I recently took three of my children to shop for new shoes, each having outgrown their prior pair. As we walked down the aisles of the store, each child picked out a pair that they liked. As you might expect, I bought shoes that fit them. I wanted them to be able to walk, run, and play with their friends without worrying about shoes that pinched their feet or might fall off.
While “equality” would have dictated that I get them the same size shoes — ignoring their differences and specific needs — “equity” prevailed because getting them the shoe size that fit was fair and what they needed to succeed. I also knew that the consequence of an “equality” approach could have meant sore feet and maybe even injuries. There is a nuanced but important distinction between the two concepts.
Similarly, as we take a whole-health approach — looking at the physical, behavioral, and social drivers of health — we must do so through the lens of health equity. Health equity means that everyone has a fair and just opportunity to be as healthy as possible, but we can’t achieve it with a one-size-fits-all approach. It requires that we account for characteristics that make us unique and reflect our lived experience. These include race, ethnicity, gender identity, sexual orientation, religion, socioeconomic status, disability, and even where we live.
Advancing health equity requires taking specific steps to mitigate bias in processes and protocols, designing programs and approaches to prevent and reduce health inequities. This is a practice I call “health equity by design.”
In Fresno County, California, for example, the pre-term birth rate for Black women is more than 64% higher than for white women. Working in partnership with two community organizations that support Black women’s maternal health, we built a program to begin to address the alarming health disparities that contribute to maternal-infant health inequity. This tightly woven, community-based care matrix supports moms-to-be with resources and training, and nearly all the women who have taken part in the program delivered babies at full term.
Sometimes health inequities manifest by geography — one key social driver of health. Life expectancy can differ by as much as 20 years in neighborhoods that are only a few miles from each other. Access to healthcare can be a pressing issue, particularly for rural communities: more than 56% of rural counties do not have a pediatrician, according to the Federal Office of Rural Health Policy.
In 14 states, we have created scholarship programs for students to enroll in healthcare degrees and pledge to practice in a rural or tribal community for at least two or three years after they graduate. The Health Equity Scholarship program also builds a pipeline of diverse talent in the healthcare workforce overall, offering similar scholarships to students of color and students with disabilities.
Health inequities are not only harmful to individuals and communities, but they exact a significant toll on society as well. Health disparities account for roughly $42 billion in lost productivity per year and significant healthcare costs: A Deloitte study found that health inequities account for about $320 billion in annual healthcare spending in the U.S.; if unaddressed, those costs could reach $1 trillion or more by 2040. As Dr. Pierre Theodore, vice president of health disparities for Johnson & Johnson Global Public Health, noted in the study, “When you address inequities for one population, you raise health for all populations.”
The healthcare system, acting alone, cannot eliminate all factors that drive disproportionately poorer outcomes for some. But we can be part of the solution. That means working closely with community organizations to address the social drivers of health. In this way, we are setting a measurable and transparent health equity agenda and establishing an entirely new standard for whole health.