Health Equity: Unraveling and Piecing the Healthcare System Back Together Again
The Guide to Community Preventive Services states that “Health equity exists when individuals have equal opportunities to be healthy. The ability to be healthy is often associated with factors such as social position, race, ethnicity, gender, religion, sexual identity, or disability. When these factors limit a person's ability to be healthy it can lead to health inequity.” Robert Wood Johnson Foundation (RWJF) says “Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.” To combine these definitions, health equity means that every individual has a fair, equal and just opportunity to be as health as possible. This concept acknowledges that there are obstacles, hurdles and structural factors at play that keep health inequality the standard.
RWJF provides an illustration differentiating the concepts of equality and equity, and a "one size fits all" approach perpetuates systematic gaps. (See image below).
How does someone’s perceived race, ethnicity, and culture by a health care professional impact the care they receive?
There is a societal gas lighting going on and it is alive and well in the healthcare sector. Would you believe your friend or family if they told you that they received bad health care because of how the doctor perceived them? The literature shows that clinicians have biases toward certain populations that impact their ability to provide effective care. The 2015 National Healthcare Disparities Report indicated that white patients receive better quality of care than 36.7% of Hispanic patients, 41.1% of black patients, 32.4% of American Indian/Alaska Native patients, and 20.3% of Asian and Pacific Islander patients.
How does someone’s zip code affect their expected life expectancy?
TIME magazine wrote that "a growing body of evidence suggests it may be a person’s zip code that holds the most information about how long they’ll live" They mentioned that researchers from the New York University School of Medicine used data from NYU Langone Health’s City Health Dashboard to find that 56 of the U.S.’ 500 largest cities are home to people who can expect to live at least 20 fewer years than those in other neighborhoods, even if they’re just blocks or miles away. The data chart (below) from the City Health Dashboard and created by the TIME team demonstrates that Chicago, Washington, D.C. and New York have large life expectancy gaps between neighbors in the same city. This means that someone in Chicago could live 30 years less than someone else in the same city because of health and other inequities.
If you are looking to get started on your own journey of exploring how health equity might be impacting you, your community, or the people you serve, here are some items to get you started.
1. Know the rankings and statistics for you, your families, and those you serve: It is imperative to know your own health inequities based on your identities and zipcode. It may be an opportunity to explore some of the health privileges you have, or have never had to think about. It is doubly important to know the statistics for the individuals you serve, support, or interact with in your job or every day life. The County Health Rankings, an easy-to-use snapshot of health of nearly every county in the nation, show that where you live matters to your health. Check out where your county stands on County Health Rankings as well as the City Health Dashboard if you live in a city.
2. Evaluate your non-medical factors that may be influencing your health: This means when evaluating your health status, you should consider adding non-medical vital signs (such as employment, education, food insecurity, safe housing, exposure to discrimination or violence, etc.) to the existing ones that the health care system prioritizes (such as heart rate, blood pressure, weight). Assessing the non-medical factors can help clinicians and you to make better-informed decisions about treatment and care that is specific to you, and look at you as a whole person. What other non-medical factors may be affecting your health or the health of the people you serve? For healthcare professionals, how are you assessing non-medical factors in your patients or clients? Shiriki Kumanyika, a research professor in the Department of Community Health and Prevention at the Dornsife School of Public Health at Drexel University emphasizes other non-medical vital signs such as:
Exposure to chronic stress
Poor sleep quality
Access to healthy food
Discrimination of any form
Law & interaction with the justice system
3. For healthcare professionals: Take inventory of what your organization is doing to regularly create a culture of health equity: This goes for anyone who interacts with the health of a community -- researchers, clinicians, medical staff, activist, community organizers, program leaders and creators, support staff, city, county, state, federal leaders and politicians, etc. What are you routinely doing to keep abreast of the issues? How are you working with non-medical organizations outside of the walls of your organization to move the dial on health related issues in your community? How are you engaging, recruiting, and hiring community members, clients, patients, care givers and family members?
Ultimately, racism is a public health issue and health equity is one lens to begin unraveling and piecing the healthcare system back together in a more humane, equitable way.