It Matters How We Define
Health Care Equity
Allan Goldberg, M.D., Merck & Co., Inc.*
January 18, 2012
Equity is not a contemporary concept.
The Oxford English Dictionary defines equity as “the quality of being fair and impartial:
equity of treatment. A branch of law that
developed alongside common law in order
to remedy some of its defects in fairness and
justice, formerly administered in special
courts: if there is any conflict between the
principles of common law and equity, equity
prevails.”1
The definition of health equity has
evolved over time, with the principal focus
on the individual and the attainment of social justice. In order to maximize the delivery of high-quality health care and avoidance of disparities, it is necessary to ensure
that the concept of health equity is clearly
defined. Ambiguity in the definition may
result in harmful policy consequences. In
due course, this can determine which
measures are monitored at the national,
state, and local level with impacts on resource allocation to address disparities and
health equity (Braveman, 2006).
Margaret Whitehead (1992) concisely
defines a lack of health equity as differences
in health that “are not only unnecessary and
avoidable but, in addition, are considered
unfair and unjust.” She goes on to state that
“equity in health implies that ideally everyone should have a fair opportunity to attain
their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential, if it can
be avoided.”
The views expressed in this commentary are
those of the author and not necessarily of the
author’s organization or of the Institute of Medicine. The commentary is intended to help inform
and stimulate discussion. It has not been subjected to the review procedures of the Institute of
Medicine and is not a report of the Institute of
Medicine or of the National Research Council.
Accordingly, equity in access to health
care implies that everyone has the opportunity to reach their full health potential; in
short, the playing field is leveled for all individuals. Whitehead goes on to define equity in heath care “as equal access to available
care for equal need, equal utilization for
equal need, and equal quality of care for
all.”
In virtually every society in the world,
social privilege is reflected in differences in
socioeconomic status; gender; geographical
location; racial, ethnic, and religious differences; and age. Pursuing equity in health
depends on reducing avoidable gaps in
health status and health services among
groups with different levels of social privilege (WHO, 1996).
Over the next several years, as the Affordable Care Act becomes fully operative,
an emergent population of Americans who
have been on the outside of the health care
system will now have access to care. Access, however, is in no way a guarantee of
equity in health care. It will be critical that
there are policies in place to ensure that the
quality, quantity, and appropriateness of
*Participant in the activities of the IOM Roundtable on
the Promotion of Health Equity and the Elimination of
Health Disparities.
1
Origin: Middle English: from Old French equité, from
Latin aequitas, from aequus, “equal.”
Copyright 2012 by the National Academy of Sciences. All rights reserved.
References
Braveman, P. 2006. Health disparities and health
equity: Concepts and measurement. Annual Review of Public Health 27:167-194.
Whitehead, M. 1992. The concepts and principles of
equity in health. International Journal of Health
Services 22(3):429-445.
WHO (World Health Organization). 1996. Equity in
health and health care: A World Health Organization initiative. Geneva: WHO (unpublished
document WHO/ARA/96.1).
care are not disparate and as a result we will
have achieved the goal of health care equity.
Suggested Citation: Goldberg, A. 2012. It matters
how we define health care equity. Commentary,
Institute of Medicine, Washington, DC.
http://www.iom.edu/insertlinktoyourpaper.
2