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If health care is a right, then it is unfair that some people can pay for care while others cannot. Moreover, as discussed in Chapter 2, regressive methods of financing health services that place a disproportionate burden on lower-income populations are an “unhealthy” way of funding health care. But affordability is only one factor that determines whether people have adequate access to health care. Health care, in turn, is but one element among many that shape people’s actual health. This chapter begins by defining the concepts of health equity and health care equity, and then reviews factors that influence equity. Because race is such a powerful factor associated with health inequities in the United States, the chapter discusses the concept of race as a social construct and how racism and other forms of oppression produce inequities.
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EQUITY: CONCEPTS AND DEFINITIONS
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The World Health Organization (WHO) defines health equity as “the absence of avoidable, unfair, or remediable differences [in health status] among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification (WHO, 2023).” The WHO emphasizes that “everyone should have a fair opportunity to attain their full health potential.” Health care equity refers more specifically to equitable access to and quality of health care services. Stated another way, health care equity means that everyone is able to receive the health care they need to be as healthy as possible. Equity is not the same as equality. To achieve health equity, a person with greater health care needs requires not the same level of care as someone with less need, but a greater level of care.
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Achieving health care equity is important for advancing the goal of health equity. But health care is not the dominant factor influencing the overall health of a population. Of the four categories of modifiable health determinants, clinical care is generally considered to contribute about 20% (Fig. 5–1). Achieving health equity requires also addressing social and environmental factors—often referred to as the “social determinants of health.”
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RACE, RACISM, AND HEALTH
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Individuals from marginalized racial groups in the United States experience inequities in both health care and health. Black and Latino individuals are much less likely to have a regular source of medical care than ...