Health equity means that every person has an equal opportunity to be healthy and well. Opportunities to be healthy and well are often assessed by examining the Seven Vital Conditions, or the Social Determinants of Health (e.g. humane housing, meaningful work and wealth). While achieving health equity is intuitively imperative and a goal of many organizations and change-makers working to advance equitable well-being, it’s also a common challenge. This is because inequities are created when barriers exist that prevent individuals and communities from reaching their full potential to be healthy and well, and there are many such barriers in communities across the Nation. Examples of barriers to well-being include poverty, discrimination, and racism, all of which can have consequences like lack of affordable housing, and lack of access to good-paying jobs or high-quality, culturally appropriate health care. To achieve health equity, we must not only decrease barriers, but also remove the societal circumstances that are a result of these barriers. To be clear, decreasing poverty is positive, but if those in poverty still lack access to health care, we have not achieved health equity.
One of the most difficult things about working toward health equity is that in many cases barriers to well-being exist because of conditions that have persisted in the U.S. for years, if not decades. It’s challenging to reverse these long-standing conditions due to their pervasive nature and the way they are deeply embedded in society. For example, racism in the U.S. is systemic and has historically prevented people of color from having the same opportunities as their white counterparts for economic, physical, and mental health. Without health equity, vulnerable populations are at risk for disparate access to community resources and conditions that create well-being because of economic, cultural, racial, or physical characteristics. Importantly, improved overall population health is not necessarily a sign of increased health equity. Health equity is demonstrated through a decrease in health disparities—worse health outcomes in marginalized groups.
While overall health in the U.S. has improved significantly in the last century (the life expectancy today is drastically improved as compared to 100 years ago), health disparities persist. We see evidence of this even in the recent progression of the COVID-19 pandemic, where people of color are disproportionately represented among coronavirus cases.
Achieving increased health equity will require engagement with people in historically marginalized communities that have experienced barriers to well-being, many of whom are advocating for themselves in unprecedented and impactful ways. It will also require allyship and commitment and work from stewards across systems and sectors to decrease barriers to conditions that lead to well-being. Adoption of a well-being framework like the Vital Conditions for Well-Being acknowledges the interconnectedness of our physical health to the community conditions in which we live, and the corresponding disparities in these conditions because of a lack of health equity. Additionally, as we consider use of data and measurement to track progress toward health equity, “a commitment to health equity requires constant monitoring not only of overall (average) levels of health and the resources [conditions] needed for health in a whole population, but also routinely comparing how more and less advantaged groups within that population are faring.”