What is the difference between inequality and inequity in health

This problem is not exclusive to lower income countries. In Glasgow, United Kingdom, the life expectancy for men can vary by as much as Inequity can also lead to chronic stress , which affects both mental and physical health. For example, the Youth Risk Behavior Study — found that young people in the United States who are gay, lesbian, or bisexual experience higher levels of bullying and sexual violence than heterosexual people.

This has lead to an increase in rates of mental ill-health and suicide. Mental health conditions and feelings of being unsafe can make it more difficult for people to attend school or work and seek help for their symptoms. Learn more about the impact of heterosexism homophobia here. Bias, prejudice, and discrimination can lead to delays in diagnosis and treatment.

Certain groups may also have difficulty being believed or taken seriously by doctors. Some studies have found that women wait longer on average for medical care when they visit the emergency department than men. Women also experience significant delays in the treatment of many conditions, including bleeding disorders and lupus.

There is no medical reason for this. A lack of awareness about the differences in heart attack symptoms between men and women also leads to higher rates of misdiagnosis, which can be fatal.

Health inequity causes preventable deaths. There are many examples of this, but one of the clearest examples is the difference between infant health and mortality among Black and white babies born in the U. Black people are more likely than white people to have babies with a low birth weight. They are also more likely to experience the loss of a baby. This is not linked to any biological differences between races, and it is true regardless of socioeconomic background.

This demonstrates that the higher rate of infant mortality is not natural or inevitable. Learn more about racism in healthcare in the U. Health inequity is due to human-made systems and structures that privilege certain groups and underserve or actively oppress others.

This occurs through the unequal distribution of power and resources. For example, these structures include :. Health inequalities can be defined as differences in health status or in the distribution of health determinants between different population groups.

For example, differences in mobility between elderly people and younger populations, or differences in mortality rates between people from different social classes. It is important to distinguish between inequality in health and inequity. Some health inequalities are attributable to biological variations or free choice, and others are attributable to the external environment and conditions mainly outside the control of the individuals concerned. GHE Research Papers.

GHE Issues Briefs. Facebook Twitter Instagram Email. Inequity is a result of failure Inequity invokes moral outrage, it is unfair and indefensible, a result of human failure, giving rise to avoidable deaths and disease. There are several related web sites with many supporting papers. Measuring global health inequity , D. Although these habits can be changed in adulthood, they can be predictors of adult choices that themselves have health effects.

Cumulative effects: Health effects resulting from long-term exposure to conditions that affect health. Examples include prolonged exposure to environmental toxins or long-term poverty. When social mobility is low and socially marginalized groups have historically limited options about where to live, early life conditions may be especially powerful in explaining current health inequalities. For example, in societies that struggle with the intergenerational transfer of poverty, or have a long history of ghettoizing marginalized groups, it is likely that individuals currently exposed to socially patterned health risks were previously exposed to socially patterned health risks as well, see Fig.

Researchers should be aware that lagged exposures, even those as distant as parental occupation or childhood neighborhood, may be useful in explaining current health outcomes. Subject matter expertise in human development should inform studies or projects that explore prior life conditions to explain current health differences between groups.

Longitudinal data, in addition to allowing for the exploration of lagged or cumulative effects, are also crucial for understanding the direction of causal relationships driving associations between health and social conditions. For example, recent evidence suggests that neighborhood poverty may indeed increase health risks 58 , but that poor health may also systematically sort individuals into poorer neighborhoods Only longitudinal study designs can help to clarify whether and the extent to which challenging social conditions and poor health outcomes reinforce each other over time.

The impact of socioeconomic status on health across the life course. Source: Taken directly from Adler et al. Social epidemiologists apply the concepts presented above to help measure and understand health inequalities.

Several broad categories of explanations 3 , 54 , 60 , 61 are generally tested when trying to explain health differences across geographies and social groups but may also drive health differences across individuals in a population. One type of explanation points to material factors in the creation of health disparities.

