What Is Health Equity, and Why Does It Matter?

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A nurse listens to a patient’s heart with a stethoscopeAs leaders in health care, insurance, and government know, health equity is a literal life-or-death issue. Perhaps nothing illustrates this better than the COVID-19 pandemic. When COVID-19 struck in 2020, the difference in outcomes among certain populations highlighted the disparities in access to health care in America. Black Americans’ risk of death due to the coronavirus was 1.7 times that of white Americans, and Native Americans’ was twice that of white Americans, according to the Centers for Disease Control and Prevention (CDC).

The need to eliminate disparities in health care access and health outcomes across all populations is more pressing than ever. Understanding what health equity is and why it matters is vital for those who are interested in a career in health care. Registered nurses who are interested in a health equity leadership role should consider earning a Doctor of Nursing Practice degree as a foundation for this rewarding career.

What Is Health Equity?

Health equity is the ability of all people to achieve optimal health, without regard to their race, gender, ethnicity, socioeconomic status, education level, geography, or any other factor. The concept of health equity recognizes that race and class bias, whether conscious or unconscious, can impact how medical professionals perceive patients, potentially causing them to provide inadequate health care services to certain populations.

To resolve a health equity problem, research must be done to understand its scope. Research data is then analyzed to support recommendations. For example, public agencies will look at the prevalence of disease in different communities as well as health care outcomes, infant mortality, longevity, and other factors to identify health disparities among those populations.

To address health inequities, health care leaders develop population health initiatives to identify and overcome barriers to care. The following are some examples of health inequities, the scope of each problem, and potential solutions.

Cancer

Cancer is the second leading cause of death after heart disease for all populations, according to the American Cancer Society. However, people of color and rural residents are less likely to have access to breast and colon cancer screenings, which can delay treatment and increase the risk of death. Black women, for example, are more likely to die of breast cancer than any other cancer, per American Cancer Society data.

Cancer screening programs, tobacco cessation education, and access to healthy food are among the health equity initiatives that can help reduce cancer in underserved populations. However, cancer is a complex problem. According to a study published in Preventive Medicine, researchers who examined more than 30 community programs found that these programs were effective at increasing cancer education and screening. However, only one program — the Delaware Cancer Consortium — was successful in eliminating cancer health disparities at the population level.

Mental Health

According to the National Alliance on Mental Illness (NAMI), 21% of adults and nearly 17% of youth in the U.S. experienced mental illness in 2020. However, nearly 36% of mixed-race or multiracial people, more than 18% of Latinos, and more than 47% of LGBTQ+ people experienced mental illness.

The stigma surrounding mental health treatment is prevalent in many communities, which can prevent sufferers from seeking treatment. Discussion of mental illness may be culturally taboo. Additionally, patients may not have insurance coverage or the financial resources to seek care. Some patients also avoid seeking help due to a lack of clinicians who are from their ethnic or cultural backgrounds.

Health equity programs focus on increasing access, decreasing stigma, and addressing the root causes of mental illness in underserved communities.

Chronic Disease

Chronic diseases such as cardiovascular disease and Type 2 diabetes are more prevalent among Black Americans, Alaska Natives, Asian Americans, Hispanics/Latinos, Native Americans, and Pacific Islanders, according to the CDC’s National Center for Chronic Disease Prevention and Health Promotion. Risk factors include genetics and family history, obesity, poverty, and lack of access to nutritional food.

Through its Racial and Ethnic Approaches to Community Health (REACH) program, the CDC provides grants to local health departments, tribal authorities, and other agencies to fund social programs to prevent and treat chronic diseases.

Examples of Health Care Disparities

Disparities in health care access and outcomes can have a significant impact on individuals’ health, wellness, and longevity — underscoring why health equity matters. These disparities stem from long-standing social inequities. These inequities have so much influence over health outcomes that they are known as social determinants of health (SDOH).

Social determinants of health encompass where a person lives, their income, what level of education they’ve achieved, and the health of the surrounding community. SDOH factors are often a greater predictor of health and wellness over a person’s life than medical treatments.

Examples of health disparities caused by health inequities and SDOH include:

Infant Mortality

The CDC defines infant mortality as the death of an infant before its first birthday. Some of the causes of infant mortality include birth defects, preterm birth and low birth weight, sudden infant death syndrome, injuries, and pregnancy complications.

The infant mortality rate varies by race. Statistics compiled by the CDC show that for Black infants, the mortality rate is 10.6 per 100,000 live births; for Native Hawaiian and Pacific Islander infants, it’s 8.2; for Native American infants, 7.9; for Hispanic infants, 5; for white infants, 4.5; and for Asian infants, 3.4.

Maternal Mortality

While modern pregnancy and childbirth have become safer over the centuries, they are still not risk-free. The CDC uses the World Health Organization’s definition of maternal death, which is the death of a woman while pregnant or within 42 days of giving birth or the termination of pregnancy.

In the U.S., the maternal mortality rate was nearly 24 maternal deaths per 100,000 live births in 2020, according to the CDC. For Black mothers, that figure rises to more than 55 maternal deaths per 100,000 live births.

