Making the Case for Hastening Progress Toward Health Equity

Health equity has been defined in many ways, but essentially the concept focuses on promoting social justice rather than economic or social status as the primary means for determining access to good health and well-being (Braveman, 2006). Another way, however, of viewing the concept of health equity is through the lens of social justice, given the longstanding disparities in access to opportunities available to different populations in our communities. Thus, not only is the aspiration of achieving health for all essential to a civilized and just society, but also, most importantly, health equity is a fundamental measure of our humanity. Health is of critical moral importance because it protects opportunities to pursue goals, reduce pain and suffering from poor health, and extend life expectancy. The poor health outcomes observed among people of color relative to the majority group population reduces their fair share of the available societal and economic opportunities (Daniel, 2008).

Although historical injustices cannot be rewritten, there are critical moral and economic imperatives that drive researchers, policy makers, and public health professionals to seek solutions that promote health equity. The principle underlying the Universal Declaration of Human Rights provides an ethical framework for society to address health inequalities. According to this principle, all human rights—civil, political, economic, social, and cultural are interdependent and inseparable. For example, the inability to realize one’s economic and social rights (the right to an adequate standard of living, the right to a high-quality education, the right to attain the highest standard of health, etc.) is an impediment to realizing one’s civil and political rights. Additionally, denial of the freedom of speech and the right to participate in the political process can potentially constitute a serious threat to health  (Braveman, 2006).

 

Health Equity: The Moral Imperative

Efforts to reduce disparities in health outcomes that complicate our progress toward attaining health equity have been critically evaluated for decades. Time is running out to reach consensus around solutions and implementation of initiatives that will move our nation to a higher level of performance, ensuring the highest quality of life and longevity for all of its citizens. The moral imperative is clear, given the rising rates of premature mortality among low-income populations and the deaths that could be prevented if health disparities were eliminated. Additionally, one component of a good quality of life is access to high-quality health care. Yet we know that millions of Americans remain without health insurance. This is even more staggering when one considers the wealth that exists in the United States.

The differences in life expectancy that Murray and colleagues (2012) noted in their study “Eight Americas” suggest that we are living in different countries rather than different counties. The Murray et al. study noted a difference of as much as 20.7 years between the healthiest of the epidemiologically clustered groups of Americans (where fresh produce is readily available) and the least healthy groups (who live in urban areas where fresh fruits and vegetables are difficult to obtain). This almost 21-year difference exceeds the 9-year difference in life expectancy among industrialized countries, with Japan representing the highest life expectancy and Turkey among the lowest. Within this ranking, the United States falls below Japan by 4.3 years and above Turkey by 4.4 years (Organisation for Economic Co-operation and Development, 2012). On the surface, it may appear we are within striking distance of achieving equity with other industrialized countries, but in reality, when we consider the differences in life expectancy within our own borders, we are miles away. Our nation deserves better health outcomes.

 

Health Equity: The Economic Case

From an economic perspective, the United States cannot fully compete globally until health equity is achieved. In the United States, health care costs account for 17.6 percent of the gross domestic product, versus 11.4 percent in Canada and 9.6 percent in the United Kingdom. The United States also spends a great deal more per capita on health care ($8,223, compared to Canada at $4,445 and the United Kingdom at $3,433). At the same time, as noted earlier, U.S. life expectancy rates are far below those found in other industrialized nations. Underlying these discrepancies in life expectancy are disparities in health outcomes, as described almost 30 years ago by Department of Health and Human Services Secretary Margaret Heckler (HHS, 1985).

In 2003, the Institute of Medicine released its seminal report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which documented the greater burden of disease among populations of color as compared to the majority population. Translating these disparities into economic terms is a complex challenge. LaVeist and colleagues (2011) estimated that the cost in direct health care expenditures due to the unequal burden of disease is $230 billion. The indirect expenditures related to premature death and illness leading to lower workplace productivity may be as high as $1 trillion. A healthy workforce is critical to the economic stability and national security. The ability of the United States to remain competitive in the global financial marketplace is thus linked to its ability to achieve health equity.

There are promising initiatives emerging across the country in communities that are prioritizing the attainment of health equity at the local level. Preventive services and safety nets for the most vulnerable groups among us are important components of efforts to promote equity in access to health care. So are effective social and public policies. Although there may be tension between those who are driven by the moral imperative to treat optimal health as a human right and those who are more influenced by economic arguments and consider health as a commodity, it is time to resolve our differences. We must push toward greater coordination of efforts to promote health equity, sooner rather than later.

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References

1. Braveman, P. A. 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
2. Daniels, N. 2008. Just health. Public Health Ethics 3:268-272. https://doi.org/10.1093/phe/phn028
3. HHS (U.S. Department of Health and Human Services). 1985. Report of the Secretary’s Task Force on Black and Minority Health. Washington, DC: HHS. Available at: https://minorityhealth.hhs.gov/assets/pdf/checked/1/ANDERSON.pdf (accessed May 15, 2020).
4. Institute of Medicine. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press. https://doi.org/10.17226/12875.
5. LaVeist, T. A., D. Gaskin, and P. Richard. 2011. Estimating the economic burden of racial health inequalities in the United States. International Journal of Health Services 41(2):231-238. https://doi.org/10.2190/HS.41.2.c
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7. OECD (Organisation for Economic Co-operation and Development. 2012. OECD health data 2012—frequently requested data. http://www.oecd.org/els/healthpoliciesanddata/oecdhealthdata2012-frequentlyrequesteddata.htm (accessed August 22, 2012).
8. Woolf, S. H., R. E. Johnson, G. E. Fryer, Jr., G. Rust, and D. Satcher. 2004. The health impact of resolving racial disparities: An analysis of US mortality data. American Journal of Public Health 94(12):2078-2081. https://doi.org/10.2105/ajph.98.supplement_1.s26

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