Achieving Health Equity

The Case for Health Equity

As defined by the United States Health Resources and Services Administration, health equity is “the absence of avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes, such as disease or mortality.” ¹ Race and ethnicity have remained a major focus of inequity in health care, where organizational, structural, and clinical barriers significantly impact access to care. ² Health inequities are and will continue to be key barriers to improving the value of the health care we deliver in the United States.

Health equity seeks to reduce and eliminate disparities in health care, by removing obstacles to care and their associated consequences that adversely affect marginalized populations. ³ Health disparities can be categorized through race, ethnicity, education, sex, sexual orientation, socioeconomic status, and place of residence. Furthermore, providing opportunities for healthy living requires improving access to the resources and conditions that can strongly influence health, including social inclusion, positive physical and social environments, and quality education. ⁴ To achieve greater health equity, marginalized groups must be considered in the planning and implementation of health policy, the delivery of care, and environmental interventions.

Key Barriers

Research in the social determinants of health (SDOH) has continually supported the notion that health goes beyond genetics and traditional medical care. Despite advances in health policy and strides to improve access to health care, there are a number of limitations that continue to plague patients seeking quality care. In the United States, an estimated 60% of preventable mortality is attributed to social and economic circumstances, outside of clinical services. ⁵

Overall, racial minorities disproportionally experience higher rates of cardiovascular disease, diabetes, behavioral health conditions, and other preventable diseases. ⁶ Significant contributing factors include inadequate access to health care resources, including health insurance, health literacy, cultural incompetence, and transportation barriers, as well as cultural mistrust of the health care system. ⁷

It is critical that health equity be addressed across the age span. Children and young adults represent an increasingly vulnerable population, as the opportunity to prevent chronic diseases begins at an early age. Specifically, children of color in lower resourced communities repeatedly fall behind majority peers in health status. ⁸ If neglected, pediatric disparities frequently contribute to adult inequities and chronic adult illnesses. Furthermore, ensuring that health care is utilized in an equitable manner across the age span will result in improved health outcomes and decreased health care costs.

Older adults experience different health conditions and die from different diseases than younger individuals, leading to additional factors—beyond fundamental factors such as race, ethnicity, socioeconomic status, disability status, and gender/sex identity—that must be considered while addressing health disparities related to aging.

Key Facilitators to Achieving Health Equity

Critical to achieving health equity requires (1) emphasis on reducing health disparities across the age span; (2) the incorporation of SDOH assessment and screening into care design and delivery; (3) the effective use of SDOH to properly identify and manage patient risk(s); (4) the provision of adequate resources and effective training for health care providers; (5) implementation and dissemination of value-based care systems and fully aligned payment incentives and mechanisms; (6) referral to a network of partnering community-based organizations addressing social needs outside of the health care system; and (7) continuous improvement in policies, systems, and environments to eliminate inequities in opportunities and resources needed to achieve good health.

Author Disclosure Statement

No competing financial interests exist.

Authors' Contributions

Julie A. Jacko made substantial contributions to the conception of the work, drafted the work, and reviewed it critically for important intellectual content. She provided final approval of the version to be published, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

François Sainfort made substantial contributions to the conception of the work, drafted the work, and reviewed it critically for important intellectual content. He provided final approval of the version to be published, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding Information

We have received funding from the Health Foundation of South Florida, Grant No. 22-05409.