Health Disparities: Equity vs Equality

By: Margaret O. Akinhanmi

“What does health disparity mean to you?” This was the first question asked by the instructor of the Mayo Clinic Center for Clinical and Translational Science (CCaTS) course, ‘What Every Researcher Needs to Know about Health Disparities’. Our instructor, Dr. Joy Balls-Berry, gave us a few minutes to answer this question. My answer was akin to the definition that most people think of when they hear the words ‘health disparity’. I simply stated that health disparity is defined as differences in healthcare treatment and access. The formal definition as stated by the Center for Disease Control (CDC) is as follows: “Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.” When one really breaks down this definition of health disparities, it can mainly be attributed to a certain group of individuals, particularly minority populations. Geographically secluded and underprivileged areas have high volumes of minorities. While violence and subsequent injury are not exclusive to these populations, they are seen to occur at greater rates here. The need for proper healthcare is therefore essential to these areas but access is limited because of low socioeconomic status, thus leading to the vicious cycle of the disparity of health and lower quality of care.

What sticks out to me in the formal definition of health disparities is that these are preventable differences. If it’s so preventable, why hasn’t it been eliminated yet? In my opinion as a student, the answer to this tough question is a combination of a long history of mistrust between minority populations and large medical institutions. The problem with lack of access is not only due to the inability to physically see a healthcare professional or financially afford it, but also an innate discomfort and lack of belonging in these large institutions. This issue is layered with the history of who was permitted to access medical institutions, while it also reflects those who could provide the best care when these institutions were being developed. History also tells us that the minority individuals that attempted to access any kind of care were often mistreated and/or under treated, leading to tragic events such as the Tuskegee Syphilis Experiments. The Tuskegee experiments are one of many examples that contribute to the uneasiness and mistrust that minority populations experience and exhibit today. Like any relationship, the trust must be rebuilt to look ahead to a brighter future of eliminating the disparities being faced by these communities.

Rebuilding this relationship begins with understanding these populations and their needs through researchers and engagement with the community members. Dr. Claire Pomeroy, President of The Lasker Foundation and expert researcher, stated during a talk at the Mayo Graduate School Symposium last year that it is the responsibility of researchers to be advocates for health disparities research. No matter the field of research, scientists should strive to include diverse individuals in their studies and grants to eliminate health disparities. In addition to inclusion, scientists must also strive to comprehend the needs of the community and involve these individuals from the beginning to the end of all research studies. This principle of research is called community engaged participatory based research. In this model, the researchers form relevant research questions and work alongside community members to address the specific needs of that community. Community members are involved from the genesis of the research objective to the point at which the results are disseminated through appropriate venues such as public meetings, radio, and peer-review journals.

While every researcher may not be called to exclusively conduct community engaged research studies, it is possible to be involved by simply being an advocate, as Dr. Pomeroy stated. During our graduate research, we can be advocates by maintaining the knowledge of how our work will eventually impact the community. As students at Mayo Clinic, we have the privilege of being able to see our work in action in the clinic. We should take advantage of this through occasional immersion in the clinic either through meeting with patients relevant to our research or discussing our work with physicians and its impact on their work. Additionally, engaging with the community (through volunteerism or social activities) outside of our research facilities will allow community members to put a human face to the large research/medical institution that can be intimidating to many. When researchers and healthcare professionals engage with the community that they work to help, bridges are built that allow certain minority populations to feel more comfortable accessing proper care. This will then positively impact recruitment efforts for important research studies to be conducted. It is equally valuable for students that are engaged in various other types of medical education (Medical School, School of Health Sciences, Nursing, and Continuing Education) to participate with patients, physicians, and community members as well. Cultivating relationships and reminding oneself of the positive effects of our work plays a crucial role the eventual elimination of health disparities.

While reducing health disparities is a positive step, complete elimination of it is the ultimate goal toward health equity for all. Truly eliminating disparities means achieving equity for all individuals regardless of race, religion, sexual orientation, or socioeconomic status. Equity is reached when patients receive the appropriate care necessary for their medical condition or situation. Equity distinctly differs from equality. Equality refers to applying the same solution to different cases, while equity examines each case carefully and applies the appropriate solution for each case. For example, in the illustration below, each person has an equal number of boxes in the ‘equality’ panel. However, an equal amount does not fit the needs of each person. The ‘equity’ panel shows appropriate distribution of the boxes to fit each person’s specific need. In this age of personalized medicine, true equity is becoming more possible. There are initiatives all over the U.S. taking action to make health more equitable. To join in these actions, we as researchers and future healthcare professionals must consistently immerse ourselves in underprivileged communities and surround ourselves with diverse populations. We will then be able to include these individuals in our studies to fully eliminate health disparities and work toward the goal of true equity for all.

Author Bio: Margaret is a third-year PhD student in the Clinical and Translational Science track at Mayo Clinic Graduate School of Biomedical Science. Her thesis work incorporates epidemiology and clinical genetics to tackle a health disparity in Bipolar Disorder. In her spare time, she enjoys spending time with friends and traveling to places that she has never been before. In the future, she hopes to be part of a research team whose goal is to eventually improve clinical outcomes and eliminate health disparities. With translational research being such an emerging field, she is eager to see where it will take research and medicine.

Acknowledgements:

Mayo Clinic

Center for Clinical and Translational Science (CCaTS)

Joy Balls-Berry, PhD, Office of Community Engaged Research

Claire Pomeroy, MD, Lasker Foundation