Going Beyond Healthcare: The Path to Health Equity, Part 1
The following is part 1 of 5 in a series of articles titled, "The Path to Health Equity" by Jason Ausili, PharmD, MSLS, Head of Pharmacy Transformation for EnlivenHealth, as well as other contributors to Ask Your Pharmacist.
Healthcare inequity is a major and ongoing concern in communities across the country. People of color, people from low-income communities, and people with disabilities are more likely to experience poor health and have worse health outcomes than their white, wealthy, and able-bodied counterparts.
This is not because those populations are inherently unhealthy. Instead, it's a matter of access. They face a number of barriers to accessing quality healthcare, such as lack of insurance, transportation, and even language access.
What can be done about healthcare inequity? And what role can community pharmacies play in that effort?
Let's start by examining health equity.
What Is Health Equity?
According to the CDC, health equity can be defined as the "state in which everyone has a fair and just opportunity to attain their highest level of health." This means that everyone, regardless of their race, ethnicity, socioeconomic status, gender identity, sexual orientation, or other factors, has the same chance to be healthy.
Health equity is not just about having access to quality healthcare. It is also about addressing non-medical factors like social determinants of health (SDOH), which are the conditions in which people are born, grow, live, work, and age. According to a report from the Department of Health and Human Services, “studies estimate that clinical care impacts only 20 percent of county-level variation in health outcomes, while social determinants of health (SDOH) affect as much as 50 percent.” That’s too big to ignore.
Social determinants of health can have a major impact on the population, and they can create unfair disparities in health outcomes. Because of that, things like affordable housing, quality education, jobs that pay a living wage, and access to healthcare and mental health services are all factors in achieving health equity.
Health Inequality Vs. Health Inequity
Health inequality and health inequity both describe differences in health between two groups of people. However, health inequity takes things a step further by describing the avoidable differences in health between two groups of people.
For instance, people in their twenties tend to enjoy better health than people in their eighties. This difference is an unavoidable fact of life, making it an example of health inequality. However, the fact that the infant mortality rate for black infants is nearly three times higher than it is for white infants can be attributed to a number of socio-economic factors, making it largely preventable. Differences in infant mortality rates among different racial groups is an example of health inequity.
Look at the image above. On the left side, each of the three people has been given the same box to stand on to see over the fence in front of them. The solutions they were offered are equal, but the outcome is not. Only two people can see over the fence, while the third cannot.
On the right side of the image, each person was given a different solution that took their needs into consideration. As a result, the outcome is the same for all three: Each person can now see over the fence. While the distribution of the resource was not equal at an individual level, it led to equality at a community level.
Health equality calls for equal treatment for all patients. Health equity prioritizes treatment and care based on need.
Addressing the Roadblocks to Health Equity
Health equity is a complex issue made up of many different components. To promote and sustain health equity, these are some of the components that need to be addressed:
Access to Quality Healthcare: Everyone should be able to access affordable, quality healthcare regardless of their income, race, ethnicity, or zip code.
Social Determinants of Health: As mentioned above, social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age. These factors can have a major impact on health, and they can create unfair disparities in health outcomes. (We will examine SDOH further in a future article.)
Eliminating Discrimination: Everyone should have the opportunity to live a healthy life, regardless of their race, ethnicity, gender identity, sexual orientation, or other factors. Discrimination can create unfair barriers to health.
Building a Culture of Health: A culture of health is one in which everyone is valued and supported in their efforts to be healthy. This includes creating environments which are conducive to health, such as safe neighborhoods with access to healthy food and recreation.
Meeting the Goal
Equality isn't enough. You cannot present the same opportunities and solutions to different groups of people and expect the results to be equal. There are other factors that impact the outcomes. And, as medical professionals, the equity of the results matters more than the equality of the solutions needed to produce them. When it comes to the health and wellbeing of a community, it's okay for the means to be different if the ends are the same.
Pharmacists and pharmacy technicians are trusted advisors that are deeply embedded in their communities and are uniquely positioned at the front lines of healthcare. In that position, they have an important opportunity — some would even say a responsibility — to create and uphold meaningful change in the lives of their patients. To achieve health equity, that means looking beyond a patient's medications and addressing the other factors affecting community health.
NEXT — Part 2: Addressing Health Disparities & Social Determinants of Health (SDOH) »