Equity
Equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification. "Health equity” or “equity in health” implies that ideally, everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential. [1]
WHO Definitions of Equity
WHO Health Equity website [1]
Equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification. "Health equity” or “equity in health” implies that ideally everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential.
WHO Health Systems Strengthening Glossary [2]
Equity in Health: the absence of systematic or potentially remediable differences in health status, access to healthcare and health‐enhancing environments, and treatment in one or more aspects of health across populations or population groups defined socially, economically, demographically or geographically within and across countries.
WHO Ageing & Health Glossary [3]
Equity of care: Fair treatment of needs, regarding both the distribution of services and allocation of resources.
WHO Health Systems website [4]
Health inequities therefore involve more than inequality with respect to health determinants, access to the resources needed to improve and maintain health or health outcomes. They also entail a failure to avoid or overcome inequalities that infringe on fairness and human rights norms.
WHO Health Equity website [5]
Equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification. "Health equity” or “equity in health” implies that ideally everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential.
Other Definitions of Equity
Government of Canada [6]
Equity means fairness. Equity in health means that peoples’ needs guide the distribution of opportunities for well-being. Equity in health is not the same as equality in health status. Inequalities in health status between individuals and populations are inevitable consequences of genetic differences and various social and economic conditions, or a result of personal lifestyle choices. Inequities occur as a consequence of differences in opportunity, which result, for example in unequal access to health services, nutritious food or adequate housing. In such cases, inequalities in health status arise as a consequence of inequities in opportunities in life.
PubMed Medical Subject Headings (MeSH)
Opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance.
Note: Year introduced: 2016
Robert Wood Johnson Foundation [7]
“Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”
The following should be added when the definition is used to guide measurement; without measurement there is no accountability: “For the purposes of measurement, health equity means reducing and ultimately eliminating disparities in health and its determinants that adversely affect excluded or marginalized groups.”
Additional Notes on Equity
WHO Task Force on Research Priorities for Equity in Health [8]
On WHO equity term definition: "The equity-oriented research discussed here is primarily defined by a desire for social justice, specifically to reduce modifiable inequalities that are particularly unfair. Our concepts of “unfairness” influence both the research questions and the methods used to address them."
Brookings [9]
Equity is difficult to define simply, but it is regarded as a cornerstone not only of policy decisions, but also of ethically legitimate social institutions. Broadly speaking, equity is concerned with maximizing the benefits, capabilities and general well-being of the worst off members of a society. [10] In the context of universal health care (UHC), equity in access could be understood as necessitating the prioritization of those who with the greatest health needs in order to secure for them equality of opportunity or capability to the furthest extent possible. At the same time, health systems must ensure that households are not made to contribute more than their ability to pay in order for equity in financing to be also secured.
Braveman (2006) [11]
“A health disparity/inequality is a particular type of difference in health or in the most important influences on health that could potentially be shaped by policies; it is a difference in which disadvantaged social groups (such as the poor, racial/ethnic minorities, women, or other groups that have persistently experienced social disadvantage or discrimination) systematically experience worse health or greater health risks than more advantaged groups.” Primary reference:
Overseas Development Institue [12]
"Equity comes from the idea of moral equality, that people should be treated as equals. Thinking about equity can help us decide how to distribute goods and services across society, holding the state responsible for its influence over how goods and services are distributed in a society, and using this influence to ensure fair treatment for all citizens. Applying these ideas in a specific country context involves hard choices, and embedding discussions of distributive justice into domestic political and policy debates is central to national development, but three areas of considerable consensus can be identified. In order of priority, these are:
- Equal life chances: There should be no differences in outcomes based on factors for which people cannot be held responsible.
- Equal concern for people’s needs: Some goods and services are necessities, and should be distributed according solely to the level of need.
- Meritocracy: Positions in society and rewards should reflect differences in effort and ability, based on fair competition."
Bambra et al. (2007) [13]
Equality is conceptualised in a number of ways: formal equality, equality of opportunity and social equality. In formal equality, all humans are equal under the law regardless of their personal characteristics (such as religion, race or gender) and have an equal right to do as they wish.17 This approach, however, is rather limited as it does not acknowledge the restrictions placed on exercising equal individual rights by wealth, social norms or abilities. For example, in most countries all citizens have the formal right to medical treatment but not all can afford to exercise this right. Equality of opportunity focuses on this wider context and advocates removing social barriers, that prevent all citizens from having the same initial opportunities to progress their natural abilities—that is, an equal social opportunity to become naturally unequal.18 Social equality instead focuses on equality of outcomes such as wages or living conditions.19 Redistributive equality aims to reduce social inequalities in outcomes by the redistribution of wealth, whereas absolute social equality requires the abolition of all private ownership. Research into redistributive equality has suggested that health and violence are worse in more unequal societies.16 20 21
Cases of Equity
Hall, R. L., & Jacobson, P. D. (2018). Examining whether the health-in-all-policies approach promotes health equity. Health Affairs, 37(3), 364-370. doi:http://dx.doi.org/10.1377/hlthaff.2017.1292
[1] https://www.who.int/topics/health_equity/en/WHO
[2] Health Systems Strengthening Glossary https://cdn.who.int/media/docs/default-source/documents/health-systems-strengthening-glossary.pdf
[3] Commission for Social Determinant for Health (2008); and La renovación de la atención primaria de salud en las Américas: documento de posición de la OPS/OMS. Washington, D.C., La Organización Panamericana de la Salud, 2007.
[4] WHO Centre for Health Development (Kobe, Japan). (2004). A glossary of terms for community health care and services for older persons. Kobe, Japan : WHO Centre for Health Development. https://apps.who.int/iris/handle/10665/68896
[5]https://www.who.int/healthsystems/topics/equity/en/
[6]https://www.canada.ca/en/public
[7] Braveman P, Arkin E, Orleans T, Proctor D, and Plough A. What Is Health Equity? And What Difference Does a Definition Make? Princeton, NJ: Robert Wood Johnson Foundation, 2017.
[8] Östlin, P., Braveman, P., Dachs, J. N., Dahlgren, G., & al, e. (2005). Priorities for research to take forward the health equity policy agenda. Bulletin of the World Health Organization, 83(12), 948-53.
[9] The Equity of Universal Health Coverage: Some Reflections from Singapore. Calvin Wai Loon HoMonday, December 9, 2013. https://www.brookings.edu/opinions/the-equity-of-universal-health-coverage-some-reflections-from-singapore/#cancel
[10] Rawls J. 1999 (1971 org. ed.). A Theory of Justice. Cambridge MA: Harvard University Press.
[11] Braveman P. “Health Disparities and Health Equity: Concepts and Measurement.” Annual Review of Public Health, 27: 167–194, 2006.
[12] https://odi.org/en/publications/equity-in-development-why-it-is-important-and-how-to-achieve-it/
[13] Bambra C, Fox D, Scott-Samuel A. A politics of health glossary. Journal of Epidemiology & Community Health. 2007 Jul 1;61(7):571-4.