Health Equity in Public Health: How Do You Measure Something That Is Not Universally Defined?
In order to achieve health equity, public health agencies need to address both social determinants of health and discriminatory practices.
In the last few years, public health agencies have increasingly emphasized the importance of achieving health equity for members of their communities. “Health equity” has become a buzzword in the field as many assert that they are working toward this goal. However, research has shown that there is a lack of a clear consensus on the standard method for measuring health equity, making it difficult to understand how effective these efforts actually are. And more than that, there isn’t even a universal definition for “health equity” itself. This begs the question: how can public health agencies accurately measure something that is not universally defined?
According to the Centers for Disease Control and Prevention (CDC), “Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health.” Presently, there are preventable differences in health outcomes that exist for individuals who belong to socially disadvantaged populations, such as minoritized racial/ethnic, gender, and disabled populations. These preventable differences are referred to as “health disparities.” The World Health Organization (WHO) states that “health equity is achieved when everyone can attain their full potential for health and well-being.”
One’s health status is greatly influenced by both determinants of health and by discriminatory practices. There are two categories of determinants of health: structural determinants of health–political and economic conditions that determine the distribution of resources and power– and social determinants of health–individual social and economic conditions. According to Healthy People 2030, social determinants of health can be grouped into 5 domains: 1) economic stability, 2) education access and quality, 3) healthcare access and quality, 4) neighborhood and built environment, and 5) social and community context. Discriminatory practices by individuals and organizations based on race/ethnicity, gender, and (dis)ability can create health inequities by depriving individuals of care or discouraging them from seeking it out. Discriminatory practices also directly affect structural determinants of health by informing the social and economic policies that influence the conditions in which people live, work, and play.
In order to achieve health equity, public health agencies need to address both social determinants of health and discriminatory practices. Public health agencies can play a central role in achieving health equity by working to recognize and eliminate inequities resulting from discrimination and injustices on the basis of race/ethnicity, gender, and (dis)ability. The CDC states that “acknowledging and addressing racism as a threat to public health” is a necessary action toward achieving health equity. Some public health departments, boards of health, and other public health entities have declared racism a public health crisis. Making this declaration is an essential first step to achieving racial health equity as it focuses on the system and structures that impact one’s health status and has the ability to guide significant and purposeful anti-racism policies and practices.
What is unclear in public health is how to measure health equity. This creates challenges in tracking the progress of these efforts by health departments. Without consensus on the definition of health equity or a standard method for measuring it, attempts at measurement become complex and challenging. A review of current research shows that most existing methods of measuring health equity use population-level data. For example, studies often use population-level data to examine differences in health outcomes between groups, like Black populations compared to White populations. This is problematic as it may mask disparities that exist within subgroups of a given population.
In order to reduce health disparities and achieve health equity, public health agencies need to first ensure that they are using similar language when discussing health equity. As scholars have suggested, public health agencies also need greater consensus around what outcomes need to be measured, like health disparities in addition to health outcomes. Then, they need to understand and address both social determinants of health and discriminatory practices that exist in their community and identify the most appropriate indicators for measuring their progress. Public health as a field can assist public health agencies in achieving health equity by creating clear and comprehensive definitions, measurements, and tools that are available to public health agencies that support them in advancing their health equity efforts.
- Skky Martin, PhD (c), MA, is a researcher at the Center for Public Health Systems. Her research interests include health disparities, social determinants of health, and the interrelationship between public health and medical education. She has experience in qualitative methods and analysis, writing surveys, and using STATA to create and analyze quantitative datasets. Ms. Martin holds a master’s degree in sociology and a Certificate in Public Health from Loyola University Chicago. She is a doctoral candidate at Loyola University of Chicago in sociology. Her dissertation specializes in medical sociology and health education, focusing on the ways in which patients, providers, and medical schools experience and conceptualize racial and ethnic disparities in maternal health.
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