Causes of high Black maternal death rates include lack of access to prenatal care, unconscious and conscious bias in health care, and chronic conditions such as hypertension, diabetes, and depression.

Life Expectancy

Life expectancy also varies by race and ethnicity. Between 2000 and 2019, life expectancy increased in the U.S., but disparities among different populations persisted, according to the National Institutes of Health. Life expectancy for Asian Americans was 85.7 years; for Latino Americans, 82.2 years; for white Americans, 78.9 years; for Black Americans, 75.3 years; and for Native Americans, 73.1 years.

The pandemic has lowered life expectancy across the board, and further exacerbated some of these disparities. Black men, for example, lost three years of life expectancy, compared to an overall drop of 1.8 years.

Health Equity and Health Care Outcomes

When industry experts examine health equity and why it matters, they often point to bias. Biases include racist, homophobic, and sexist beliefs about patients, which can lead to a lower quality of care. This diminished care contributes to iatrogenic harm — harm that patients suffer in the course of receiving care. The American Medical Association’s Journal of Ethics provides examples of iatrogenic harm, including undertreating Black patients for pain relief compared to white patients.

Government agencies at the local, state, and federal levels have funded research and developed programs aimed at reducing health disparities by increasing health equity. Health care leaders are also striving to eliminate bias in health care, starting with awareness and training.

Insurance companies are looking for ways to improve access to health care. Insurers such as Blue Cross Blue Shield and Highmark have partnered with community health programs to provide access to care; support food, housing, and education programs; and boost diversity and inclusion training in insurance sales.

Health industry experts encourage insurers to develop provider networks that strengthen connections with communities of color and include more preventive care benefits, such as better maternal care for pregnant mothers and medications that reduce the transmission of HIV in gay communities.

Health Equity and the Influence of the Nursing Profession

The nursing profession can take a leadership role in advancing health equity in underserved populations. Advanced practice nurses and Doctors of Nursing Practice (DNPs) have been trained in research and health data to develop programs that identify health disparities and use best practices to improve health equity. DNPs have training in evidence-based health care, in which data drives decision-making at the individual and population levels.

Some of the ways nurses can promote health equity include:

  • Integrating social care into health care. Nurses are trained to understand the social environments of their patients and their patient’s families and incorporate that knowledge into treatment, allowing them to adopt a more holistic approach to care. They can also identify programs such as telehealth and in-home care to support patients at home, improving access to care.
  • Taking a multidisciplinary approach. Nurses work with other clinicians and staff to provide insight into a patient’s needs instead of just focusing on their disease, which can improve patient outcomes.
  • Advocating for change. DNPs have the professional experience and education to advocate for social change to improve SDOH for their patients and communities.

Health Equity and Leadership in Nursing — The Change Starts Here

Advanced practice nurses are uniquely equipped to understand what health equity is and why it matters. These nursing professionals are at the forefront of initiatives to improve health care for all through practice and advocacy.

Excited about the chance to transform health care and achieve greater health equity? Explore the online BSN to DNP program at Regis College and start making a difference today.

Recommended Readings

What Kind of Nurse Should I Be? Examining Advanced Practice Nursing Paths

What Degree Does a Nurse Practitioner Need?

How Does Nursing Influence Health Care Policy?

Sources:

AHIP, Working to Advance Health Equity

AMA Journal of Ethics, “Clinicians’ Racial Biases as Pathways to Iatrogenic Harms for Black People”

American Cancer Society, “More Black Women Die from Breast Cancer Than Any Other Cancer”

American Public Health Association, COVID-19 and Equity

Centers for Disease Control and Prevention, Health Equity

Centers for Disease Control and Prevention, Infant Mortality

Centers for Disease Control and Prevention, Maternal Mortality Rates in the United States, 2020

Centers for Disease Control and Prevention, Promoting Health Equity

Centers for Disease Control and Prevention, Risk for COVID-19 Infection, Hospitalization, and Death by Race/Ethnicity

Centers for Disease Control and Prevention, Working Together to Reduce Black Maternal Mortality

Centers for Medicare and Medicaid Services, Health Equity

The Commonwealth Fund, “How Insurers Can Advance Health Equity Under the Affordable Care Act”

Healthline, “Access to Mental Healthcare Is Harder for Black Americans. Here’s Why”

National Academies Press, “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity”

National Alliance on Mental Illness, Mental Health by the Numbers

National Institutes of Health, “Life Expectancy in the U.S. Increased Between 2000-2019, but Widespread Gaps Among Racial and Ethnic Groups Exist”

Preventive Medicine, “Examining Aspects of Successful Community-Based Programs Promoting Cancer Screening Uptake to Reduce Cancer Health Disparity: A Systematic Review”

Reuters, “U.S. Life Expectancy Falls to Lowest Level in Almost 20 Years Due to COVID-19 — CDC”

The New England Journal of Medicine, “Tackling Implicit Bias in Health Care”