Every person deserves to live a healthy life. Due to social, economic, and environmental factors, though, not everyone has access to health care and proper health education. Native Americans have a life expectancy that is 4.4 years less than that of Americans of all other races, for example.
The aim of healthcare equity is to ensure that everyone can access affordable, culturally competent health care regardless of:
- Gender identity or expression
- Sexual orientation
- Socioeconomic status
- Geographical location (i.e., 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:
- 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 vulnerable people
Equity in health care 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 doesn’t always equal fairness, though. Suppose two students had already eaten lunch while the other two students hadn’t 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 health care interventions. Racial and ethnic minorities, low-income groups, and members of the LGBTQ+ community face such risks at a higher rate than the general population.
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 people, in particular, are often harmed by health disparities in our country. This can be due to limited economic resources and limited access to health care. When studies are controlled for age, location, education, and class status, Black Americans have been found to die sooner and suffer more preventable illnesses compared with white Americans.
Time and again, statistics reveal racial inequities in health care, reflecting a legacy of racial discrimination in our healthcare system that plagues Black people from womb to tomb. 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:
- Black infant mortality is 250 percent higher than white infant mortality.
- Blacks are more likely than whites to suffer from cancer, diabetes, and heart disease.
- Black mothers are at least three times more likely than white mothers to die in childbirth.
- Black Americans have the highest rates of post-traumatic stress disorder (PTSD) of all races.
- Black Americans are more likely to die prematurely from all types of disease.
Race is not the only factor when it comes to health care 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:
- 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 and other forms of oppression that, in turn, hinder health outcomes
How equity of access is measured in health care often relates to the social determinants of health. Healthcare professionals can use the social determinants of health to take into consideration the external factors that affect any given individual’s health.
The Centers for Disease Control and Prevention defines the social determinants of health as “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes.” Social determinants of health include:
- 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 such as discrimination, incarceration; positive factors such as sense of community, social cohesion, civic participation
Why is equity important in health care? Because so many people experience adverse conditions outside of their control that lead to poorer health outcomes. Tracing SDOH and understanding how specific adverse SDOH lead to health disparities gives healthcare professionals insights into how to improve equity in health care.
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.
Our society may not have a one-size-fits-all approach to achieving equity in health care. 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.
According to a self report of nearly 300 mobile health clinics in a study published by the International Journal for Equity in Health, 56 percent of mobile clinics specifically aim to serve uninsured patients, 55 percent target low-income patients, 38 percent cater to homeless patients, and 36 percent target rural patients.
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.
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.
Tulane University continues its legacy of developing outstanding professionals with the skills and experience to advance equity in health care.
Explore Tulane University’s Online Master of Health Administration program, designed with working professionals in mind. Tulane’s Online MHA 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 University’s Online MHA program supports graduates as they lead the way toward equitable, sustainable health administration.