In 2020, I (Jess) wrote about how a second pandemic was occurring alongside COVID-19: the ever-increasing rise of racial injustice in the US. In it, I highlighted the prevalence of racial disparities in health care, as well as the importance of addressing the drivers of health (a.k.a. the social determinants of health) in helping to heal those disparities.
In reading this post again, I notice that I’m guilty of something that I see often: the interchangeable use of the words “disparity” and “inequity”. While these words are commonly used interchangeably, they each have a unique meaning, and it’s critical for organizations outlining a social care strategy to understand the nuances between them.
Language holds a significant amount of power. It conveys messages and shapes ideas in people’s minds, which ultimately lead to action. When organizations are seeking to improve health outcomes for their patients, using the right language is critical in order to effectively convey what they can, and cannot, do.
Disparities vs inequities
A disparity is defined as “a noticeable and usually significant difference or dissimilarity.”
An inequity is defined as “an instance of injustice or unfairness.”
In health care, a health disparity is a “preventable difference in health outcomes”. Meanwhile, health inequities are “injustices that result from systemic, avoidable, unfair, and unjust barriers, which create poor health”.
Now let’s dig deeper into why this distinction matters.
Systems issues require system-level solutions
As Jess wrote in 2020, and we further showcased in our report You Are What You Treat, many health organizations are starting to address the drivers of health as a part of their value propositions. And mostly, these efforts are aimed at addressing disparities in a number of ways. Examples include:
- Providing healthy food, through an onsite garden or a partnership with a food delivery or subscription service,
- Helping patients secure stable housing, such as UnitedHealth’s efforts to house patients without a home, or
- Tackling social isolation by incorporating mentorship or buddy programming into health care offerings.
These efforts seek to improve patients’ health outcomes, and ideally will lessen outcome disparities within a given patient population. However, these internal efforts do not dismantle the embedded and unjust barriers preventing better health for all. For that to occur, we need federal, systems-level change.
Health disparities are the near-term consequences of health inequities. While programs addressing disparities address these preventable differences in health outcomes, broader efforts are required to tackle the root cause of inequities. Among these are federal changes to alter the health care system as we know it today. These changes include system redesigns that expand access to care, enhance diversity and cultural competence of providers, ensure accuracy of health data for disadvantaged populations, and enhance investments in public health. Social policy changes are also required, such as initiatives aimed at racial equity, as years of policy choices have led to outcomes such as unequal economic and educational opportunities.
Where do we go from here?
Both disparities and inequities are symptoms of centuries old, societally engrained socioeconomic injustices in the US. While individual organizations have the power to address health disparities, inequities require a higher level of systemic action to reverse.
For organizations looking to improve outcomes for their patient populations, it’s important to understand a critical distinction: one’s drivers of health strategy can be an effective lever to address disparities, but it will not eliminate health inequity and injustice. Even so, that doesn’t mean they are powerless in the fight to bring about change.
Instead, health care entities should use their power within their communities and states as conveners, large employers, and trusted providers of care to work alongside policy makers. Together with local and federal government, universities training the next generation of providers, and other health equity-focused institutions, health systems can drive change to create a more equitable future. The result will be both fewer disparities, and fewer inequities, because as we’ve outlined here, they are not one in the same.
