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In this cluster, we define a group of concepts relating to equity and equality: ‘Equity in health/Health inequity’, ‘Equality’ and ‘Health inequalities’.
Equity in health/health equity:
… equity in health can be defined as the absence of systematic disparities in health (or in the major social determinants of health) between social groups who have different levels of underlying social advantage/disadvantage—that is, different positions in a social hierarchy.
Source: Braveman P, Gruskin S (2003) Defining equity in health. J Epidemiol Community Health 2003; 57: 254-258. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732430/pdf/v057p00254.pdf
Example of the term in use:
Health equity could exist but often does not. The goal of health equity − for communities, for service systems and for practitioners in their work − is to make sure no one experiences poor health and wellbeing because of such unfair and avoidable disadvantage.
Health inequity:
… health inequities, which are defined as health inequalities that are systematic, socially produced (and therefore modifiable) and unfair. Health inequities are the result of the circumstances in which people grow, live, work and age and the health systems they can access, which in turn are shaped by broader political, social and economic forces. They are not distributed randomly, but rather show a consistent pattern across the population, often by socioeconomic status or geographical location.
Source: World Health Organization, The WHO Centre for Health Development, Kobe, and United Nations Human Settlements Programme (UN HABITAT) (2010) Hidden Cities. Unmasking And Overcoming Health Inequities In Urban Settings. Page XIII. https://books.google.co.uk/books?id=gXqgaPtPzrQC&lpg=PP2&lr&pg=PP2#v=onepage&q&f=false
Health Inequities systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health. (page 256)
The concept of health equity focuses attention on the distribution of resources and other processes that drive a particular kind of health inequality—that is, a systematic inequality in health (or in its social determinants) between more and less advantaged social groups, In other words, a health inequality that is unjust or unfair. (page 255)
Source: Braveman P, Gruskin S (2003) Defining equity in health. J Epidemiol Community Health 2003; 57: 254-258. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732430/pdf/v057p00254.pdf
Example of the term in use:
The aim of this proposed framework is to aid in assessing whether adaptation targets current inequities and determinants of health that may reduce unequally distributed health outcomes. To evaluate health-related climate change adaptation for its climate justice contribution, the theoretical framework draws from two main concepts: (i) health inequity and (ii) resilience to climatic changes.
Equality:
It is important to distinguish between two similar-sounding, but quite different, concepts: “equality” and “equity”. The former implies equal shares of something; the latter, a “fair” or “just” distribution, which may or may not result in equal shares.
Source: Rice T (1998) The Economics of Health Reconsidered. Health Administration Press. Page 152.
Example of the term in use:
While it is important, … to be clear about the distinction between health inequalities and health inequities, the concepts of equality and equal rights are none the less central and indispensable. The concept of equality is indispensable for the operationalisation and measurement of health equity and is important for accountability under the human rights framework. Equality can be assessed with respect to specified measurable outcomes, whereas judging whether a process is equitable or not is open to interpretation.
Health inequalities:
Health inequalities can be defined as differences in health status or in the distribution of health determinants between different population groups. For example, differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes.
Source: World Health Organization. Health Impact Assessment (HIA). Glossary of terms used. Health inequality and inequity.
Example of the term in use:
Health inequalities … are an issue of fundamental importance for general practice. The role of the GP as an expert medical generalist at the heart of the community, and the first point of contact for the vast majority of patients, means that general practice has a pivotal role to play in combatting the causes of health inequalities and their effects.
Example of how some of the terms in this cluster are used:
It is important to distinguish between inequality in health and inequity. Some health inequalities are attributable to biological variations or free choice and others are attributable to the external environment and conditions mainly outside the control of the individuals concerned. In the first case it may be impossible or ethically or ideologically unacceptable to change the health determinants and so the health inequalities are unavoidable. In the second, the uneven distribution may be unnecessary and avoidable as well as unjust and unfair, so that the resulting health inequalities also lead to inequity in health.
