Every person deserves to live a healthy life. Due to social, economic, and environmental factors, however, not everyone has access to health care and proper health education. For example, a report by the Centers for Disease Control and Prevention (CDC) found that life expectancy at birth for American Indians and Alaska Natives is 10.1 years less than that of Hispanic individuals, seven years less than that of non-Hispanic white individuals, and three years less than that of non-Hispanic Black individuals. The CDC ascribes this disparity to economic and social conditions, such as poverty and discrimination in the healthcare system.
Healthcare equity aims to ensure that everyone can access affordable, culturally competent health care regardless of:
- Race
- Ethnicity
- Age
- Ability
- Sex
- Gender identity or expression
- Sexual orientation
- Nationality
- Socioeconomic status
- Geographical location (e.g., rural or urban)
Health delivery services evolve and technology advances. Accordingly, healthcare professionals must keep pushing for equity in health care. Health equity advocacy takes many forms, including the following:
- Ongoing research on the causes of health disparities
- Continuing education for healthcare professionals, including administrators, about the social determinants of health
- Implementation of equitable health policies to effect lasting structural change that will improve health outcomes for underserved populations
Healthcare administrators are key to this advocacy, helping shape policy and promote equitable healthcare services for all patients. These professionals can use their knowledge of healthcare systems to improve healthcare equity. Future healthcare leaders should consider the benefits of an advanced education in health administration in building a foundation in healthcare ethics and how it influences public health.
What Is Health Equity?
Health equity is fairly simple in concept. The basic difference between equality and equity in health care can be explained using the common example of splitting a pizza.
In an equal distribution, a group of four classmates may split a pizza evenly — say, two slices per person. Equality does not always equal fairness, though. Suppose two students had already eaten lunch while the other two students had not eaten anything that day. A more equitable distribution of the pizza may call for the two students who ate lunch to get just one slice of pizza while the hungry classmates get three. That way, each person gets pizza according to their need, even when that means an unequal number of slices distributed among the classmates.
Many people in the United States are starving, in a figurative sense, for adequate health care. Some groups are disproportionately exposed to a combination of health risks, such as poverty, violence, unsafe living conditions, and environmental health hazards, that can increase the need for healthcare interventions. Racial and ethnic minorities, low-income groups, and members of the LGBTQIA+ community face such risks at a higher rate than the general population.
Health Disparities
Healthcare professionals refer to inequities in health outcomes as health disparities. A health disparity is a health difference linked with unfair economic, social, or environmental disadvantage. Health disparities harm groups who experience greater social or economic obstacles. For example, higher maternal mortality rates among Black women as compared to white women are a health disparity.
Black individuals, in particular, are often harmed by health disparities in our country. This can be due to many intersecting factors, such as limited economic resources and other barriers to health care.
Black Patients Face Health Care Inequities
Time and again, statistics reveal racial inequities in health care, reflecting a legacy of racial discrimination in our healthcare system that affects Black people across their life spans. The unfair imbalance in access to health care among the U.S. Black population ranges from infant mortality to premature death. Consider the sobering implications of the following statistics:
- According to the U.S. Department of Health & Human Services, Black infant mortality is 2.4 times higher than white infant mortality, and Black Americans are more likely than white Americans to suffer from cancer, diabetes, and heart disease.
- According to the CDC, Black mothers are at least three times more likely than white mothers to die in childbirth.
Vulnerable Populations Face Health Care Inequities
Race is not the only factor when it comes to healthcare inequities. Vulnerable populations in the U.S. often face multiple barriers to accessing health care, as well. Such barriers range from discrimination to lacking affordable options to living far away from treatment centers (as is the case for many rural Americans). Mobile health clinics — vehicles equipped with medical equipment — may help to increase access, which can improve equity in rural areas.
Achieving equity in health care often means eliminating or reducing the barriers to social and economic resources that affect an individual’s health.
Some specific ways to achieve this might include the following:
- Expanding access to health care through the introduction of mobile health clinics or telehealth initiatives, such as remote healthcare services or education
- Further developing culturally competent care, for example, by expanding medical translation services
- Championing policies that reduce harms perpetuated by structural racism, sexism, and classism, as well as other forms of oppression that, in turn, hinder health outcomes
Importance of Healthcare Equity
Disparities in healthcare equity often prevent people from receiving, or even seeking, healthcare services and can result in reduced quality of life. According to the CDC, these disparities are preventable, making the burdens they place upon many Americans unacceptable.
Poor health can limit people’s ability to function in society by making it hard to work, reducing financial opportunities, and limiting personal growth. These health disparities are often caused by systemic and complex issues that primarily affect vulnerable populations, including minority groups, those in poverty, or those with chronic health issues, regardless of the choices they have made in life.As a matter of healthcare ethics, healthcare professionals should make an effort to understand and acknowledge their patients’ intersectional identities and needs to provide relevant, quality care. By advocating for better practices that reduce the effects of these disparities and strategizing to allocate resources effectively, healthcare leaders can have a significant impact on improving the quality of life of patients nationwide.
