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What Is the Difference Between Equity and Equality?

A Health Equity Story
April 4, 2022

What Is the Difference Between Equity and Equality?

If asked, most of us would agree that we support equality in nearly every context — the idea that everyone deserves an equal chance to thrive, to be safe, healthy, and happy. Equality is a widely understood concept. The idea of equity, on the other hand, has only gained much-needed attention in recent decades. Equity means allocating resources and opportunities according to actual need, alongside working to address longstanding biases and societal barriers that have prevented some people and groups from achieving their full potential.

Embracing Health Equity to Improve Health Outcomes

Working toward health equity involves looking at many factors that can impact a person’s health —  age, geography, race, gender identity, sexual orientation, disability — to ensure that they have the opportunity to be as healthy as possible. For instance, rates of Type 2 diabetes and COVID-19 are measurably higher in the Black community, but that is certainly not because of biologic differences between Black people and those who identify as another race or ethnicity. Those differences are largely attributed to social drivers of health that create barriers to care and put them at greater risk. It’s vitally important to address these barriers at their source as well as within the healthcare system — for the health of individuals, communities, and the nation. 

“Advancing health equity is everyone’s business,” said Dr. Shantanu Agrawal, Elevance Health’s chief health officer. “It’s not just my job. It's not just the job of the healthcare and community-based providers with whom we partner. It’s not just the job of our call center staff on the frontline with our members. It’s everyone's job.

A History of Health Equity Policy in the United States

While the need for health equity has always been present, it became a priority for the federal government in the mid-1980s with the publication of the Report of the Secretary’s Task Force on Black & Minority Health released by then Health and Human Services Secretary Margaret Heckler. The report called out “a continuing disparity in the burden of death and illness experienced by Blacks and other minority Americans as compared with our nation’s population as a whole.”

“That disparity has existed ever since accurate federal record keeping began — more than a generation ago,” wrote Secretary Heckler. “And although our health charts do itemize steady gains in the health status of minority Americans, the stubborn disparity remained — an affront both to our ideals and to the ongoing genius of American medicine.”

The Office of Minority Health was created by Congress in 1986, with the goal of developing health policies and programs that help eliminate disparities. A series of policy initiatives, laws and reports have followed. In 1990, President George H.W. Bush signed the Americans with Disabilities Act into law. Modeled after the Civil Rights Act of 1964, the law prohibits discrimination against people with disabilities and guarantees that they have the same opportunities to live, learn, work, play, and participate in state and local government programs as everyone else. Equality would be providing stairs in a public building; equity is providing a wheelchair ramp or elevator for everyone to use. Equality is giving everyone a pen to fill out a paper job application; equity is posting that application on a website that is compatible with assistive technology such as a screen reader or refreshable Braille display for people with visual disabilities. 

Every decade since 1980, the Department of Health and Human Services has released its “Healthy People” report that has been increasingly aimed at eliminating health disparities and promoting health equity. The latest initiative, Healthy People 2030, includes data-driven national objectives to improve the health and well-being of all Americans in the next 10 years.

What Can the Healthcare Industry Do to Advance Health Equity? 

The healthcare industry must evolve its priorities to ensure that every person has their best chance to live a healthy life. “There are some populations and people for whom we need to really prioritize resources in working with them to achieve their best health and well-being,” said Dr. Agrawal. “The goal is that everyone has a fair and just opportunity to be as healthy as possible, and there are people who do not have a just or fair opportunity to be as healthy as possible.” That’s why it’s important for all of us to embrace our role in focusing on equity over equality.

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