Health equity


Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. This is especially important in areas with increased diversity across social, ethnic, and racial groups, as underrepresentation in healthcare systems is a global issue. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.
According to the World Health Organization, "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". The quality of health and how health is distributed among economic and social status in a society can provide insight into the level of development within that society. Health is a basic human right and human need, and all human rights are interconnected. Thus, health must be discussed along with all other basic human rights.
Health equity is defined by the CDC as "the state in which everyone has a fair and just opportunity to attain their highest level of health". It is closely associated with the social justice movement, with good health considered a fundamental human right. These inequities may include differences in the "presence of disease, health outcomes, or access to health care" between populations with a different race, ethnicity, gender, sexual orientation, disability, or socioeconomic status.
Health inequity differs from health inequality in that the latter term is used in a number of countries to refer to those instances whereby the health of two demographic groups differs despite similar access to health care services. It can be further described as differences in health that are avoidable, unfair, and unjust, and cannot be explained by natural causes, such as biology, or differences in choice. Thus, if one population dies younger than another because of genetic differences, which is a non-remediable/controllable factor, the situation would be classified as a health inequality. Conversely, if a population has a lower life expectancy due to lack of access to medications, the situation would be classified as a health inequity. These inequities may include differences in the "presence of disease, health outcomes, or access to health care". Although, it is important to recognize the difference in health equity and equality, as having equality in health is essential to begin achieving health equity. The importance of equitable access to healthcare has been cited as crucial to achieving many of the Millennium Development Goals.

Socioeconomic status

is both a strong predictor of health, and a key factor underlying health inequities across populations. Poor socioeconomic status has the capacity to profoundly limit the capabilities of an individual or population, manifesting itself through deficiencies in both financial and social capital. It is clear how a lack of financial capital can compromise the capacity to maintain good health. Income is an important determinant of access to healthcare resources. Because one's job or career is a primary conduit for both financial and social capital, work is an important, yet underrepresented, factor in health inequities research and prevention efforts. There are many ways that a job can affect one's health, such as the job's physical demands, exposure to hazards, mechanisms of employment, compensation and benefits, and availability of health and safety programs. In addition, those who are in steady jobs are less likely to face poverty and its implications and more likely to have access to health care. Maintenance of good health through the utilization of proper healthcare resources can be quite costly and therefore unaffordable to certain populations.
In China, for instance, the collapse of the Cooperative Medical System left many of the rural poor uninsured and unable to access the resources necessary to maintain good health. Increases in the cost of medical treatment made healthcare increasingly unaffordable for these populations. This issue was further perpetuated by the rising income inequality in the Chinese population. Poor Chinese were often unable to undergo necessary hospitalization and failed to complete treatment regimens, resulting in poorer health outcomes.
Similarly, in Tanzania, it was demonstrated that wealthier families were far more likely to bring their children to a healthcare provider: a significant step towards stronger healthcare. Unequal income distribution itself can be a cause of poorer health for a society as a result of "underinvestment in social goods, such as public education and health care; disruption of social cohesion and the erosion of social capital".
The role of socioeconomic status in health equity extends beyond simple monetary restrictions on an individual's purchasing power. In fact, social capital plays a significant role in the health of individuals and their communities. It has been shown that those who are better connected to the resources provided by the individuals and communities around them live longer lives. The segregation of communities on the basis of income occurs in nations worldwide and has a significant impact on quality of health as a result of a decrease in social capital for those trapped in poor neighborhoods. Social interventions, which seek to improve healthcare by enhancing the social resources of a community, are therefore an effective component of campaigns to improve a community's health.

Economic inequality

Poor health outcomes appear to be an effect of economic inequality across a population. Nations and regions with greater economic inequality show poorer outcomes in life expectancy, mental health, drug abuse, obesity, educational performance, teenage birthrates, and ill health due to violence. On an international level, there is a positive correlation between developed countries with high economic equality and longevity. Based on where a person lives and how much money they make, experts can predict roughly how long that person will live. According to the World Health Organization in 2017, a baby born and raised in Africa will die an average of sixteen years sooner than a child born at the same time in Europe. This is unrelated to average income per capita in wealthy nations. Economic gain only impacts life expectancy to a great degree in countries in which the mean per capita annual income is less than approximately $25,000.
The United States shows exceptionally low health outcomes for a developed country, despite having the highest national healthcare expenditure in the world. The US ranks 31st in life expectancy. Americans have a lower life expectancy than their European counterparts, even when factors such as race, income, diet, smoking, and education are controlled for.
Relative inequality negatively affects health on an international, national, and institutional levels. The patterns seen internationally hold true between more and less economically equal states in the United States, that is, more equal states show more desirable health outcomes. Importantly, inequality can have a negative health impact on members of lower echelons of institutions. The Whitehall I and II studies looked at the rates of cardiovascular disease and other health risks in British civil servants and found that, even when lifestyle factors were controlled for, members of lower status in the institution showed increased mortality and morbidity on a sliding downward scale from their higher status counterparts.
The negative aspects of inequality are spread across the population. For example, when comparing the United States to England, the US shows higher rates of diabetes, hypertension, cancer, lung disease, and heart disease across all income levels. This is also true of the difference between mortality across all occupational classes in highly equal Sweden as compared to less-equal England.
Unconditional cash transfers for reducing poverty used by some programs in the developing world appear to lead to a reduction in the likelihood of being sick. Such evidence can guide resource allocations to effective interventions.
The quality of health care varies among different socioeconomic groups. Children in families of low socioeconomic status are the most susceptible to health inequities. Children in poor families under 5 years of age are likely to face health disparities because the quality of their health depends on others providing for them; young children are not capable of maintaining good health on their own. In addition, these children have higher mortality rates than those in richer families due to malnutrition. Because of their low socioeconomic status, receiving health care can be challenging. Children in poor families are less likely to receive health care in general, and if they do have access to care, it is likely that the quality of that care is not highly sufficient.

Education

Education is an important factor in healthcare utilization, though it is closely intertwined with economic status. An individual may not go to a medical professional or seek care if they do not know the ills of their failure to do so, or the value of proper treatment.
In Tajikistan, since the nation gained its independence, the likelihood of giving birth at home has increased rapidly among women with lower educational status. Education also has a significant impact on the quality of prenatal and maternal healthcare. Mothers with primary education consulted a doctor during pregnancy at significantly lower rates when compared to those with a secondary education, technical training or a higher education. There is also evidence for a correlation between socioeconomic status and health literacy; one study showed that wealthier Tanzanian families were more likely to recognize disease in their children than those that were coming from lower income backgrounds.
Social inequities are a key barrier to accessing health-related educational resources. Patients in lower socioeconomic areas will have less access to information about health in general, leading to less awareness of different diseases and health issues. Health education has proven to be a strong preventative measure that can be taken to decrease levels of illness and increase levels of visiting healthcare providers. The lack of health education can contribute to worsened health outcomes in these areas.
Education inequities are also closely associated with health inequities. Individuals with lower levels of education are more likely to incur greater health risks such as substance abuse, obesity, and injuries both intentional and unintentional. Education is also associated with greater comprehension of health information and services necessary to make the right health decisions, as well as being associated with a longer lifespan. Individuals with high grades have been observed to display more consistent engagement in healthy lifestyle choices and fewer instances of harmful habits than their less academically gifted counterparts. Factors such as poor diets, inadequate physical activity, physical and emotional abuse, and teenage pregnancy all have significant impacts on students' academic performance and these factors tend to manifest themselves more frequently in lower-income individuals.