Inequities vs' Inequalities vs' Disparities in Health

1
Inequities vs. Inequalities vs. Disparities in
Health

• A quick guide to the terms and a framework for
  understanding differences in health

2
Health Disparities

• Health disparities - population-specific
  differences in the presence of disease, health
  outcomes, or access to health care (HRSA
  definition)
• Key is that there are differences between
  populations in measures of health (e.g. access to
  care, health outcomes, rates of chronic disease)

3
How to eliminate health disparities?

• Commonwealth Fund (www.cmwf.org) recommends the
  following steps in developing policies to
  eliminate racial and ethnic disparities
• Consistent racial and ethnic data collection by
  health care providers.
• Effective evaluation of disparities-reduction
  programs.
• Minimum standards for culturally and
  linguistically competent health services.
• Greater minority representation within the health
  care workforce.
• Establishment or enhancement of government
  offices of minority health.
• Expanded access to services for all ethnic and
  racial groups.
• Involvement of all health system representatives
  in minority health improvement efforts.

4
Health inequalities

• Equivalent to health disparities
• Again, the issue is that there is a difference
  between the health status of one population
  compared to another population

5
Health Equity

• Health equity absence of systematic disparities
  in health (or in the major social determinants of
  health) between groups with different social
  advantage/disadvantage (e.g. wealth, power,
  prestige).
• -Braveman, Gruskin (2003)
• Thus, health inequities are the presence of such
  differences

6
Example inequality or inequity?

• Example the disproportionate numbers of poor and
  minority citizens in the U.S. that do not have
  inadequate access to health care
• Is it a health inequality? Yes, since there is a
  difference in rates of access to health care
  amongst segments of the population
• Is it a health inequity? Depends on whether your
  idea of justice involves the right to health
  care if so, then yes, it is unfair and unjust
  that there are differences in this fundamental
  right, the right to health care
• The important difference is that we must make a
  value judgment in the case of health inequities

7
A Suggested Framework

• Until the recent past, difference in health and
  disease were not important enough for governments
  and researchers to study.
• This suggests a troubling value judgment that was
  made for these last centuries health
  inequalities are not important enough to
  studythese inequalities were not considered
  inequities, and thus, did not deserve attention
  (for if differences are not unfair differences or
  unjust differences, then they can be minimized
  and shrugged off)

8
A Suggested Framework (Cont.)

• Therefore, our default should be to consider
  every health inequality/disparity as a health
  inequity, until we can prove that it is not so.
• In other words, we should ground our thinking in
  the human right to health (a value judgment) and
  the human right to health care and therefore
  treat each and every health inequality/disparity
  as unfair and unjust until we can prove
  otherwise.