The terms equity and equality are sometimes used interchangeably, but they’re actually different concepts. Equality means that everyone is treated the same. Equity, however, considers each person’s unique situation to ensure that everyone is operating on a level playing field. As the saying goes, equality is giving everyone the same pair of shoes; equity is giving everyone a pair of shoes that fits. Equal doesn’t always mean fair and right.
How do these concepts apply to health? The Robert Wood Johnson Foundation says health equity means that everyone has a fair and just opportunity to be as healthy as possible. Without it, some groups of people will — and do — unjustly experience higher rates of illness and death. Health equity hinges on factors such as race, ethnicity, gender, gender identity, religion, socioeconomic status, disability, and even where you live. Whether you realize it or not, health disparities have an impact on everyone, causing higher illness and death rates and greater financial strain on communities and the nation. Individuals can only be as healthy as their communities. We believe everyone deserves access to quality healthcare, clean air, stable housing, transportation, and nutritious food — access that leads to better health. “It is both a health and moral and social imperative that health equity be our aim, and it will take intentionality and investment to achieve it,” said Dr. Darrell Gray, chief health equity officer at Elevance Health.
Health Disparities Undermine Equity
Health disparities are differences in health outcomes that are experienced by some groups of people and not by others. The impact of the COVID-19 pandemic is one example: Racial and ethnic minorities have experienced higher rates of COVID-19 and associated hospitalizations and deaths. This is not solely due to underlying health conditions such as diabetes or asthma, but it is also a factor of social drivers of health that have influenced a person’s lived experience. According to the Centers for Disease Control and Prevention, the rate of hospitalization for COVID-19 among Black and Hispanic/Latino people is about 4.7 times the rate of non-Hispanic white people.
While race and poverty are well-documented barriers to good health, inequities can happen for many different people. Individuals who identify as LGBTQIA+ have a higher risk of some behavioral health conditions; they are up to two and half times more likely to experience depression, anxiety and substance use disorders. People with disabilities can experience multiple barriers to care: Nearly half of adults with disabilities reported experiencing delays in receiving primary and preventive care.
Sometimes health inequities result from simple geography. For example, nearly 39.5 million people were living in low-income areas without easy access to affordable, healthy food in 2017, according to the United States Department of Agriculture’s most recent food access research report.
How to Advance Health Equity
Advancing health equity will not happen by chance. It requires that programs and approaches be intentionally crafted to address the unmet needs of populations made vulnerable by systemic inequity. The root causes of inequities must be identified and addressed. This is a practice that we 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. In that community, Elevance Health partnered with an organization dedicated to supporting Black women’s maternal health and a community-based doula organization. Together, we have worked to address the alarming disparities that contribute to maternal-infant health inequity by pairing moms-to-be with support and training. Due to this grassroots approach, nearly all the women who have taken part in the program delivered babies at full term.
Many people living in rural communities can’t simply drive to a local doctor’s office because there isn’t one. More than 56% of rural counties do not have a pediatrician. With the goal of expanding access to rural medical care, Elevance Health has created scholarship programs in 14 states for students who want to enroll in healthcare degrees and pledge to practice in a rural or tribal community for at least 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.
The healthcare system, acting alone, cannot eliminate all factors that drive disproportionately poorer outcomes for some people and communities. But it can take many steps to advance equity by improving the quality and safety of care for each individual person and by working with other sectors to address health-related social needs.
“We have to transform our approach to health and healthcare,” said Gray. “We act with urgency to understand what makes our members unique, to build their trust and to effectively partner with them to optimize their health. We are also working closely with community organizations to address the social drivers of health.”
Healthcare can serve as a beacon by setting a measurable and transparent health equity agenda — and then holding itself accountable.