HEALTH EQUITY “Equity is Justice. Health Equity is Social Justice in Health.” *
Pursuing Health Equity means taking action to reduce Disparities in health of persons who are socially and economically disadvantaged.
A commitment to HEALTH EQUITY means accountability to:
– provide resources
– remove barriers, and
– dismantle systemic discrimination such as social, economic, and healthcare exclusion.
HEALTH DISPARITY is the preventible differences in the burden of disease and early death experienced by certain populations.
HEALTH DISPARITY was once considered to be primarily due to lack of access to healthcare but now increasingly recognized as due to changes in the Brain-Body from traumatic life experiences (including Everyday Discrimination) and from differences in care by healthcare providers.
Groups that have been demonstrated to experience HEALTH DISPARITY include racial, ethnic or religious groups; groups identified by sexual orientation or gender identity, immigrants and groups stigmatized for mental suffering or physical disability.
Photo: Equal Justice Initiative
* Paula Braveman (2014) What is Health Equity? Will a Life Course Approach take us Further Toward It? Matern Child Health.
Paolo Vineis et al (2020) Special Report: the Biology of Inequalities in Health: the Lifepath Consortium. Frontiers in Public Health. FREE Full Text
PREJUDICE is a preconceived opinion that is not based on reason or actual experience.
BIGOTRY is intolerance toward those who are different or who hold different opinions from oneself.
PREJUDICE, discrimination, or antagonism directed against someone of a different – based on the belief that one’s own group is superior. PREJUDICE based on:
– ethnic background or religion
– gender or sexual orientation
– ability or other quality
RACE is not a biological reality. RACE is a SOCIAL CONSTRUCT.
A SOCIAL CONSTRUCT is a “human invented” idea, concept or classification system*
However, even though “Race as Biology is Fiction, Racism as a Social Problem is Real.” **
* Ta-Nehisi Coates (2013) What We Mean When We Say ‘Race is a Social Construct’. The Atlantic.
EVERYDAY DISCRIMINATION is the scientific measurement of a person’s life experience of daily discrimination.
The EVERYDAY DISCRIMINATION scale was developed by David R Williams, PhD in 1997 and has been used in over 100 scientific research studies.
As described by Heather Hall, MD, the experience of DISCRIMINATION can result in a “double dose” of TRAUMA for excluded persons.
High rates of experience of EVERYDAY DISCRIMINATION have been shown to correlate with incidence of many serious diseases including hypertension, diabetes, heart disease, cancer and maternal mortality.
Photo: David Williams, PhD – Harvard Professor of Public Health
IMPLICIT BIAS is unconscious attitudes or stereotypes that affect our understanding, actions, and decisions.
IMPLICIT BIAS (favorable and unfavorable) is activated involuntarily, without awareness or intent.
Ohio State University: Understanding Implicit Bias
The concepts of HISTORICAL and STRUCTURAL RACISM and DISCRIMINATION are a recognition that the experience of DISCRIMINATION is not just an individual perception of inequity but public policies, institutional practices, cultural images and behaviors which are built into the structure of the dominant culture and which reinforce social inequity.
Examples include discrimination in:
– economic opportunity and employment
– the right to marry
as well as outright brutality such as
– separation of children from parents
– predatory policing and excessive incarceration
– abusive treatment of indigenous peoples including dispossession of land, desecration of sacred land, penalties for reading or speaking indigenous language
STRUCTURAL RACISM and STRUCTURAL HOMOPHOBIA-TRANSPHOBIA are major root causes of HEALTH DISPARITY
Paul Farmer et al (20 ) Structural Violence and Clinical Medicine. PLOS Medicine. FREE Full Text
JIM CROW is a symbol of racial segregation and prejudice.
JIM CROW Laws enforced racial segregation in 35 Southern US states from 1877 to the mid-1960’s.
These laws mandated segregation for blacks and whites in public schools, public places, and transportation plus prohibited intermarriage.
JIM CROW legal segregation ended after 1954 US Supreme Court decision Brown v Board of Ed, 1964 Civil Rights Act and 1965 Voting Rights Act – however de facto segregation still exists in America to this day.
The character called JIM CROW was a racist depiction of an African-American man performed in the 1830’s in blackface by a white traveling actor, named Thomas Rice.
Photo: National Library of Congress
For research about the HEALTH DISPARITY impact of JIM CROW SEGREGATION, see:
Krieger N et al, Jim Crow and Premature Mortality among the US Black and White Population, 1960-2009, Epidemiology 2014.
The study showed enduring impact of a two-fold excess mortality of Blacks even 50 years post-Jim Crow.
INTERSECTIONALITY is the complex and cumulative way that one person or group may experience multiple types of discrimination (such as race, gender, class).
The WEATHERING HYPOTHESIS is a proposed explanation of why multiple and severe experiences of discrimination lead to physiologic changes in Brain-Body leading to increased disease and early death. Similar to the concept of ALLOSTATIC LOAD.
See also Dr. Heather Hall’s concept of a “double dose” of adversity.
Geronimus AT (2006) “Weathering” and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the US. Am J Public Health. FREE Full Text