What is health equity?

Health equity is about more than individuals or individual behavior but its also about history and context of places and systems. It’s about system level factors contributing to inequities in health and opportunities - to experience educations, work, safe housing, and clean environments.
— LISA COOPER - Bloomberg Distinguished Professor, Johns Hopkins University School of Medicine & Bloomberg School of Public Health, Steering Committee Rep., Alliance for a Healthier World

Defining a Complex Concept

Health equity is about the fair achievement and capability for good health and wellbeing, and not simply the equal distribution of health care. It is a multidimensional concept that cannot be viewed in isolation from inequities in social and environmental conditions that affect health. These determinants include socioeconomic status, education, the physical environment, employment, and social support networks.

Sources: Sen A (2002). Why Health Equity? Health Econ. 11: 659–666 + Health Equity Institute

Press Play to watch Lisa Cooper and David Peters from Johns Hopkins Alliance for a Healthier World share thoughts on what defines the complex challenge of health equity (footage from 2017 AHW event)

Getting Past the Jargon

Social Determinants of Health

Inequities in the social determinants of health – including socioeconomic status, education, the physical environment, employment, and social support networks – have wide-ranging effects on people’s health and survival. 

Social, economic, and environmental conditions affect health in a number of ways.

  • Social Conditions - Social inequities occur when a person or group is treated unfairly because of race, gender, class, sexual orientation, or immigration status.
  • Economic Conditions - Institutions such as governments, churches, corporations, or schools use their authority to create unequal opportunities among groups of people.
  • Environmental Conditions - Where you live affects your health. Lower income neighborhoods tend to be in poor social, economic, and physical conditions.
  • Health Behaviors - Smoking, poor nutrition, and lack of exercise are all behaviors that may lead to poor health. Social, economic, and environmental conditions affect health knowledge and health behaviors.
  • Disease or Injury - Chronic disease or injury can result from inequities and health behaviors. Genetics also affect health differences.
  • Mortality -Your social status, economic opportunities, where you live, and health behaviors all affect life expectancy

Understanding Academic Phrases

Socio-structural or Social Structures - A term often used by sociologists to describe patterns within relationships between people and social institutions such as family, religion, education, media, law, politics, and economy. Within each, there is a hierarchy based on some organizations and people holding more power than others and getting to determine what happens to all within, ultimately shaping the overarching social structure of a society.

Resource-constrained contexts - Economic, physical and political shortages of key resources needed for maintaining or improving conditions in communities.  For example, limited availability of electricity, water, roads and transportation networks, trained staff and institutional leadership, or access to financial credit, healthcare, or education.

More to come!

Why Focus on Improving Healthy Equity?

Health equity is an ambitious goal for global health. A key challenge of global health is to raise the health, nutrition and wellbeing of the world’s poorest people. Growing inequities in health, both between and within countries, threaten the community development gains made over the past decades.

  Farmer selling carrots at Lusulu Market, Malawi & Mozambique Border, March 2011. Photo credit: Sheridan Jones McCrae © 

Farmer selling carrots at Lusulu Market, Malawi & Mozambique Border, March 2011. Photo credit: Sheridan Jones McCrae © 

Health inequities typify a so-called “wicked problem” that is seemingly intractable, complex, and difficult to solve. Different stakeholders have conflicting values, and multiple explanations and interventions are possible. 

Examples

  • Efforts to enhance economic opportunity in disadvantaged communities can also produce hazardous waste that damages air, water, and soil, and harms human health, particularly for marginalized populations.
  • Market forces incentivize the development of medicines that provide benefits for those who can afford them, at the expense of preventive measures and new drug development for conditions that primarily affect the poor.
  • Improving access to antimicrobials has led to widespread use in animals and humans that improve food supplies and human health, but also contribute to anti-microbial resistance and its deadly consequences.

Health care interventions intended to address conditions of the poor or that are provided in low-income settings are often preferentially consumed by those better off (Hart’s Inverse Care Law - “the availability of good medical care tends to vary inversely with the need of the population served”); they require more specific strategies to engage disadvantaged people and demonstrate that interventions actually reach the poor. 
See Hart JT (1971). The Inverse Care Law. Lancet 297 (7696) 405-412; Peters DH et al. (2008) Poverty and access to health care in developing countries. Annals of the New York Academy of Sciences. 1136:161-71

Perspectives from Multiple Sectors Are Essential

Achieving health equity requires not only health professionals, but also specialists from a wide range of other disciplines to analyze the patterns and propose and test innovative solutions.

It also requires active participation and leadership from governments, business, and civil society, and particularly those who are most disadvantaged. 

Our Multiple Perspectives Approach

Read more about our vision of bringing together specialists from various professional disciplines and geographic contexts to integrate their skills and experiences, under the Interconnected Solutions section.

Often, when people think about Johns Hopkins, they think about this wonderful facility and the breakthough solutions, but what we know is that if we want to achieve a healthier world, we need to not just think about biomedical aspects but also social, economic, and political factors that contribute to health and wellbeing.
— PATRICIA DAVIDSON - Professor and Dean of School of Nursing at Johns Hopkins University and Steering Committee Rep., Alliance for a Healthier World

Further Learning Resources

Interested to read more about this complex topic?  Check out the sources below.

  • Marmot M. et al. (2008). Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Lancet 372 (9650):1661–1669).