What Is Health Equity? Ensuring Access for Everyone

Child showing his healthy lunch. I don’t think this is a good photo for the article. Health equity is typically about race or ethnicity, and all of these people are white, and the health professional looks like a nurse or doctor in a clinical setting, not a public health worker. I know (first hand!) how hard it is to depict public health in an image, but this doesn’t do it.

What is healthy equity? Health equity honors the idea that every individual deserves an equal opportunity to live the healthiest life possible. People’s race, economic circumstances, or gender should not affect their access to such basics as healthy food or proper medical care. Nor should geographic region determine the availability of health education. However, today these very factors influence our nation’s disease rates, life spans, disabilities, and mortality rates, among other things.

According to the National Vital Statistics System, life expectancy can vary by up to seven years between racial and ethnic populations. An unequal distribution of resources can be a contributing factor leading to many such alarming differences. And while differences in health will always exist, the American Public Health Association (APHA) explains we can avoid those “linked with social, economic, and/or environmental disadvantage.”

Besides their human toll, health disparities also weigh heavily on the economy, costing the U.S. billions of dollars in lost productivity and excess medical expenses. Failing to address the urgent need to create health equity will hurt everyone.

The barriers to achieving health equity are great but not insurmountable. Public health professionals stand on the front lines of the fight. With ingenuity and tenacity, they can help eradicate those disparities in health between communities that are unjust and unnecessary. APHA outlines six strategies that should guide the work of public health professionals.

  • Explicitly identify the communities who suffer health disparities.
  • Confront racial biases in policies and behaviors with training and education.
  • Address how housing, employment, transportation, and other determinants affect health equity.
  • Implement health equity goals into organizations while also ensuring internal organizational practices do not contribute to health disparities.
  • Engage affected communities to actively participate in solving the problems they face.
  • Assess the impact of initiatives meant to reduce health inequities.

Those who want to learn these principles and promote health equity need the right preparation. Tulane University offers an Online Master of Public Health that fosters the skills and understanding needed to effect change in the realm of public health.

Barriers Preventing Access to Health Care

To answer the question, What is health equity? and develop a comprehensive understanding of how to achieve it, we must closely examine some factors that create health disparities and prevent people from accessing care.

Nutrition

What we eat and the quality of our food directly impact both our physical and mental development. Poor nutrition can negatively affect growth and prevent us from reaching our full potential. Poor diets result in weakened immune systems, increasing susceptibility to communicable diseases, and poor diets contribute to noncommunicable diseases such as diabetes, stroke, and even some cancers. However, a proper diet can potentially stave off these unfortunate health outcomes.

What happens when a community lacks access to fresh and healthy food? According to the Centers for Disease Control and Prevention (CDC) poor access to nutritious foods leads to unhealthy diets. Today, many rural, minority, and low-income communities in the U.S. are known as food deserts. Food deserts have very few grocery stores that provide fresh fruits, vegetables, and other whole foods. The stores available in food deserts sell mostly high-fat, high-sugar, processed foods. People who live in food deserts will inevitably find it more difficult to eat a healthy diet, which accounts for their higher rates of negative health outcomes.

For instance, living in economically disadvantaged neighborhoods has been associated with increased risk of cardiovascular problems. The study “Change in Neighborhood Characteristics and Change in Coronary Artery Calcium” suggests food deserts might be to blame. According to the research, those living more than a mile from fresh food sources develop coronary calcium build up, a leading risk factor for heart disease, faster than those living outside of food deserts.

According to the United States Department of Agriculture (USDA), up to 18 percent of the population lives in food deserts. Public health professionals work to combat these figures by advocating for programs, such as the federal government’s Healthy Food Financing Initiative, that support the opening of fresh food sources like grocery stores and farmers markets within food deserts.

However, solving the problem of poor nutrition in these communities requires more than introducing grocery stores and farmers markets into food deserts. True access to good nutrition requires increasing awareness about healthy food choices. Public health advocates play a key role in providing the information communities need to change food purchasing behavior and assume healthier habits. In addition, public health advocates can promote the adoption of government programs that defray the cost of healthy foods for low-income communities so they can afford to buy them.

Variations in life expectancy by neighborhood

Data and research from the CDC indicate that people who live in certain geographic areas — identified down to the zip code level — can have lower life expectancies than those of their immediate neighbors. Public health professionals target these geographic areas in order to address the factors responsible for such gaps. People living in certain geographic areas and neighborhoods can face a variety of issues that impact their health.

  • Transportation
    Those who cannot afford the expense of a car will likely need reliable and affordable public transportation to access meaningful employment, child and health care, as well as other services. Individuals living in areas where such transportation does not exist often find themselves isolated from opportunities and cut off from meeting basic needs associated with health care and nutrition.
  • Crime
    Crime affects low-income neighborhoods at higher rates, and exposure to violence produces many health and behavioral issues. Children who live with the threat of violence experience increased levels of depression and anxiety and exhibit increased aggression. As adults, they are at a greater risk for alcohol and drug abuse as well as risky sexual behavior.
  • Poverty
    Those living in poverty face greater obstacles to receiving medical care, including primary and specialty care. When they do receive care, they are less likely to be treated with newer drugs or more advanced technologies. Their higher stress environments also make them more susceptible to behavioral risk factors such as smoking, drinking, and obesity.
  • Environmental hazards
    Living in environments with greater exposure to pollutants can adversely affect health and cause disease. Low-income individuals and minority communities experience greater exposure to air pollution and lead-based paint. They are also more likely to live near toxic waste facilities and landfills and have reduced access to clean drinking water.

