Quinn C. '25
Any discussion of social equity and justice requires positioning health as a key concern. Health is, after all, a social consideration. To discuss justice without health equity is a grave omission, as health is never in isolation: it is a core tenet of the rest of our lives, both individual and social. But to understand why health equity is so important, we must first understand what it means.
What is health equity?
A central distinction of equity is that it is not synonymous with equality. Equality is, sometimes, a facile ideal, one shared by most everybody, albeit in different ways. Take the example of the communist, the promoter of democracy, and a libertarian. Each wants equality of something valuable, central, to their respective political beliefs. The communist wants equality of income; the democrat, equality of political rights; the libertarian, equality of liberty. Each of these ideologies strives for equality of some given variable central to their theory of justice. Equality itself has no teeth. There remains the question of what is being equalized, and how. That is equity.
Let us illustrate with some examples. First, think of women’s versus men’s life expectancy. Women, for a variety of biological reasons, tend to have better survival chances and a lower incidence of certain illnesses; even female fetuses have a lower chance of miscarriage. Judged purely from the point of view of longevity, there is a sex-related inequality that can only be eliminated by an anti-female bias in healthcare. This, of course, would be morally unacceptable. This is a case where equality is not, and cannot be, equity. Equity requires the fairness of process in addition to the fairness of outcome.
Health Equity as Multidimensional
Take a second example, of Person X and Person Y. They have identical illnesses, a very painful one, however X is very rich, and has the means to get their ailment cured or suppressed via an expensive medical treatment. Clearly, there is an inequality of health. One might even say there is a violation of equity, as the resources used to cure X could be shared to provide some alleviation to both X and Y, or, in the case care is indivisible, provide an equal chance at care through some probabilistic machinery. Now imagine a policy aimed at creating health equality that prevents X from buying any care Y cannot buy. They are now equal in health, however while Y is unaffected, X now suffers from their painful ailment, and spends their money on a variety of luxuries to make life more bearable. While this policy certainly promotes health equality, does it advance health equity? The gut instinct of many would say no. While inequality in the health sphere has been reduced, inequality in other spheres, spurred by X’s lavish spending on consoling items, has been increased. Thus, health equity is a multidimensional question, which cannot be reduced to one factor of equality or another. Health equality, in this instance, does not constitute equity, as health equity is a multifaceted problem, which encompasses more than the mere biological, but the social and psychological as well. Many physicians attempt to address the multidimensional nature of health by examining Social Determinants of Health (SDHs) and Environmental Determinants of Health (EDHs), however it remains an inevitable truth that health equity is not just the allocation of healthcare–it is also the result of the distribution of psychosocial, economic, and political capital.
How to Approach Health Equity
Health equity extends beyond traditional measures of health and outcomes. It must be able to enhance the capability of an individual to lead a fulfilling life. Fulfillment, after all, is a diverse and transient goal, which, although relies in part on health, is largely independent of it nonetheless. Therefore, policy cannot focus on providing goods or services towards the end of fulfillment. Rather, it must empower each individual with capabilities and freedoms while removing barriers to well-being. Capability is more than function, however. While function is one’s ability to do or achieve something, capability is one’s ability to choose. Thus, health equity is a matter of agency–the agency of the individual to choose a path toward a life they value.
This article originally appeared in healthbites. Read more at healthbites.blog.