Much of the health policy debate in the US over the past 40 years has centered on access to health care, and particularly how individuals gain access to health care through health insurance. In recent years, however, health professionals have highlighted the role that factors other than health insurance play in determining how healthy individuals and communities are or how healthy they can become. There is a growing agreement that health “equality,” defined as a “level playing field” where everyone has the exact same access to health care, would still result in some individuals enjoying healthier lives than others—even if everyone started life with the same genetic characteristics.
Click here to learn more about how the graphic above became an iconic image of equity.
“Health equity” is the term that describes the conditions that would allow every person to have to the opportunity to be as healthy as possible. Rather than focusing on “equality” of access to care, health equity includes access to care, but goes far beyond that to include environmental, social, and economic factors that influence health. Achieving health equity means removing barriers to good health–not just providing equal access to treatment for poor health. In fact, providing health equality rather than health equity could perpetuate health disparities within a community.1
Check out the Robert Wood Johnson Foundation’s video on health equity versus health equality.
Achieving health equity results in the elimination of health disparities in the community. Health disparities are the gaps in burden for disease, injury, mortality, disability, and access to healthcare. These differences can be attributed to social, economic, or environmental disadvantages and “adversely affect groups of people who have experienced greater social or economic obstacles to health” because of their race, ethnicity, religion, sexual orientation, or “other characteristics historically linked to discrimination or exlusion.” 2 Individuals who fall into the population crippled by health disparities will face greater health risks and poorer health outcomes.
Health outcomes are impacted by the social determinants of health, which are the conditions and factors affecting an individual’s ability to achieve good health. 3 These conditions are part of the environment where individuals are born, work, play, and live their everyday lives. This can include both social determinants, such as quality of education or area of residence, and physical determinants, such as exposure to hazards and built infrastructure. 4
The Importance of Health Equity
Health is the foundation for how a person can live and enjoy their life to the fullest. Good health allows an individual to seek the opportunities that can contribute to a more satisfying life, such as having and maintaining a job, participating in leisure activities, being physically active, and building meaningful relationships. Rather than simply focusing on whether people can get treated when they are in ill-health,
Marginalized populations are especially vulnerable to the negative impacts of health inequity. These populations commonly find themselves in areas with concentrated poverty, low educational attainment, unsafe neighborhoods, food insecurity, unemployment, and poor access to affordable, high quality health services, and transportation. Failing to address these existing disparities could have detrimental affects not only on the overall health of the US, but to the workforce, economy, and future generations. 5
Health Equity and Health Disparities in Texas
The current population of Texas is nearly 30 million and is expected to exceed 40 million by 2050. 6 Part of this growing population will be an increase in the population of people of color – most notably the Hispanic population. 7 The overall health and well-being of this growing population will have a direct impact on the condition of both the economy and workforce in the state of Texas. Therefore, it is essential that policymakers, non-profits organizations, grassroots organizations, and people in the communities collaborate to tackle the existing health disparities.
How does Texas fare when compared to the rest of the country? For well over a decade, Texas has had the largest number of individuals with no health coverage. In 2018, at 17.7% – that is 5 million people – Texas had over double the 2018 national average of 8.5%. While this is an improvement from the 24% uninsured rates of 2010, this is still 3% higher than the 2nd most uninsured country in the US – Oklahoma at 14%. Additionally, for the last 30 years America’s Health Rankings partnered with the United Health Foundation has released a comprehensive report on the nation’s health on a state-by-state basis. In their 2018 report, they found that Texas ranked 37th out of the 50 states – a drop from 34th in 2017. Texas also remains one of only 14 states in the country who has chosen not to expand Medicaid. These numbers cannot and should not be ignored because of the damaging effects these disparities could have on the future overall well-being of the state.
A 2016 report released by the Episcopal Health Foundation, estimated the vast economic impact health disparities could have if they aren’t minimized. The report states that health disparities for “people of color in Texas cost families, employers, insurers, and governments an estimated $1.7 billion in excess medical care spending and $2.9 billion in lost productivity.” 8 If left unaddressed, by 2050 these numbers would almost double with a projected $3 billion in excess medical care spending and $5.5 billion in lost productivity. 9 Despite these staggering numbers, awareness of these issues remains a concern. Vice President and Director of the Texas Center for Health Disparities at the University of North Texas Health Science Center in Fort Worth, Jamboor K. Vishwanatha, PhD, noted that awareness – even for those who are directly affected – is low.
Keep the Conversation Going
Although the current state of health equity in Texas is not optimal, there is still time and opportunities to improve. In 2018, the CDC granted Texas over $3.5 million in funding to administer several programs: State Physical Activity and Nutrition Program (recipient is Texas Department of Health Services), High Obesity Program (recipient is Texas A&M), and Racial and Ethnic Approaches to Community Health program (REACH 2018; recipients are the City of San Antonio Metropolitan Health District and the American Heart Association). Other entities are working to tackle health disparities in Texas, including the Texas Health Institute, Dell Medical School, University of North Texas’ Center for Health Disparities, and other government agencies.
This a move in the right direction, but these programs alone will not reach all uninsured and vulnerable populations. Policymakers, community leaders, and every day citizens must continue to stay engaged and proactive. As Texans, it is absolutely vital for the future of the state that we raise awareness, contact your representatives to continue implementing initiatives to narrow health disparities, and encourage others in your community to get involved in the fight for health equity.
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- Josephine Gurch, “3 Things to Know: Health Equity,” Hogg Foundation for Mental Health (blog), August 20, 2018, https://hogg.utexas.edu/3-things-to-know-health-equity.
- “The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020,” Phase I Report: Recommendations for the Framework and Format of Health People 2020 (Healthy People 2020: Office of Disease Prevention and Health Promotion, October 28, 2008), https://www.healthypeople.gov/sites/default/files/PhaseI_0.pdf.
- “Disparities,” Healthy People 2020, n.d., https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities.
- “Social Determinants of Health,” Healthy People 2020, n.d., https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health.
- Baciu, Negussie, and Geller, Communities in Action: Pathways to Health Equity (National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice;Committee on Community-Based Solutions to Promote Health Equity in the United States: National Academic Press, 2017), https://www.ncbi.nlm.nih.gov/books/NBK425853/
- Ani Turner et al., “Economic Impacts of Health Disparities in Texas” (Episcopal Health Foundation, 2016), https://www.episcopalhealth.org/files/7314/8106/4634/Economic_Impact_Report_EHF_and_MHM_Logos_FINAL.pdf.
- Turner et al.
- Turner et al.
- Turner et al.