It Matters How We Define Health Care Equity
Equity is not a contemporary concept. The Oxford English Dictionary defines equity as “the quality of being fair and impartial: equity of treatment. A branch of law that developed alongside common law in order to remedy some of its defects in fairness and justice, formerly administered in special courts: if there is any conflict between the principles of common law and equity, equity prevails.” (Origin: Middle English: from Old French equité, from Latin aequitas, from aequus, “equal.”)
The definition of health equity has evolved over time, with the principal focus on the individual and the attainment of social justice. In order to maximize the delivery of high-quality health care and avoidance of disparities, it is necessary to ensure that the concept of health equity is clearly defined. Ambiguity in the definition may result in harmful policy consequences. In due course, this can determine which measures are monitored at the national, state, and local level with impacts on resource allocation to address disparities and health equity (Braveman, 2006).
Margaret Whitehead (1992) concisely defines a lack of health equity as differences in health that “are not only unnecessary and avoidable but, in addition, are considered unfair and unjust.” She goes on to state that “equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential, if it can be avoided.”
Accordingly, equity in access to health care implies that everyone has the opportunity to reach their full health potential; in short, the playing field is leveled for all individuals. Whitehead goes on to define equity in heath care “as equal access to available care for equal need, equal utilization for equal need, and equal quality of care for all.”
In virtually every society in the world, social privilege is reflected in differences in socioeconomic status; gender; geographical location; racial, ethnic, and religious differences; and age. Pursuing equity in health depends on reducing avoidable gaps in health status and health services among groups with different levels of social privilege (WHO, 1996).
Over the next several years, as the Affordable Care Act becomes fully operative, an emergent population of Americans who have been on the outside of the health care system will now have access to care. Access, however, is in no way a guarantee of equity in health care. It will be critical that there are policies in place to ensure that the quality, quantity, and appropriateness of care are not disparate and as a result we will have achieved the goal of health care equity.
References
- Braveman, P. 2006. Health disparities and health equity: Concepts and measurement. Annual Review of Public Health 27:167-194. https://doi.org/10.1146/annurev.publhealth.27.021405.102103
- Whitehead, M. 1992. The concepts and principles of equity in health. International Journal of Health Services 22(3):429-445. https://doi.org/10.2190/986L-LHQ6-2VTE-YRRN
- WHO (World Health Organization). 1996. Equity in health and health care: A World Health Organization initiative. Geneva: WHO (unpublished document WHO/ARA/96.1).