Cultural humility

Our communities and cities are diverse, and all individuals face unique roadblocks that can obstruct their ability to live healthy lives. When it comes to sexual orientation, socioeconomic background, or race, religion, and ethnicity, living a healthy life can mean something different to each community. Public health leaders must understand the needs of specific communities to ensure all individuals have an equal opportunity.

Healthcare providers and institutions must operate with sensitivity to social and cultural differences if they want to create health equity. People from different backgrounds may have perspectives about health unknown to their providers, or they may have different expectations that can affect how well they adhere to medical advice. According to research discussed in the article “Evidence on Patient-Doctor Communication” published in the journal Cancer Prevention & Control, 22 studies indicate that communication between patients and providers correlates with health outcomes.

Achieving cultural humility requires clinicians to examine their biases, attitudes, and beliefs, all of which can potentially contribute to delivering disparate care. Unconscious bias can also influence how healthcare providers diagnose and treat their patients. Numerous studies testing bias have demonstrated how preconceived notions about different groups have resulted in different treatment regimens and misdiagnoses, among other inconsistencies.

One such study, called “Do Gender and Race Affect Decisions About Pain Management?” published in The Journal of General Internal Medicine, found that doctors prescribe African American men less pain medication than their white counterparts for the same conditions. Another study, called “The Effect of Race and Sex on Physicians’ Recommendations for Cardiac Catheterization” published in The New England Journal of Medicine, found doctors had different patterns when referring patients for cardiac catheterization based on race and gender. Doctors referred fewer African American women for the procedure even though they presented with the same symptoms. Clearly, confronting health disparities requires addressing cultural competence so such discrepancies can be eliminated.

Reaching Out to Individuals and Communities

Public health advocates ensure health equity by working within local agencies and programs, tackling the challenges of advancing health in a variety of ways. Organizations such as the Louisiana Public Health Institute utilize a multitiered approach to addressing health disparities through research, communications, partnership building, and the implementation of programs. By using social media and marketing, they work to inspire collective action that improves community health. They collect and organize data to help government agencies, community-based organizations, and others make evidence-based decisions and policies. They also design health initiatives for the local, state, and national levels.

The Louisiana Public Health Institute works across different sectors in order to address the layers of issues that play into health disparities. They collaborate with urban housing planners, social service providers, regional and national partners, local residents, and others to improve behavioral and family health and to ensure better and more accessible health care to communities overall.

Earn a Master of Public Health Degree and Support Public Good

Innovating the solutions to our nation’s health disparities takes commitment and knowledge. Tulane University’s Online Master of Public Health program helps develop the expertise required to serve this greater good. By including courses on and elements of epidemiology, behavioral health, environmental health, biostatistics, and management, students gain the tools necessary for serving local communities.

The program cultivates respect for the inherent value of each individual, making health equity a priority. Students have the opportunity to study research done in real-world situations and build their understanding of how to implement meaningful interventions for underserved communities. In addition, graduates become public health advocates who know how to use data to influence policies that advance health.

What is health equity, and how can public health advocates provide the resources to the individuals who need them? Explore Tulane University’s Online Master of Public Health program and join the mission to promote health equities and create a world of greater dignity for all.

Sources

American Public Health Association, “Creating the Healthiest Nation: Advancing Health Equity”

American Public Health Association, Health Equity

Cancer Prevention & Control, “Evidence on Patient-Doctor Communication”

Center for American Progress, “5 Things to Know About Communities of Color and Environmental Justice”

Centers for Disease Control and Prevention, A Look Inside Food Deserts

Centers for Disease Control and Prevention, Health Equity

Food and Agricultural Organization of the United Nations, “Pulses and the Link Between Nutrition and Health”

Health Affairs, “Cultural Competence and Health Care Disparities: Key Perspectives and Trends”

Health Affairs, “Health, Income & Poverty: Where We Are & What Could Help”

Louisiana Public Health Institute, Healthy Communities

Medscape, “Cultural Competency in Healthcare: A Clinical Review and Video Vignettes from the National Medical Association”

Medscape, “‘Food Desert’ Dwellers Have Worse Heart-Disease Risk Profiles”

Medscape, “Not Me! Doctors, Decisions, and Disparities in Health Care”

National Center for Biotechnology Information, Coronary Artery Calcium Score: Current Status

Office of Disease Prevention and Health Promotion, Crime and Violence

Tulane University, ‘Neighborhood Stressors Associated with Biological Stress in New Orleans Kids”

Tulane University, Online Master of Public Health

U.S. Department of Agriculture, “Access to Affordable, Nutritious Food Is Limited in ‘Food Deserts’”

U.S. Department of Health & Human Services, Healthy Food Financing Initiative