Material factors include food, shelter, pollution, and other physical risks and resources that influence health outcomes. Measures of absolute resources, such as absolute income, are useful in testing the role of material deprivation in creating health differences, as are objective measures of physical health risk factors such as air quality. An unequal distribution of physical health risks and resources across geographies and social groups contributes to social inequalities in health via material pathways.

A second class of explanation points to psychosocial 62 factors as driving health inequalities and social group differences in health in particular. Psychosocial health impacts stem from feelings of social exclusion, discrimination, stress, low social support, and other psychological reactions to social experiences. Negative psychological states affect physical health by activating the biological stress response, which can lead to increased inflammation, elevated heart rates, and blood pressure, among other outcomes 63 , Measures of relative position, perceived versus objectively measured variables, and instruments that capture different experiences of stress are all useful in studies of psychosocial risk factors.

To the extent that certain social groups are systematically more likely to have stressful, demoralizing, and otherwise emotionally negative experiences, psychosocial factors can help explain health inequities. Behavioral differences are also commonly cited as contributing to health inequalities. For example, a behavioral explanation might attribute health inequalities to differences in eating habits, smoking prevalence, or cancer screening rates across social groups or across individuals in a population.

While health behaviors often do vary across groups, ecosocial 65 , 66 and social—ecological 67 frameworks prompt us to ask what upstream factors might be responsible for these variations. For example, if differences in smoking rates are caused by unequal educational opportunities, an inequitable distribution of psychosocial risk factors, and targeted marketing, attributing health disparities to behaviors may be of limited usefulness. A fourth type of explanation points to differences in biological health risk factors that are patterned across social groups or contexts 60 , 68 , or vary across individuals in a population.

Biomedical explanations can suffer the same weaknesses as behavioral explanations for social inequalities in health when they focus on the downstream effects of social context without acknowledging why levels of biological risk factors vary across populations. Genetic and gene-by-environment interactions explanations are also, in part, biomedical in their nature. This class of explanation may be more useful for understanding variations in health observed across individuals in a population where social group differences are not the focus of investigation.

Applying a life course perspective to the consideration of all four types of explanations while considering that factors from each category may be main exposures, mediators, or moderators creates useful complexity in thinking about how health inequalities arise.

This article has introduced definitions and concepts that may be combined and applied in a wide range of settings. Previous work on health inequalities has introduced critical concepts and explored defining questions 3 , evaluated relevant theories and considered resulting policy implications 4 , discussed measuring and monitoring disparities 5 , 7 , 69 , among other contributions.

Building on these and other valuable resources, this paper has sought to unite salient theories, concepts, and methods into a single article, and to highlight previously under-discussed aspects of disparities research, such as the distinctions between space and place.

When considering differences in health, it is important to determine whether inequalities were measured across individuals in a single population, or describe group-level differences. Group definitions will vary by historic and social context, and establishing meaningful groupings will be specific to those contexts. Social group health inequalities may be generated early or late in life by differences in access to material resources, social circumstances that generate stress, or health behaviors.

Understanding causal pathways linking social factors to health, as well as conditional health, can aid in intervention planning. Geographic health disparities are also common and often reflect unjust social structures. Differentiating the concepts of place and space can help uncover what generates geographic health differences. Even more difficult than executing well-designed studies of health inequalities is deciding what to study and how to use findings to narrow gaps between groups.

A central task is deciding when a health inequality is inequitable, and why. Setting a policy agenda around health inequities is also fraught with difficult questions and decisions, including whether it is better to reduce absolute or relative health differences between groups; whether to focus on improving health for the worst-off groups or for the largest groups; and how to set benchmarks for health outcomes for various groups.

For example, should we set the target life expectancy for black Americans to that of whites, or should we be aiming for both groups to live even longer? Are certain social groups or health outcomes more deserving of attention than others? If so, why? Do particularly unjust health differences deserve attention, or should we focus on health outcomes that are especially expensive or prevalent? What are the merits of investing resources into improving overall population health, and what are arguments for focusing on the elimination of health disparities instead?

