What is meant by the term “health equity” is far from obvious.
Particularly in research and policy, the impact of differences in the meaning of a term can be significant. Here’s six reasons why we need to keep our eye on the ball when it comes to the meaning of health equity--and concrete, practical ways you can dig into those differences in meaning.
The day this episode airs, I’ll be giving a keynote address at a health literacy conference, so I thought I could get into one of the topics I’ll be talking about: the meaning of the term Health Equity. It’s a big topic, but I’m going to try in the next 10 minutes to give you six reasons why we need to be concerned about what is meant by Health Equity, and then specific, concrete things you can do to help make sense of and start to take action on this crucial topic.
Let’s see how it goes!
Hi everybody, I’m Dr. Anne Marie Liebel and this is 10 Minutes To Better Patient Communication From Health Communication Partners an independent, Health Equity-focused communication and education consultancy.
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All right, so I think the programs and initiatives and research that address issues of Health Equity are essential. But having good intentions and hope and love in our hearts is necessary but insufficient to achieve Health Equity! We also need to be clear-headed and hard-nosed about this. And here is 6 reasons why. All right, I’m going to go kind of fast. Here we go!
#1. Health equity is almost trendy. According to pubmed, 6000 papers were published on Health Equity in 2020. And that is not all down to COVID. Yes 2020 was the highest number of Publications, but it was the highest number in an upward trend that has been going for more than a decade and picked up speed somewhere around 2014. I’m happy Health Equity has made it into more common use, but there’s a risk. We might all think we mean the same thing by it, but that’s not necessarily the case.
That brings me to #2. A 2020 paper by Adam Wildgen and Keith Denny in the journal Public Health ethics states that “Since 1984, the idea of health equity has proliferated throughout Public Health discourse,” so this trendiness is not necessarily new. But they go further and say that the term Health Equity has become an “empty signifier.” They explain: “Widespread invocation of Health Equity has been associated with a considerable emptying of its semantic and political content,” and in their article they explain why this is problematic an counterproductive. So I’m going to of course put the link in the show notes.
#3. The use of the same term can suggest the same meaning, and this can make it tough for us to realize when there are real and substantial differences. For this I’m going to lean on my mentor Susan Lytle and her longtime collaborator Marilyn Cochran-Smith who say “it is important to unmask the very real differences that exist among projects and initiatives that use the same language.” I think unmasking these differences is important for Health Equity for two reasons. One, we want to be able to align our work with folks who have similar or at least complementary notions of Health Equity. So we need to be clear about what is meant by it. We also want to be able to spot when the term Health Equity is being co-opted, maybe glossing over things, or being used in service of actions that are inequitable or that merely maintain inequality.
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All right, #4. Policy! There’s a lot of policy-making going on right now. I’ve written and podcasted about some of it–I’ll put links in the notes. This is exciting! But we still need to keep our eye on the ball. There’s all sorts of layers of policy activity going on. And it’s arguably even more important now to be vigilant about what counts as Health Equity at this busy policy time. For this, I’m going to turn to my late professor, Brian Street, who encourages us to think about “the ways in which the power to name and define is a crucial component of inequality. This is because,” Street says, “not only is it crucial to know the term if we’re to develop a policy that actually works, but also because the very act of naming and defining is already an act of power, not just a separate academic exercise.” And of course I’ll put links to that in the notes.
# 5. Research. Our most recent podcast episode was about research and I’m going back there now! Health equity of course can be the subject of research, people study inequalities usually. Health Equity can also be the rationale for some research. But for the reasons i’ve just mentioned, we need to think carefully about how Health Equity is defined in research. Going back to Brian Street, “from this perspective the term inequality is not simply a given, that we as moral as committed reformers need to respond to, but a construct that needs careful analysis and justification.”
# 6. Okay so in addition to Health Equity being an important construct, a concept, Health inequalities are real! They are real things in the world! There are health differences that are unnecessary and avoidable and unfair and unjust when we compare them to what is going on in the larger society, as Margaret Whitehead famously stated in 1991–and as we’ve observed across the globe during the pandemic. Now we’re not just studying Health inequalities to study them, to point at and go, “look at all those injustices!” This is about meaningful action research policy and practice.
So I’m arguing we’re gonna need to be uptight sticklers about the meaning of equity and Health Equity in anything we’re involved with, and any research that we lean on. How can you do this? I’m going to give you a few specific concrete things you can do right now.
First of all, please check out for yourself some of the literature on the meaning of Health Equity. Literally, if you go to Google Scholar and put in “Health Equity definition” or “Health Equity meaning,” it’s a significant knowledge base that goes back about twenty years. It’s substantial. So do yourself a favor and even just dip your toe into a couple pieces here or there, and see how different people are taking up this issue.
Right, once you’ve done that, once you’ve got some of the sense of the different ways of thinking about Health Equity, I’m going to ask you to read carefully anything you’re involved in–that includes any research that you lean on. And I’m going to suggest you read it in specific ways.
One is of course what’s the expressed definition of of Health Equity? Usually around that first paragraph writing gets thrown in there, so read that. But then also read it for the implied meanings of Health Equity. And those are going to be more subtle, and they’re usually sprinkled throughout an article, right? So you’ve got the expressed definition of Health Equity, and then what’s the implied definition of Health Equity. What do they have to do with each other?
And then I’ll ask you to take a further step and see: how is Health Equity–in this project or research, initiative, policy– how is it being operationalized? That is, what’s taken as an acceptable proxy or stand in for Equity? What’s supposed to be appropriate action? And think carefully about that! Look closely at the relationships between those explicit and implicit definitions of equity, and whatever they’re suggesting should be done about it.
So there you go! I got through all of them! And I want to thank my brother and audio producer Joe Liebel for helping get this episode together in time for my Keynote! This is 10 Minutes to Better Patient Communication from Health Communication Partners. I’m Dr. Anne Marie Liebel, thanks for listening!