What is Health Equity?

Healthy People 2000 (HP 2000) and 2010 (HP 2010) included goals that focused on health disparities. HP 2000 aimed to reduce health disparities among Americans and HP 2010 aimed to eliminate, not just reduce, those health disparities.

  • The goal was expanded for HP 2020 and aims to achieve health equity, eliminate disparities, and improve the health of all groups

For the first time in the initiative's history, HP 2030 includes an emphasis on health literacy and this is is reflected in foundational principles and overarching goals.

In September 2020, a revised version of the 10 Essential Public Health Services (EPHS) was released to address the dramatic shift in the public health landscape since they were initially released 25 years prior.

  • The revised EPHS framework now has a greater emphasis on equity, and strives to protect and promote the health of all people in all communities by incorporating concepts relevant to current and future public health practice

To achieve equity, the EPHS actively promote policies, systems, and overall community conditions that enable optimal health for all and seek to remove systemic and structural barriers that have resulted in health inequities. Such barriers include poverty, racism, gender discrimination, ableism, and other forms of oppression. Everyone should have a fair and just opportunity to achieve optimal health and well-being

10 EPHS

The following definitions are from the San Francisco State University Health Equity Institute.

Health Equity

Attainment of the highest level of health for all people

Health Inequities

Differences in health that are avoidable, unfair, and unjust

Health Disparities

Differences in health outcomes among groups of people

Health equity means ensuring all people have full and equitable access to opportunities that allow them to lead healthy lives. This requires a commitment on the professional and health department level to:

  • Value everyone equally
  • Address avoidable inequalities and historical and contemporary injustices
  • Eliminate health and health care disparities

The MDPH Health Equity Workgroup, which includes both MDPH staff and community stakeholders, has expanded the definition of health equity to include both the process and the outcome of addressing disparities by considering the social determinants of health.

This establishes health equity as not just an ideal state where everyone has the same access to, and quality of, care or health outcomes. Rather, it is also the ongoing process of assessing and improving of systems in order to eliminate the inequities that result in, or perpetuate, disparities.

Inequities involve the social drivers as well as the systemic factors (i.e., policies) that result in health and other disparities among populations.

Example - Infant Mortality

The infant mortality goal of HP 2020 is 6 deaths per 1,000 live births.

The 2017 Massachusetts State Health Assessment reports that Massachusetts achieved a 2.6% annual decline in the infant mortality rate from 2005 to 2014 and currently has the lowest rate of all of the states in the nation.

Yet, racial and ethnic disparities still persist.

  • The infant mortality rate for black non-Hispanics was more than twice the rate of white non-Hispanics
  • The infant mortality rates varies by city/town

 

Infant Mortality Rate by Race/Ethnicity in MA, 2014

Race/Ethnicity

Infant Mortality Rate (per 1,000 live births) in 2014

Asian, non-Hispanic

2.9

White, non-Hispanic

3.4

Hispanic

5.0

Black, non-Hispanic

7.3

 

MA Communities with the Highest Infant Mortality Rate, 2014

Town

Infant Mortality Rate (per 1,000 live births) in 2014

Fitchburg

9.9

Chelsea

8.5

Worcester

7.4

 

Before moving on, think about what causes these disparities in infant mortality rate. Would you consider these inequities? Now consider what steps we can take to achieve health equity.


According to the 2017 Massachusetts State Health Assessment, "disparities in infant mortality rate result from differential developmental pathways shaped by early life experiences and cumulative wear and tear on the body as an individual is exposed to repeated or chronic stress over time."

Repeated or chronic stressors such as poor/unstable housing, environmental hazards in the community or on the job, limited access to nourishing food, discrimination, or no access to adequate health insurance and/or health care can be contributing factors to a higher infant mortality rate.

The disparities in the infant mortality rate in Massachusetts do constitute an inequity because the outcomes vary by racial/ethnic category and by geographic location. Even when individual health behaviors like smoking and alcohol consumption rates for pregnant women are considered, the infant mortality rate for some groups remain high, indicating that the outcomes may be a result of their environment, which is both unjust and preventable.

In order to achieve health equity, women's exposure to risk factors must be addressed not only during pregnancy, but over their life course. Doing so must take into account all of the social determinants that impact a woman's ability to be healthy, stay healthy, and help her child be and stay healthy