What is the Difference Between Health Disparities, Equity?

August 10, 2020 - Health disparities and health equity are two phrases that have often been used interchangeably to refer to the fact that some populations are able to achieve health and wellness more easily than others.

As the push for value-based care has become more prevalent, clinicians and health industry leaders have acknowledged that to promote wellness and achieve optimal outcomes, they must address the upstream factors that influence health: the social determinants of health.

And innately tied to that conversation are health disparities and health equity. By and large, having some populations that experience more social determinants of health than others results in health disparities and health equity issues.

But those two terms cannot be used interchangeably, as they so often have been during recent discussions about social determinants of health. Health disparities and health equity are two distinct terms that refer to two distinct phenomena.

Below, PatientEngagementHIT outlines the definitions for both health disparities and health equity, and how these two separate phrases are related.

What are health disparities?

Health disparities are the patterns one observes related to health among different patient populations — that is, an outcome being more or less for a specific group.

“Health and health care disparities refer to differences in health and health care between groups,” says the Kaiser Family Foundation.

“A ‘health disparity’ refers to a higher burden of illness, injury, disability, or mortality experienced by one group relative to another. A ‘health care disparity’ typically refers to differences between groups in health insurance coverage, access to and use of care, and quality of care.”

The outbreak of the novel coronavirus offered a prime example of health disparities. Black and Hispanic patients were more likely to contract the illness and experience higher rates of hospitalization than their white peers. That disease burden was higher for Black and Hispanic patients than it was for white patients, resulting in a health disparity.

What is health equity?

Health equity, or its foil health inequity, are often viewed as the causes of a health disparity. They are the structural or institutional patterns that ultimately result in health disparities.

“Health equity means that everyone has a fair and just opportunity to be as healthy as possible,” the Robert Wood Johnson Foundation says. “This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”

When there is not health equity (meaning, when there is health inequity), health disparities emerge.

Health equity usually refers to the non-clinical factors —social determinants of health — that can ultimately affect health outcomes for patients. Some examples of health inequity may include, but are not limited to:

• Redlining, which can still be seen in limited financial, educational, or health resources
• Limited career opportunities
• Income disparities
• Neighborhood safety
• Access to nutritious food

Those factors each have a downstream impact on patient health. If a patient lives in a low-income neighborhood, she may not receive the education that would lead to a well-paying job with employer-sponsored health insurance.

That in itself would also result in a heath disparity: those who do and do not have insurance.

But that could also result in health disparities related to outcomes: because that patient does not have insurance, she may be able to afford preventive care that would have detected pre-diabetes. That patient could then develop diabetes, resulting in another health disparity.

How are health disparities, health equity linked?

Health disparity and health equity or inequity are often used interchangeably because it is challenging to speak of one without the other. Inequity kept the patient in the previous section from obtaining insurance and accessing affordable preventive care, and she ultimately developed a chronic illness. That demonstrates both health inequity and health disparities at play.

The example about COVID-19, too, demonstrates health inequity and health disparities.

Black and Hispanic patients carried the burden of the disease more than their white peers, but that wasn’t because their bodies were less able to combat the virus. Instead, a number of inequities made it more likely they would contract the virus and become sicker with it.

For example, because of limited financial or educational resources, Black and Hispanic patients were more likely to be working in jobs deemed essential during the pandemic, meaning they were exposed to more people while the virus spread across the country. Black and Hispanic patients became more likely to contract the virus.

And when they contracted the virus, they were more likely to become seriously ill. Decades of institutional racism have eroded trust between minority patients and their often white providers. Meanwhile, low income, lack of insurance, inability to make time, and lack of proximity to a health clinic have limited minority patient access to care. As a result, Black and Hispanic patients are more likely to have a chronic illness that would make it harder to fight to the novel coronavirus.

The differences between health disparities and health equity are clearly nuanced, making it easy to use the phrases interchangeably. However, acknowledging those subtle differences will be important as the healthcare industry turns its focus toward population health and the social determinants of health.