Health Equity vs. Equality: Understanding Disparities in Healthcare

00:01 Hello. Welcome back to our Health System Science series.

00:05 My name is Megha Garg, and today I hope to introduce some general concepts of health equity to you.

00:12 So formal definition of health equity is here.

00:14 It is the attainment of the highest level of health for all people.

00:21 This is not just a goal but a process.

00:25 And I appreciate Doctor Camara Phyllis Jones, an anti-racism thought leader who really helps us understand the process of the assurance of the condition of optimal health for all people.

00:37 And she describes the ways to achieve health equity.

00:41 We do this by valuing all individuals and populations equally.

00:46 That is, there are no invisible, undervalued, or disposable people. We recognize and rectify historical injustices and provide resources according to need, not equally, but according to need.

01:03 Here's one example of thinking about equality versus equity.

01:08 Equality here on the left is about giving people the same resources.

01:12 Everyone is going to get the same box to stand on and let them figure it out on their own. No matter where they're starting from, they're going to get this box to get that apple from that tree. And equity here on the right side is focused on the outcome.

01:27 It's about giving people what they need in order to achieve the goal.

01:33 Here's another example of equality versus equity.

01:36 Here we have three people who are trying to watch a baseball game.

01:42 And you can see here on the left there's a fence that is in the way of them seeing the game and everyone gets the same box, but the outcome of everyone being able to see the game is not achieved.

01:56 Now on the right side here, we give people different boxes to achieve the goal of seeing over the fence so that we achieve our outcome of everyone being able to see the game. I want to introduce another idea to you that when we think about equality versus equity, we are not only thinking about resources, but we're also thinking about removing the systemic barriers that people have to achieving the desired outcome.

02:25 So here in this final picture, we've removed the fence altogether.

02:30 So it doesn't matter where people are starting from.

02:34 If the systemic barriers to watching the game have been removed.

02:40 So the source of the inequity has been resolved.

02:45 We've known about the impact of health inequities.

02:48 For a long time, there was a seminal report by the National Academies of Science, engineering and medicine.

02:56 Unequal treatment Confronting the Racial and Ethnic Disparities in Health care.

03:00 This report showed us that variation in the rates of medical procedures and health outcomes differed by race, even when accounting for other determinants of health like insurance status, age, income, and severity of conditions.

03:16 So race was an independent factor in demonstrating health disparities and different outcomes across populations.

03:26 Minorities were less likely than white people to receive needed services.

03:30 And the differences in treating heart disease, cancer and HIV infection contributed to a higher mortality for minorities.

03:40 Health equity is inextricably linked to the ideas of health Disparities and racism and bias.

03:49 And there are pieces of these differences that we can change.

03:52 We can affect change in healthcare through the choices that we make as physicians and the skills that we have in combating health inequities.

04:03 We further know that socioeconomic factors have more impact on US health outcomes than behavior, genetics, or clinical care.

04:13 And we can see here that while there have been large gains in life expectancy across racial and ethnic groups over time, racial disparities have been longstanding and persistent over time. Black people have consistently had a lower life expectancy than white people, while conversely, Hispanic people have consistently had longer life expectancies. Further, black infants in America are now more than twice as likely to die as white infants.

04:46 This is related to the lived experience of being a black person in America.

04:51 There are biases in the perceptions from clinicians, the treatment decisions that are made for these patients, and underlying historical injustices that have contributed to their health status.

05:03 And here's one more example of how health equity can be impactful even in the future of medicine. In thinking about artificial intelligence and the algorithms that we are using in healthcare for treatment decisions for our patients.

05:19 There are examples of software that guides care for millions of US patients that have been found to underestimate the sickness of black patients versus white patients, with all other factors being equal.

05:32 It is incumbent upon us to understand where health equity and health inequities are contributing to the treatment decisions that we make and the algorithms that we are using in healthcare. I think this is a good point to I wish to remind us of the social determinants of health.

05:52 These are the factors that impact health equity.

05:56 The social determinants are the conditions in which people live, work, play, and age that influence health outcomes.

06:03 And the structural determinants of health are the policies, the histories, and the values that drive the social determinants of health and health inequities. So we really can't talk about health equity without thinking about the social determinants of health.

06:18 And similarly, health disparities are linked to health equity.

06:22 Health disparities are differences in health and health outcomes between groups of people.

06:29 There are particular types of health differences that are closely linked with social, economic and environmental disadvantages, and some examples are racial and ethnic groups as we've been talking about religion, socioeconomic status, gender, age, mental health, disability, sexual orientation, gender identity, geographic graphic location and other characteristics historically linked to discrimination or exclusion.