Health equity and health equality both aim to improve outcomes and increase access to services, especially for underserved populations and marginalized groups. That said, they are distinct approaches and theories that can lead to very different outcomes.
Health equality means giving everyone the same opportunities, care, and services. A doctor might offer the same test to everyone at the same interval, without regard to risk factors, or provide the same information to everyone. The doctor might also believe that, as long as they treat everyone the same, they are not behaving in biased ways.
Health equity means ending institutional and discriminatory barriers that lead to health inequities and inequality. This includes factors within the healthcare system, such as racism and sexism, as well as factors outside the healthcare system, such as poverty and unequal distribution of resources.
On the policy level, health equality gives everyone the same support to access healthcare, while health equity prioritizes justice. In an equality-based approach, everyone would get the same healthcare funding and services. In an equity-based approach, funding would depend on need, and the services a person could access would depend on their need. For example, all people with a cervix would have the option to have a Pap smear.
Health equity takes into account different cultures, access to resources, and socioeconomic status. For example, poverty can affect health by reducing access to nutritious food, increasing stress and trauma, and forcing people to live in unsafe communities.
In a health equity framework, health professionals consider the impact of social determinants of health and strategies for addressing them.
For example, a doctor who knows a person has limited access to healthy food may work with the person to strategize ways to overcome this challenge and reduce the risk of health issues. The doctor might also lobby for policies to address this issue.
Health equality focuses on treating everyone the same and ensuring equal access to health care.
In some cases, health equality can overcome disparities, especially when the disparities are due to unequal treatment.
For example, a
Transgender individuals also frequently report discrimination and poor quality care. In a National LGBTQ Task Force survey, 50% of trans respondents said they had to teach their doctors about trans healthcare. Additionally, 28% reported harassment in medical settings, and nearly one in five said they faced care denials.
A health equality lens would focus on removing discrimination and harassment against trans individuals, but it would not fully solve the problem. An equity-based approach would also ensure doctors know how to care for trans people.
A health disparity is not the same thing as a health difference. A difference simply means different groups have different outcomes.
For example, people with a uterus can often get pregnant. This is a biological difference rather than a disparity. People with a uterus over the age of 50 are less likely to get pregnant than those under the age of 30. Again, this is a difference but not a disparity.
For example, Black men are more likely than white men to die of prostate cancer. A
This suggests that preventable issues account for the high death rates of Black men with prostate cancer, rather than any actual predetermined differences. These issues include access to quality care, the type of care a person receives, and social inequality that undermines health.
Both health equality and health equity can help resolve health disparities, but the right approach varies with different health challenges.
Disparities based on racism
Black people get melanoma, a highly aggressive skin cancer,
A health equality lens would focus on giving both white and Black people equal access to skin cancer screenings. This approach would educate doctors about the fact that Black people can and do die of melanoma and encourage them to be equally cautious about suspicious growths on both Black and white skin.
In this framework, researchers might attempt to correct inequalities in science, such as not including Black subjects in skin cancer research.
This might ensure that more Black people get cancer screenings but could fail to address other issues. An equity lens takes a more comprehensive approach. In this framework, there would be a focus on equal access to screenings. But healthcare professionals would also look at other factors, such as:
- lobbying for funding for programs that ensure that Black people can access skin cancer screenings
- reaching out to Black communities to overcome barriers to skin cancer screenings, such as lack of transportation or health insurance
- identifying any cultural barriers to seeking or getting treatment
- educating people about the risks of skin cancer
Disparities based on sexism
The data suggest that people assigned female at birth often struggle to get an accurate diagnosis for reproductive and female-specific health problems. For example, a
Some health equality approaches would not solve this problem at all. For example, giving males and females access to the same screenings would exclude female health issues like endometriosis.
An alternative equality-based approach might be to provide equal training in medical school and continuing education on male-specific and female-specific health issues. This could ensure doctors have adequate education, but it might not solve the problem.
A health equity perspective might look at the specific challenges that people who identify as female face at the doctor. Several studies suggest that people, including doctors, take their pain less seriously. For example, a 2021 study found that observers attributed female pain to mental health issues but believed males regarding their pain. Observers consistently underestimated females’ pain levels.
Implicit bias training, education about how doctors tend to disbelieve females’ perceptions of pain, and similar interventions might help. Public health advocates might develop campaigns specifically targeting health issues that doctors often underdiagnose and ensure the messaging was available in places where people could easily access it.
Health equality can resolve some health disparities, especially when the disparity stems from lower quality treatment, deliberate discrimination, or lack of adequate screening.
Numerous social factors influence health. This includes characteristics of the health system and issues in the wider society.
Equity-minded medical professionals must consider how social determinants of health such as access to a healthy diet, stress, and trauma affect outcomes. They must also consider how apparently equal systems lead to inequitable and unjust outcomes.
An equity lens moves health systems closer to removing disparities. It also encourages policymakers to think about the myriad ways social environments affect health.
One way to understand equity
Each layer of connection can influence health outcomes. For example, a doctor may engage in individual discrimination because of social conditioning, or a health system may produce inequitable outcomes due to societal issues even if individual medical professionals do not intentionally discriminate.