Equality is not Equity: 3 Steps Public Health Professionals Can Take to Advance Health Equity

Updated: Sep 12, 2021

By: Dr. Jovonni Spinner, MPH, CHES


What is Health? Health is not merely the absence of disease but rather, the “state of complete physical, mental, and social well-being” as defined by the World Health Organization. For good health to be achieved, all three areas need to be working well. Oftentimes, people may find themselves doing really well in one area and lacking in another area. This is perfectly normal and happens to everyone. It does not make it any easier living in a country that emphasizes health care instead of prevention, but, as the old saying goes, “an ounce of prevention is worth a pound of cure”; so health promotion efforts should focus on prevention and wellness.

Causes of Poor Health Achieving good health is complicated and influenced by many factors.

Many Black people do not get the opportunity to attain good health due to health inequities that continue to plague our society.

I purposely use “opportunity” because almost 40% of health outcomes are related to socioeconomic factors, which are referred to as the social determinants of health (SDOHs). These factors are the conditions in which people live, play, work, and worship. Another 30% of health outcomes are due to personal health behaviors, health care (20%), and environment (10%), all of which can be impacted by SDOHs. Issues like lack of access to green space for physical activity, nutritious foods, quality education, reliable transportation, safe housing, affordable health insurance, and quality healthcare with culturally competent medical providers, are examples of the SDOHs that some Black people do not have access to, which in turn impact one’s ability to make decisions about their health.

Health Disparities: Naming the Problem Health disparities are the preventable differences in the health status of different groups of people and occur when one group of people experience a higher burden of disease, injury, or death, compared to another group. Our laws, policies, and institutional practices are entrenched in disparities that have been perpetuated by historical issues, such as systemic racism, sexism, unequal distribution of power to name a few. For example, in general, Blacks have higher rates of chronic diseases (e.g., hypertension, diabetes, or obesity) leading to heart disease, which is the number one killer in the United States. Examples of other health disparities— compared to whites, Blacks are: · 40% more likely to have asthma and 3 times more likely to die from asthma-related causes · 8.4 times more likely to be diagnosed with HIV · 1.3 times more likely to be obese · 2–3 times more likely to die during childbirth

Race and ethnicity are the demographic characteristics that are most often thought about when reporting health disparities, but disparities also exist based on gender, socioeconomic status, disability, or geography (rural vs. urban), among other categories. Oftentimes, Black people fall into multiple categories (e.g., Black women). This matters due to the increased morbidity and mortality for these groups, increased costs incurred by the healthcare system in treating them, and limited gains in the overall quality of care.

Health Equity: Solving the Problem Health equity is the “attainment of the highest level of health for all people,” which means that everyone is given the chance to live their best life—long and healthy. It should be noted that the terms “equality” and “equity” are not the same.

Equality may sound fair, but in reality, it is not because it means everyone gets the same thing. However, disenfranchised communities need more—more tailored resources, tools, and investments—so they have a chance to be on a level playing field.

This is why equity is the right course of action because it accounts for the provision of the tools and resources needed for Black communities to make the best decisions about their health. The Robert Wood Johnson Foundation has an excellent graphic that depicts the differences between equity and equality.

Using the social ecological model as a framework for discussion, there are three areas where public health practitioners can contribute to improving the health of Black people: Individual and Interpersonal Level: As public health professionals, we have to create and support programs and resources that can help connect people to the healthcare system so they can take ownership of their health. It is imperative that individuals have the ability to take charge of their health as much as possible by scheduling regular checkups with their doctors, asking for age-appropriate health screenings during hospital visits, understanding how to manage chronic conditions like high blood pressure, engaging in healthy behaviors, and having conversations with family members about their health. When it comes to health, people should always feel empowered to advocate for themselves by asking questions and doing their research. These are key areas where public health professionals can support members of the communities we serve.

Organizational/Health Care Systems Level: It is critical to have a culturally competent trained medical workforce that is reflective of our community’s diversity. Providers should be trained on how to identify and suppress bias, provide culturally competent care, and effectively engage with Black patients as well as focus on providing patient-centered care by involving patients in the decision-making process. These changes can only be made and sustained if healthcare systems commit to equity and implement strategies that change the organizational culture by supporting equity-driven conversations, providing training, and most importantly accountability. Health equity is not a check box—concerted, ongoing efforts need to be employed to realize systems-level change with accountability measures in place.

Policy: Health in All Policies should be standard practice. Equity-based laws, regulations, and practices that reverse the historical abuse that has disenfranchised Black communities need to be implemented. Policies need to address urban planning, housing, universal access to quality health care, and education from early childhood through adulthood. People make decisions based on their resources, and as such, policies that promote building and sustaining healthy communities need to be implemented. This requires a multi-sectoral approach, realizing that everyone has a hand in building and promoting healthy communities ranging from transportation to education, for example. These are just some strategies that can be employed to advance health equity and are by no means is meant to be an exhaustive list.

It is my hope that “healthy equity” does not become another buzz word that we as public health professionals toss around but instead, a concept that is embedded into every facet of our society.

Health equity has to be a strategic priority backed by action, resources, and accountability. Moving forward, we have to be assertive in calling out inequities when we see them and be brazened to take action. By achieving health equity, we can help close the health disparity gap and ensure that Black and brown communities are healthy and thriving.




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