Equality is not Equitable: An Important Distinction for Health Care

Mark Twain famously quipped the difference between the almost right word and the right word is “the difference between the lightning bug and the lightning.” This is an important lesson to remember during global health discussions which sometimes, incorrectly, interchange “equality” and “equity.” Let’s examine the two terms to understand their importance in planning and implementing global health programs.

Most of us are familiar with the concept of equality. In this system, everyone is treated the same and provided the same resources to succeed. But from a global health perspective, equality doesn’t always address the issue at hand. For example, a health clinic in a small village can be open to everyone. But some villagers may lack the means to get to the village, or may not be able to afford medication. In this scenario, equality of health services has still created an inequity of care.

The World Health Organization defines health equity as creating an environment in which everyone has equal opportunities to live a long and healthy life. Rather than providing equal resources for all, health equity solutions examine and try to remove the underlying causes of health disparities. In the example above, health care workers might provide mobile care to reach villagers who cannot come to the clinic. They might also dispense medication on a sliding scale of payment so poor patients can get the treatment they need.

According to a paper from the Journal of Epidemiology and Community Health, there are several principles to health equity that public policy should consider:

  • Equal opportunity to access health care for those with equal need.
  • Greater opportunity to access health care for those with greater need.
  • Equitable health outcomes — for example, infant mortality rates and life expectancy.

We can see these principles come into play in real world examples of global health programs. In 2015, the United Nations formally adopted the Sustainable Development Goals (SDGs) — an ambitious list of 17 aspirational global goals to reach by the year 2030. A total of 193 nations signed the agreement which includes specific targets in poverty, hunger, health, and education, among others. Health equity is a common theme woven through many of the goals. In fact, good health and well-being is one of the specific SDGs. But by simultaneously addressing challenges in clean water and sanitation, infrastructure, and gender equality, the U.N. is laying groundwork to ensure global health initiatives touch on the health equity principles above. Otherwise, its well-intentioned programs may not reach the people who most need them.

Much of the challenge stems from differing interpretations of the very terms we use. A 2010 CDC report discusses the four concepts of difference in health status rates: disparity, inequity, inequality and burden. The CDC lands on a similar definition of health equity as the WHO, explaining it as, “the fair distribution of health determinants, outcomes, and resources within and between segments of the population, regardless of social standing.” But the CDC concludes terminology continues to evolve, and is not always used consistently by researchers.

Without understanding disparities, we cannot create health equity and achieve the opportunity for all to access health resources. And for health care workers, the difference between finding the right solution and almost the right solution will be far more significant than Twain’s parable. Our global health is at stake.


Learn more about the differences between equity and equality from MPH@GW, George Washington University’s online mph program.