“Fairness does not mean everyone gets the same. Fairness means everyone gets what they need,” wrote author Rick Riordan. When it comes to allocating scarce medical resources justly, healthcare leaders have a choice: Treat all patients the same (equally), or treat patients according to their unique needs (equitably).
Aiming at health equality may be a good short-term strategy for improving outcomes for patients currently facing medical discrimination, including transgender people. Yet aiming at health equity — focusing directly on the roots of social injustice and giving additional resources to at-risk patients — may be a better long-term strategy to create policies that reduce health disparities for vulnerable groups.
By noting the difference between the two, health equity vs. health equality, providers and policymakers are better able to determine where to allocate scarce medical resources and how to support populations that may not have the healthcare resources they deserve.
What Is Health Equality?
In healthcare, equality means treating all patients the same way. For example, a hospice nurse may spend equal amounts of time with every patient, or a dermatologist may offer the same information about sun exposure and skin cancer risks to each of theirs.
When health disparities arise due to unequal treatment — such as when certain patients face discrimination — health equality can help to bridge the gap.
For example, transgender people frequently experience discrimination in healthcare. According to a June 2020 Center for American Progress Report, 68% of transgender people of color experienced mistreatment by a medical professional. When transgender patients sought treatment, medical professionals reportedly:
- Refused to see transgender patients
- Performed physically rough or abusive treatment
- Intentionally misgendered the patient
- Deliberately used the person’s birth name (known as “deadnaming”) when referring to the patient
- Refused to provide healthcare related to gender transition
- Used harsh or abusive language during treatment
While these forms of discriminatory treatment are both morally wrong and illegal, they still happen.
The lack of safety and support in some medical settings causes undue stress for transgender people seeking healthcare, as shown by the report’s results:
- Transgender people who said their providers displayed visible discomfort due to their actual or perceived gender identity: 32%
- Transgender people who had to teach their provider about transgender healthcare to receive proper treatment: 33%
- Transgender people who experienced insurers denying them coverage for gender-affirming care: 50%
Equality could go a long way toward making healthcare safer for transgender people. By treating cisgender and transgender people equally, medical professionals can drastically reduce transgender discrimination in healthcare settings.
Recognizing the Limitations of Equality
Health equity focuses on seeking to address practices that lead to health inequities and inequality. This means researching and addressing the ways in which poverty, racism, ableism, sexism, and other forms of oppression can make people sick or create barriers to care.
For example, the stress of navigating a lifetime’s worth of racism has damaging health effects. The Centers for Disease Control and Prevention (CDC) has found that Black, American Indian, and Alaska Native women are three times more likely to die from pregnancy-related illness or injury than white women as a result.
Understand Underlying Causes of Health Disparities
Health disparities are preventable health differences experienced by people from socially disadvantaged groups.
Multiple factors contribute to health disparities, including:
- Educational inequality, which can lead to increased health risk behaviors such as smoking, drinking, or not seeking mental health services
- Inadequate access to healthcare, which is particularly prevalent in rural areas and spaces lacking public transportation
- Environmental hazards, such as pollution, violence, or unsafe buildings or neighborhood infrastructure
- Poverty, which can contribute to delays in seeking preventive care and a higher risk of poor nutrition as healthy food may be expensive
According to the CDC, health disparities such as these “are directly related to the historical and current unequal distribution of social, political, economic, and environmental resources.” That is, if our healthcare system, government agencies, and communities can work together, we may be able to reorganize and rebuild healthcare systems to reduce and prevent increasing health disparities.
How to Reduce Health Disparities
Health disparities reveal the importance of addressing social justice in the healthcare system. Obstacles that the most vulnerable among us face are driven by longstanding disenfranchisement, including through structural oppression, discrimination, stigma, and neglect.
To address health disparities, healthcare professionals need to adopt a health equity approach. This means recognizing the social determinants of health and reforming healthcare to make the overall population safer and healthier.
What Is Health Equity?
Health equity prioritizes social justice in healthcare. Unlike health equality, which calls for equal treatment for all patients, health equity prioritizes treatment and care based on need.
Equality does not always work in practice because some people need more support — or a different kind of support — than others. For example, the American Public Health Administration (APHA) reports that over 2 million people in the U.S. lack access to running water or plumbing, which can lead to serious health issues. Many other people lack access to clean drinking water. The people disproportionately affected by poor water quality tend to be:
- Older adults
- Low-income individuals and families
- Rural communities
- Communities of color
An equitable approach to addressing the issue of unclean drinking water would be to allocate extra government funding (or raise additional funding) for clean water systems.
In another example, the APHA has noted that while online and telehealth options may work well for patients with access to the internet, online platforms may exclude patients who do not have internet access. No matter how well an organization designs a website or web platform, if some patients cannot gain access to it due to living in a rural area, being unhoused, or lacking the income to purchase an electronic device, these efforts will not enable health equity.
An equity approach, according to the APHA, strives to give everyone the “opportunity to attain their highest level of health” — which means giving extra attention and resources to people with ill health because of a lack of access.
Learn to Drive Health Equity in Our Communities
When it comes to health equity vs. health equality, health professionals, educators, and policymakers should focus on creating opportunities for people to access high-quality medical care. Equality in healthcare can help us to minimize our discriminatory practices toward marginalized groups, but we also need health equity to address social injustice at its roots.
When searching education programs, students can consider schools that prioritize health equity and social justice in healthcare. At St. Catherine University, students learn how to address the social determinants of health and achieve health equity through compassionate policies and healthcare leadership.