What is Health Equity and Health Disparity?
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
― Dr. Martin Luther King, Jr.
How We Define Health Equity, Disparity, Inequality, and Inequity
The Centers for Disease Control and Prevention (CDC), describes health equity as the situation when "everyone has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance.."1 We utilize the U.S. Health and Human Services (HHS) and CDC definition of health disparities, “…differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes.”2 Although sometimes used interchangeably with health disparities, the CDC distinguishes health inequalities as “…summary measures of population health associated with individual- or group-specific attributes (e.g., income, education, or race/ethnicity),”3 and health inequities as a “…subset of health inequalities that are modifiable, associated with social disadvantage, and considered ethically unfair.”4
The definitions and uses of these terms are important, and have implications for the type of data and indicators collected and monitored by government agencies.5
Is Health Equity Achievable?
Racial and ethnic minority patients are found to receive a lower quality and intensity of healthcare and diagnostic services across a wide range of procedures and disease areas….these disparities…occur independently of insurance status, income, and education, among other factors that influence access to healthcare. These disparities are unacceptable.” 5
- Despite significant improvements to the health of U.S. residents, disparities by race and ethnicity, income and education, gender, disability status, and other social characteristics remain persistent and widely documented. 6
- Improvement is also lagging in the majority of core health measures for all priority groups. 7
- The most severe disparities in U.S. health outcomes are divided along racial and ethnic lines and inextricably tied to social disadvantage, discrimination, exclusion, and geographic segregation.
- The need for equity in health outcomes has been recognized as a national priority.
Why Is Health Equity Research Important?
- The burden of health care disparities in the U.S. results in an estimated difference of 33 years between the longest and shortest living groups1
- “…the combined costs of health inequalities and premature death in the U.S. were $1.24 trillion” between 2003-2006.2
- The racial/ethnic minority population groups that presently experience the most disadvantaged health are estimated to grow resulting in an even greater cost-related burden associated with health disparities, inequities, and inequalities.
- The problem of racial/ethnic health disparities may be underestimated due to the difficulty and controversy surrounding the issue of collecting rigorous data with racial/ethnic identifiers which has led to calls for the elimination of such data.
1Brennan Ramirez LK, Baker EA, Metzler M.Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008:6.
2Carter-Pokras O, Baquet C. What is a "health disparity"? Public Health Report 2002;117:426-34.
3Asada Y. A summary measure of health inequalities for a pay-for-population health performance system. Preventing Chronic Disease 2010;7:A72.
4Braveman P, Gruskin S. Defining equity in health. Journal of Epidemiology & Community Health 2003;57:254-8
5Braveman P. Health disparities and health equity: concepts and measurement. Annual Review of Public Health 2006;27:167-94.
6HHS Action Plan to Reduce Racial and Ethnic Health Disparities. A nation free of disparities in health and health care: Department of Health and Human Services; 2011.
7U.S. Department of Health and Human Services Agency for Healthcare Research and Quality. National Healthcare Disparities Report: U.S. Department of Health and Human Services; 2011. Report No.: 12-0006.
8Smedley B, Stith A, Nelson AL. Unequal Treatment: Confronting Racial and Ethinic Disparities in Health Care. Washington, DC: Committee on Understanding and Eliminating Racial Disparities in Health Care, Institute of Medicine, National Academies Press; 2003