Health Disparities & Health Equity

Definitions and Core Concepts

Understanding health disparities and health equity is essential for promoting personal and public health. These concepts are foundational to social justice and health promotion efforts in nursing and allied health professions.

• Health Disparities: Gaps in the quality of health and health care among population groups, often paralleling differences in socioeconomic status, race/ethnicity, economic status, and education level. Disparities are observed both between and within countries.

• Health Equity: The attainment of the highest level of health for all people, emphasizing social justice in health. Health equity seeks to eliminate unfair systems and policies that cause health inequalities.

• Social Determinants of Health (SDOH): The conditions in which people are born, grow, live, work, and age, including factors like socioeconomic status, education, neighborhood, and access to health care.

Social Justice and Health Promotion

Principles of Social Justice

Social justice in health refers to the fair distribution of society’s benefits, responsibilities, and consequences. It is based on equality, equity, solidarity, human rights, and the recognition of human dignity.

• Equality: Everyone receives the same resources or opportunities.

• Equity: Resources are distributed based on the needs of individuals or groups to achieve fair outcomes.

• Inclusion: Ensuring all individuals, regardless of background, are fully included in society and have access to opportunities.

Social Justice in Nursing

Nursing as a discipline is committed to justice in health care, with a focus on active engagement in social justice issues. The Canadian Nurses Association (CNA) Code of Ethics emphasizes promoting social justice and addressing social determinants of health.

• Guiding Principles:

  • Respect for social justice and consideration of SDOH

  • Advocacy for rights and freedom from oppression, exclusion, racism, and discrimination

  • Stewardship of the environment as a determinant of health

  • Safeguarding health during disasters and public health emergencies

Major Issues Affecting Health Equity

Socioeconomic Issues and Social Safety Nets

Socioeconomic status, social support, access to health services, child care, economic security, gender, and food security are all critical determinants of health. Social safety nets, such as government programs and community resources, are essential for reducing health inequalities but are at risk of erosion.

Access to Health Services

Inequities in health service access are influenced by factors such as income, education, and geographic location (rural vs. urban). Prenatal and child care access are particularly affected by these disparities.

• Barriers include inability to pay for food, shelter, and proper care.

Impact of Poverty

Poverty is a significant determinant of health, especially for children. It leads to both short- and long-term physical, mental, emotional, economic, and social harms. Marginalized groups face higher rates of poverty and associated health risks.

• High use of food banks

• Increased risk of conduct disorders, emotional problems, and school dropout

• Higher infant mortality among poor, isolated, and Indigenous populations

Gender and Intersectionality

Gender influences access to resources and interacts with other determinants of health, creating unique experiences for cis-women, cis-men, and gender-diverse individuals. Intersectionality recognizes that overlapping identities (race, sexual orientation, age, class, disability) compound disadvantage and affect health outcomes.

Food Security

Definition and Importance

Food security exists when all people, at all times, have access to sufficient, safe, healthy, and culturally appropriate food. It is a key component of health promotion and is influenced by economic, social, and environmental factors.

• Food must be affordable, safe, healthy, and obtained in a dignified manner.

• Food insecurity arises when food is inaccessible due to lack of resources, distance, or environmental issues.

Food Security Initiatives

Strategies to improve food security include community kitchens, gardens, food cooperatives, and participatory action research. Nurses play a vital role in developing and implementing these initiatives.

Sustainable Development Goals (SDGs)

Overview and Relevance to Health

The United Nations Sustainable Development Goals (SDGs) are 17 global goals aimed at eradicating poverty, protecting the planet, and ensuring prosperity for all by 2030. SDG 3 focuses on ensuring healthy lives and promoting well-being for all ages, including reducing maternal mortality.

• SDG 3.1: Reduce global maternal mortality ratio to less than 70 per 100,000 live births by 2030.

• Maternal mortality is higher among women who are marginalized, poorly educated, or face gender discrimination.

Health Promotion Interventions

Strategies for Advancing Health Equity

Health professionals can promote health equity by advocating for healthy public policy, participating in public awareness campaigns, and promoting intersectional approaches in health policy and program planning.

• Lobby government representatives for policy change and SDG commitments

• Promote equity considerations in all health initiatives

• Engage in community-based participatory research and action