Health Inequity vs Health Inequality - what's the difference and why does it matter?

Good health and wellness are not enjoyed equally by all individuals. However achieving equity in health and wellness is a key challenge for health leaders globally. Policy makers, health systems and clinicians are striving to improve their population’s overall health and reduce observed differences in health between different geographies, communities, demographics and ethnicities.

What does health equity and health equality actually mean? Despite sounding similar, there are fundamental differences between the two terms.

Health Inequality is used to describe observed differences in the health or wellbeing between different individuals or groups. An example would be the higher incidence in a disease observed in one group than in another, assuming the disease is randomly distributed across the whole population. It does not impart moral judgement and assumes differences observed are more likely attributable to biological differences or life choices. By way of an example that illustrates health inequalities; women in their thirties enjoy better overall health, then women in their seventies do.

Health Inequity however, are differences that are viewed as avoidable, unfair, often stemming from structural barriers and injustice. The National Institute of Health defines health inequity as “differences in the incidence, prevalence, mortality, burden of diseases and other adverse health conditions that exist among specific population groups” differentiated by factors such as age, ethnicity, gender and socio-economic. A widespread view is that when observed health differences are preventable and unnecessary, allowing them to persist is unjust. Most observed health differences across social groups, class and ethnicity for example, are commonly viewed as unjust because they reflect a distribution that is unfair.

Differences observed therefore reflect more an individual’s lifetime experiences and environment, such as access to safe housing and jobs, educational opportunities, affordable and accessible health care, and the social bases of self- respect. WHO’s Commission on the Social Determinants of Health described the pathways of causation through which health inequities are created and influence an individual or population’s health and wellbeing. Structural determinants, government policies for example, influence factors, such as income, education, class, ethnicity, housing, employment, and access to services, which in turn influences health and wellbeing. This results in inequities in the health experienced across a population.

To use an example to illustrate health inequities. In the US, infant mortality rates are nearly three times higher in blacks versus white individuals which could to some degree be attributable to preventable differences in access to healthcare, high quality prenatal care and lifetime education.

Muddying the waters, are the differences in opinions in the role of personal choice, free will and an individual’s responsibility for self-care. If I choose to smoke and get lung cancer is that contributing to inequities or inequalities? Does this viewpoint change if I grow up in a culture where all around me smoke and I’m not educated to understand the risks?

What are your thoughts? Please share them in the comments!

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