There are no clear cut answers to any of these questions, though they are among the central factors shaping how health inequalities are studied and discussed. Criteria for prioritizing scarce resources may by economic, political, moral, or practical.

These and other factors must be weighed in crafting research and policy agendas to track and understand health inequalities. SVS provided overall supervision and critical edits. The authors have no conflicts of interest to report. Nothing in this manuscript is intended to represent the official policy or position of the US.

Environmental Protection Agency. National Center for Biotechnology Information , U. Journal List Glob Health Action v. Glob Health Action. Published online Jun Mariana C. Arcaya , 1 Alyssa L. Arcaya , 2 and S. Alyssa L. Author information Article notes Copyright and License information Disclaimer. Arcaya et al. This article has been cited by other articles in PMC.

Abstract Individuals from different backgrounds, social groups, and countries enjoy different levels of health. Keywords: health disparities, inequality, inequity, theory. Motivation for studying health inequalities Despite considerable attention to the problem of health inequalities since the s 8 , striking differences in health still exist among and within countries today 9.

Health inequalities versus health inequities The term health inequality generically refers to differences in the health of individuals or groups 3. Concepts for operationalizing the study of health inequality Group-level differences versus overall health distribution There are two main approaches to studying inequalities within and between populations.

Social group health inequalities: defining groups Health disparities along racial, ethnic, and socioeconomic lines are observed in both low- and high-income countries, and may be widening 9 , underscoring the importance of studying of group-level health differences.

Table 1 Indicators of socioeconomic position used in health research measured at the individual level. Education Usually used as categorical measuring the levels achieved; also as a continuous variable measuring the total number of years of education Income Indicator that, jointly with wealth, directly measures the material resources component of SEP.

Some cases may provide insight into the mechanism that explains the underlying association of SEP and a particular health outcome. However, they may be associated with the health outcome through independent mechanisms not related to their correlation with SEP.

Open in a separate window. Absolute versus relative social position The second, related question deals with whether absolute or relative 36 position matters for health. Geographic health inequalities: place versus space Geographic setting, not just social group, plays an important role in shaping health 45 — Tracking health inequalities over time Regardless of how researchers operationalize the study of health inequalities, they also must decide how to report observed differences.

Framework for understanding health inequalities Previous sections of this article dealt with practical issues of how health inequalities can be measured, including whether health differences are studied across individuals or groups, how inequalities may be measured across geographies and social groups, and how observed differences can be reported cross-sectionally and over time.

Causal pathways and conditional health effects When studying the relationship between an exposure, such as occupation, and an outcome, such as blood pressure, it often becomes clear that a third variable matters as well. Key Terms: Mediator: A variable that lies on the causal pathway between exposure and outcome, helping to explain the association between them.

Selection Selection is another fundamental concept for understanding health inequalities Context versus composition When selection may be a source of geographic health inequalities, researchers generally want to distinguish contextual from compositional effects Life course perspective The impact of geography and social group membership on health is not only powerful but also persistent.

Key Terms 56 : Life course perspective: A consideration of health inequalities that acknowledges that one's health status reflects both prior and contemporary conditions, including in utero and childhood effects.

Explaining health inequalities Social epidemiologists apply the concepts presented above to help measure and understand health inequalities. Conclusions This article has introduced definitions and concepts that may be combined and applied in a wide range of settings.

Conflict of interest and funding The authors have no conflicts of interest to report. References 1. Townsend P, Davidson N, editors. Harmondsworth, Middlesex: Penguin Books Ltd; Inequalities in health: black report; p. A glossary for health inequalities. J Epidemiol Community Health. What or who causes health inequalities: theories, evidence and implications? Health Policy.

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Bull World Health Organ. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. Critical reflection — health inequalities and social group differences: what should we measure? Braveman P, Tarimo E. Social inequalities in health within countries: not only an issue for affluent nations.

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