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
In a review of public health literature and practice, the Centers for Disease Control and Prevention (CDC), reached a definition of health equity that describes it 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 the terms health disparities, inequalities, and inequities are important and have practical implications for the type of data that are collected and which indicators are 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.”-- Smedley 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
Although there have been significant improvements to the health of U.S. residents overall in the past several decades, disparities by race and ethnicity, income and education, gender, disability status, and other social characteristics remain persistent and widely documented.6 Further, improvement is 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. Thus, there is a lot of work to be done to reduce health disparities and the need for equity in health outcomes has been recognized as a national priority.
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.