An Introduction to Health Equity - Part 1
By Tim Barr, Collective Impact Strategy Manager
The vision of Methodist Healthcare Ministries is “to be the leader for improving wellness of the least served." In that spirit, Methodist Healthcare Ministries strives to promote a sense of health equity across the 74 counties we serve and to reduce health disparities, while improving overall population health by focusing our efforts on the most vulnerable populations. We recognize that disease management and direct services alone cannot, and ultimately will not, transform individual or community health in our service area. They may improve wellness for a period of time, but they do not create lasting change, especially not on a community level.
To support transformational change in the communities we serve, we need continued learning about, implementation of, and shared commitment to health equity. Toward that end, this post kicks off a three-part series introducing health equity language, practical recommendations and tools for healthcare professionals, as well as strategic considerations for healthcare organizations.
For starters, equity is not the same as equality. Pursuing equality means focusing on a final goal of equal or equitable services for all people. As depicted in the image below, equality assumes that one size fits all, that we can all reach the same destination of living at the highest level of health if we simply receive an opportunity to do so (i.e., consistent access to clinical care). Equity, by contrast, is far more ambitious and much more specific to the differences between groups and reasons for those differences.
Visualizing Health Equity: One Size Does Not Fit All
As defined by Healthy People 2020, health equity is the “attainment of the highest level of health for all people.” Beyond levelling the playing field to make it fair and equitable for all people, health equity requires righting historic and ongoing wrongs, and correcting the generational impact of biased policies and norms that have favored some groups over others. These policies and norms include slavery, forced migration, redlining, wage discrimination, and mass incarceration.
FOR FURTHER LEARNING: Watch this 76 second video about the difference between health equity and health equality
These and other social processes have created significant health disparities between different population groups. For example, in the United States, life expectancy from birth varies greatly in urban areas; residents in lower-income neighborhoods of color often live 10-20 years less than residents in higher-income, predominantly white neighborhoods of the same city.
FOR FURTHER LEARNING: Does where you live affect how long you live? Enter your zip code to compare life expectancy in your community to life expectancy in your county, state, and the United States
In Corpus Christi, Texas, when mapped by census tract, this disparity ranges from a life expectancy of 69.6 years in the Hilcrest area to 85.2 years on the south side. A similar gap exists for San Antonio, as demonstrated by the map below:
Alternatively, obesity rates offer another obvious example of health disparities. Latinx individuals are more likely than whites to develop obesity; furthermore, the prevalence of Latinx obesity is higher for women than men and decreases by increasing levels of educational attainment.
It is important to note that while disparities reflect historical and contemporary injustices in a society, they also offer a measurable means of demonstrating progress toward achieving health equity. From the American Medical Association to the Surgeon General of the United States, healthcare organizations are being exhorted to prioritize the elimination of disparities as a means to improve overall health outcomes and strive toward equity.
The next post in this series will dig deeper into specific disparities, offering a few practical recommendations for pursuing health equity in everyday healthcare practice.
Tim Barr is the Collective Impact Strategy Manager for Methodist Healthcare Ministries. He supports, develops, and facilitates collaborative efforts in South Texas. Tim is also a member of the Climate Equity workgroup for the City of San Antonio’s Climate Action and Adaptation Plan.
Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010). Socioeconomic Disparities in Health in the United States: What the Patterns Tell Us. American Journal of Public Health, 100(S1), S186-S196. doi:10.2105/AJPH.2009.166082
Braveman, P. A., Kumanyika, S., Fielding, J., LaVeist, T., Borrell , L. N., Manderscheid, R., & Troutman, A. (2011). Health Disparities and Health Equity: The Issue is Justice. American Journal of Public Health, 101(S1), S149-S155. doi:https://doi.org/10.2105/AJPH.2010.300062
Healthy People 2020. (n.d.). Disparities. Retrieved from Healthy People 2020: https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities
Lopez, E. B., & Yamashita, T. (2018). The relationship of education and acculturation with vigorous intensity leisure time physical activity by gender in Latinos. Ethnicity & Health, 23(7), 797-812. doi:10.1080/13557858.2017.1294664
Murphy, S. L., Xu, J., Kochanek, K. D., Curtin, S. C., & Arias, E. (2017). National Vital Statistics Reports, Deaths: Final Data for 2015. US Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_06.pdf
VCU. (2016, September 26). Mapping Life Expectancy. Retrieved from Center on Society and Health: https://societyhealth.vcu.edu/work/the-projects/mapping-life-expectancy.html