Benefits of Healthcare Equity
Reducing healthcare disparities helps improve access and quality of care, improving health outcomes for individuals and communities affected by those disparities. For example, patients struggling with health issues and chronic conditions who reside in rural areas with limited healthcare services can benefit from mobile health clinics that can travel closer to them, increasing the odds of receiving treatment.
Reducing the impact of healthcare disparities also goes hand-in-hand with public health initiatives. Public health equity helps bring healthcare resources and education to diverse communities, such as education on preventing the spread of contagions or protection against sexually transmitted infections. As healthcare burdens are often shared among families and the community when equitable healthcare services are lacking, public health equity can reduce the strain disparities cause on these communities.
The Social Determinants of Health
How equity of access is measured in health care often relates to social determinants of health (SDOH). Healthcare professionals can use SDOH to consider the external factors that affect any given individual’s health.
The CDC defines SDOH as “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of risks and outcomes.” SDOH includes the following:
- Education: Language and literacy rates, highest level of education, quality of education
- Health Care: Access to primary care, health literacy
- Economic Stability: Employment, food security, housing stability
- Environment: Quality of housing, proximity to violence and crime, distance from pollutants and environmental hazards
- Social and Communal Factors: Negative factors (discrimination, incarceration) and positive factors (sense of community, social cohesion, civic participation)
Tracing SDOH and understanding how specific adverse SDOH lead to health disparities gives healthcare professionals insights into how to improve healthcare equity.
Case Study: Racism, Sexism, and Chronic Stress
Repeatedly, independent research studies confirm that systemic oppression and discrimination causes higher rates of chronic stress. This, in turn, translates to earlier health deterioration among people of color. For instance, according to the “weathering” hypothesis, Black women experience early health deterioration due to racism’s and sexism’s cumulative effects of economic, environmental, and interpersonal stressors.
Clearly, the high mortality rates and PTSD rates among Black men and women speak to ways that living in a racist society unduly burdens and systematically wears on individuals, leading to poorer mental health and physical health overall. Racism is indeed a public health issue.
Considering health care from an equity perspective means taking social determinants of health, such as systemic racism and sexism, seriously.
How Professionals Measure Equity of Access in Health Care
Our society may not have a one-size-fits-all approach to achieving healthcare equity. Researchers have choices when it comes to measuring individual policy initiatives’ effectiveness. For example, they can evaluate whether an initiative lowers the Black maternal mortality rate or reduces chronic disease rates for people of color.
Another way to measure equity of access is to focus on the services available for individuals in a given location. In rural communities, for example, specialized healthcare facilities may not exist or may offer very limited services. Increasing health equity may mean deploying mobile health clinics or extending health literacy programming.
Healthcare providers can tailor their services to specific communities, allowing professionals to respond to a population’s current and evolving health needs. For example, healthcare providers working in a small town facing high cancer rates due to environmental factors may caution patients against drinking unfiltered water.
How Health Administrators Balance Equity and Efficiency
Equity and efficiency can go hand in hand in healthcare delivery. Offering equitable health care leads to more efficient healthcare systems overall, as a healthier population requires less medical care. That means fewer doctor’s visits, less healthcare spending per patient, and better health outcomes.
Health administrators in particular have a unique role in bringing about greater equity in health care. Administrators can champion initiatives to hire and retain professionals from diverse backgrounds and work to address implicit biases in healthcare settings.
Health administrators can also support early adoption of telehealth technologies, mobile health clinic capabilities, and other innovative health delivery service options. Harnessing creative, population-specific technologies and service offerings can connect more patients to providers for health support.
Overall, health administrators must recognize that patients from historically marginalized groups still face disproportionately negative outcomes. Everyone who works in health care has a part to play in developing policies and practices that balance equity and efficiency.
Forging the Future of Health Administration
Tulane University continues its legacy of developing outstanding professionals with the skills and experience to advance healthcare equity.
Explore Tulane’s Online Master of Health Administration (MHA) program, designed with working professionals in mind. The program offers flexibility for students looking to gain advanced education while continuing full-time work. Students gain the training they need to become competent, compassionate leaders in their fields.
Learn more about how Tulane’s Online MHA program supports graduates as they lead the way toward equitable, sustainable health administration.
Recommended Readings
Patient-Centered Care: Definition and Examples
An Organizational Chart in Health Care Explained
What Is Quality Improvement in Healthcare?
Sources
American Public Health Association, Creating the Healthiest Nation: Advancing Health Equity
American Public Health Association, Health Equity
Center for American Progress, “Public Options Will Improve Health Equity Across the Country”
Centers for Disease Control and Prevention, Advancing Health Equity in Chronic Disease Prevention and Management
Centers for Disease Prevention and Control, “Mortality Profile of the Non-Hispanic American Indian or Alaska Native Population, 2019”
Centers for Disease Control and Prevention, Working Together to Reduce Black Maternal Mortality
Health Affairs, “Fewer Pharmacies in Black and Hispanic/Latino Neighborhoods Compared With White or Diverse Neighborhoods, 2007-15”
Indian Health Services, Disparities
National Partnership for Women and Families, “Black Women’s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities”
U.S. Department of Health & Human Services, Heart Disease and African Americans
U.S. Department of Health & Human Services, Infant Mortality and African Americans
World Health Organization, Mobile Clinics
World Health Organization, Social Determinants of Health