Achieving health equity
What is Health Equity?
Health equity is the idea that every individual deserves a fair and just opportunity to be as healthy as possible. This requires the elimination of obstacles that block or compromise access to quality health care, such as poverty and discrimination. This is often presented as powerlessness and lack of access to “living wage” jobs, quality education, safe housing and health care.
Factors Influencing Health Equity
Social determinants of health (SDOH) play a major role in individual health, including education, socioeconomic status, reliable transportation and access to healthy food and fresh air. In fact, a key predictor of a child’s A1C, for example, is the parents’ education level and socioeconomic status.
Health literacy, the ability to understand health and medical information and use it to access optimal care, also plays a key role. High health literacy translates into more options for medical treatment and ability to communicate health and healthcare decisions. Those with lower health literacy levels are often challenged to understand their diagnoses and treatment plans, which makes it harder to communicate their needs or preferences to their healthcare professional.
Health disparities also have an impact, but it is important to understand the difference between health disparities and health equity and equality.
Know the Terms: Health Disparity, Equality and Equity
Health disparity is a difference that affects a person’s ability to achieve their best health. Examples include race, gender, education, income, disability, geographic location and sexual orientation. A health disparity is often beyond an individual’s control. What’s more, health disparities create health inequities.
Health equality means everyone has the same opportunities. Examples include a community center offering free or low-cost checkups to everyone. This is not always preferable. For example, if a clinic offers free checkups every morning, a person who must work during the morning cannot take advantage of this service. While the clinic offers checkups to everyone on the same terms, some people still cannot take advantage of the service.
Health equity means that people have opportunities based on their needs. An example is a health center charging people based on their ability to pay. A person who cannot afford care may receive it for free while another person may pay for the same care. In same scenario as above, health equity would mean offering alternative checkup times in the afternoon or evening so that everyone can access the service at a time that works for them.
Those Impacted Most by Health Inequity
Using the COVID-19 pandemic as an example, Black and Hispanic/Latino individuals were disproportionately impacted, with the virus rate 10% higher among Black individuals and 30% higher among Hispanic/Latino individuals compared with white non-Hispanic people. The differences in hospitalizations have been even more substantial, with Black and Hispanic/Latino individuals being approximately 3x more likely to be hospitalized with COVID-19 than white non-Hispanic individuals. What’s more, mortality risk is 1.9x higher for Black individuals and 2.3x higher for Hispanic/Latino individuals compared with white non-Hispanic individuals.
Decades of systemic racism have eroded trust between minority patients and their frequently white providers. Meanwhile, low income, lack of insurance, limited free time and lack of a nearby health clinic limits minority patient access to care. As a result, Black and Hispanic patients are more likely to have a chronic illness that would make it harder to fight off the coronavirus.
This disparity exists across various health measures. In fact, life expectancy among Black people is four years lower than white people, with the lowest expectancy among Black men. Another example, low-income people have worse health status than higher income individuals, while lesbian, gay, bisexual, and transgender (LGBT) individuals experience certain health challenges at increased rates.
Barriers to Health Equity
The health equity issues across the U.S. healthcare can be attributed to:
Socioeconomic status – Healthcare in the United States is high cost. Also, options that benefit overall wellness, such as healthy eating or visiting a gym, may be inaccessible to many due to cost.
Lack of insurance or underinsurance – In many case, people cannot afford health insurance or their deductible is so high that they are unable to use the insurance in a way that impacts health.
Race and ethnicity – Studies show that race and ethnicity are still major factors in determining the quality and type of care that a person receives due in part to unintentional biases in healthcare professionals. Historically, people of color were not equally included in clinical trials, which affects treatment and standards of care to this day.
Age – Age discrimination can cause healthcare professionals to assume someone’s medical issues are a result of aging, instead of looking for an alternative reason based on their symptoms. Also, elderly people are not always trusted to accurately report their symptoms and are often excluded from clinical trials.
Geographic region – More healthcare professionals live in cities, making it more challenging for people in rural regions to access care.
Achieving Health Equity
More healthcare organizations are making health equity a strategic priority. A growing number have initiated resources, infrastructure and programs designed to make health equity a leader-driven priority, developing structures and processes to support equity, and taking actions to better address SDOH and close care gaps.
A growing number of healthcare professionals understand that some patient populations need additional support to achieve the same health outcomes as other patient populations, such as helping them get to doctor appointments or arranging home visits.
The first step is to confront institutional racism within the organization by identifying, addressing and dismantling structures, policies and norms that perpetuate race-based advantage. It’s also beneficial to partner with community organizations.
From there, healthcare organizations must tackle health disparities with proven interventions designed for their disadvantaged populations. This typically involves:
- Adopting new vital signs to screen SDOH
- Committing to helping low-income and non-English-speaking patients access the care they need
- Guarding against biases that influence medical care
- Ensuring that elderly, women and racial/ethnic minorities are well represented in clinical trials
- Understanding the impact of adverse childhood experiences and relying on trauma-informed care
A community-based approach connects its members with the services they need for optimal health, such as training and education, support groups, care coordination, home improvement, transportation, community health programs, housing supports, resource assistance and other services that address SDOH.
Health Equity Training
Health equity training can be effective when it is geared toward developing competencies. It should provide the opportunity for the participant to learn the facts about health equity and how to apply this knowledge in the workplace.
It’s recommended that the objectives of the training include specific and measurable behaviors that will be changed through the training program. This enables an organization to measure the effectiveness of the training and identify potential areas for improvement.
The behaviors identified for change should be measured prior to training to establish a baseline for comparison and then measured in intervals and after the training. This process enables follow-up training or support to fill in gaps in learning.
Training should be tailored to the needs of the participants, which can be determined through a needs assessment prior to designing the training. Information for a needs assessment can be based on surveys and interviews to determine the participants’ baseline knowledge of health equity, the context of their work and how health equity relates to their job and the participants’ perceived learning needs.
It’s important for the health equity training to include content specific to participants’ workplace roles and responsibilities to make the training more meaningful and engaging, encourage applied learning, and develop opportunities for team building and cohesiveness.
Important topics to include are racism, power and privilege, intersectionality and disability. Furthermore, the training should address vulnerable and marginalized populations, including age specific groups, Indigenous peoples, people with disabilities, ethno-racial populations, homeless individuals, low-income people, religious and faith communities, rural and remote populations, women and LGBTQ+ people.
The most effective training is interactive and applied to make room for discussion that can help participants process new ideas. It should also include case examples that present problems based on particular work situations that participants face to help them learn how to apply what they learn in the real world. It is also important for participants to have an opportunity to work individually and in group settings that mimic their workplace environment.
The effectiveness of the nation’s healthcare hinges on achieving health equity for all Americans. Success will rely on how well federal, state and local agencies, as well as private healthcare organizations and individuals, are able to work together to eliminate health disparities across populations that have experienced a disproportionate burden of disease, disability and death.