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What would health equity look like?

Health equity— the absence of unjust health inequalities can be said to have been achieved when health outcomes are randomly distributed throughout the population, regardless of socio-demographic characteristics that should be unrelated to health (i.e., race, class, gender and ethnicity).

Some health inequalities are not inequitable. For example, since only women can give birth, their disproportionate share of maternal mortality vis-à-vis men is unequal, though not inequitable.  Likewise, some inequalities in health outcomes between social groups may have a genetic basis that is unrelated to social status such as the clustering of sickle cell anemia in African-Americans and Tay-Sachs disease in Ashkenazi Jews.

However, the reality we encounter on a daily basis is very different. Wealthier individuals live longer and have fewer health morbidities across the life course than poorer individuals. Race compounds this economic disparity, with certain racial and ethnic minorities suffering a higher burden of disease even if socioeconomic status is consistent. Nor is this reality limited to the U.S. where access to health care is inequitably distributed.  Even social democracies like Sweden with universal access to health care exhibit social gradients in health outcomes.

An account of health equity that is defined in terms of outcomes is a large departure from most liberal accounts of its meaning traditionally equated with opportunity.  By the equal opportunity account, so long as individuals have equal access to the means of achieving health and well-being (i.e., universal access to health care), this is considered sufficient to constitute equity. Equality of outcomes is too stringent a requirement and unachievable.

Others would argue what makes health inequalities unjust is the special relationship between health and opportunity. Ill health impinges on an individual’s ability to succeed and flourish and is unjust on these grounds.

Yet, true equality of opportunity (where social distinctions and structural inequalities do not determine our means to be healthy) would produce something very close to equality of outcome.

If the opportunity to be healthy were equitably apportioned, and not itself determined by social conditions, the causes of health inequalities should be unrelated to the social environment and due to random chance. In this case, health inequalities would constitute a difference, but not an unjust difference.

Health equity would therefore mean that everyone has equal odds of being sick or healthy, regardless of their social position.

About Ashley Fox

Ashley Fox, Ph.D., is an Assistant Professor at the Mount Sinai School of Medicine, Department of Health Evidence and Policy. Learn more about Ashley here.

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