Inequities vs. Inequalities vs. Disparities in Health

1. Inequities vs. Inequalities vs. Disparities in Health A quick guide to the terms and a framework for understanding differences in health

2. Health Disparities • Health disparities - population-specific differences in the presence of disease, health outcomes, or access to health care (HRSA definition) • Key is that there are differences between populations in measures of health (e.g. access to care, health outcomes, rates of chronic disease)

3. How to eliminate health disparities? Commonwealth Fund (www.cmwf.org)recommends the following steps in developing policies to eliminate racial and ethnic disparities: • Consistent racial and ethnic data collection by health care providers. • Effective evaluation of disparities-reduction programs. • Minimum standards for culturally and linguistically competent health services. • Greater minority representation within the health care workforce. • Establishment or enhancement of government offices of minority health. • Expanded access to services for all ethnic and racial groups. • Involvement of all health system representatives in minority health improvement efforts.

4. Health inequalities • Equivalent to health disparities • Again, the issue is that there is a difference between the health status of one population compared to another population

5. Health Equity • Health equity = absence of systematic disparities in health (or in the major social determinants of health) between groups with different social advantage/disadvantage (e.g. wealth, power, prestige). -Braveman, Gruskin (2003) • Thus, health inequities are the presence of such differences

6. Example – inequality or inequity? Example: the disproportionate numbers of poor and minority citizens in the U.S. that do not have inadequate access to health care • Is it a health inequality? Yes, since there is a difference in rates of access to health care amongst segments of the population • Is it a health inequity? Depends on whether your idea of justice involves “the right to health care”; if so, then yes, it is unfair and unjust that there are differences in this fundamental right, the right to health care • The important difference is that we must make a value judgment in the case of health inequities

7. A Suggested Framework • Until the recent past, difference in health and disease were not important enough for governments and researchers to study. • This suggests a troubling value judgment that was made for these last centuries – health inequalities are not important enough to study…these inequalities were not considered inequities, and thus, did not deserve attention (for if differences are not unfair differences or unjust differences, then they can be minimized and shrugged off)

8. A Suggested Framework (Cont.) • Therefore, our default should be to consider every health inequality/disparity as a health inequity, until we can prove that it is not so. • In other words, we should ground our thinking in the human right to health (a value judgment) and the human right to health care and therefore treat each and every health inequality/disparity as unfair and unjust until we can prove otherwise.