic status. 

Under an equality focused approach, a doctor might offer the same test to everyone at the same interval or provide the same information to everyone. The doctor might also believe that, if they treat everyone the same, they are not behaving in biased ways.  Policies and laws that focus on this can resolve some health disparities, especially when the disparity stems from lower quality treatment, deliberate discrimination, or lack of adequate screening.   

Disease and health disparities cause different but preventable outcomes among groups. These can include race, such as Black men dying more often from prostate cancer due to lack of access to quality care and social inequality. Sexism can lead to the level of pain not being believed. Disparities can also create barriers due to lack of transportation, age, financial status, and literacy levels, to name a few. While current cancer screening guidelines focus on it equality, data indicates that these need to be adjusted to disparities within specific communities. The incidences of preventable cancer and higher mortality are impacted by the type of cancer, geographic location, race and ethnicity, country of origin, and gender. Studies and guidelines also need to expand to add more underrepresented groups.  While studies show that at least half of the patients offered to participate in a trial do, physicians are less likely to discuss a clinical trial with a patient of color. 

 To address the underlying issues and individual needs, public health needs to move toward an equity-based approach. Health equity considers different cultures, access to resources, and socioeconomic status. The goal is to ensure equal access to quality healthcare and good health, even if this requires giving some people more support and resources. Some initiatives are underway to address this.  The Woodlawn Center in Chicago, added a clinic to serve Black men. This has improved the experiences with the health care system, increasing a positive environment leading to increased usage. In Multnomah County Oregon a partnership between nonprofits, government organizations, local health care providers and several community- and faith-based groups was formed to address the specific needs of the local Black and Latino communities.   

We must strive to take equity further by applying justice, where we move to fix the issues. Equity-minded medical professionals must consider how social determinants of health such as access to a healthy diet, stress, and trauma affect outcomes. They must also consider how apparently equal systems lead to inequitable and unjust outcomes. An equity lens moves health systems closer to removing disparities. It also encourages policymakers to think about the myriad ways social environments affect health. 

Until medical schools and training of health care professionals expand to include environmental and social impacts, patients and care partners need to work with the health care professionals to include these factors.  Find out if the testing and screening is based on the “average” person or includes the segment of the population that includes the patient.  Do the “standard of care” recommendations consider the ability of the patient to comply?  For example, a doctor who knows a person has limited access to healthy food may work with the person to strategize ways to overcome this challenge and reduce the risk of health issues. The doctor might also lobby for policies to address this issue. There is no “average” person.  Everyone is unique and the best outcomes come from the medical personnel, patient, and care support working together as a team. 

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References

“What are the differences between health equity and health equality?”, Medical News Today 

Racial Disparities in Cancer Outcomes, Screening, and Treatment”, KFF 

“Equity vs. Equality: What’s the Difference?”, Milken Institute School of Public Health at George Washington University