An Overview of Healthcare Equity

Healthcare equity refers to the opportunity for everyone to attain their highest level of health. It includes giving people the resources to improve their health and prevent illness, including access to quality care.

Disparities in health outcomes among people of color and other underserved groups have long been challenging. But now, with COVID-19 looming over communities across the country, this is a critical issue to address.

Social Determinants of Health

The social determinants of health are the underlying community-wide economic and physical conditions in which people are born, grow, live, work, and age. Unfortunately, these factors are not experienced equally by everyone and can persist across generations, driving health inequities.

Socioeconomic status is one of the essential nonmedical factors that influence a person’s health and is associated with many short-term and long-term adverse effects on health. This can include a person’s access to affordable housing, employment security, healthy food options, education, and transportation (source).

Governmental social policies also have an impact on how social determinants are affected. For example, how a municipal, provincial, or federal government decides to focus its regulatory legislation and funding can have different health impacts on individuals from various socioeconomic groups.

Healthcare systems are increasingly taking a lead role in addressing these social issues. They partner with communities, governments, and the private sector to address these issues. They are also changing how they provide services, incorporating community-based care delivery models and population health assessment.

Healthcare leaders are responsible for reducing health inequities and ensuring that all citizens access essential medical care. They are collaborating with communities to create sustainable healthcare systems that are accessible to all. In addition, they are working to develop a Culture of Health by making health a shared value; fostering cross-sector collaboration to improve well-being; creating healthier, more equitable communities; and strengthening the integration of community services with clinical health.

Disparities in Access to Care

Disparities in access to care are a significant factor contributing to health inequities. They are caused by racial and ethnic differences in socioeconomic status, access to resources, and geographic location that can be influenced by policies such as healthcare insurance coverage, immigration law, and environmental hazards.

Research finds that racial and ethnic disparities in health outcomes occur across many medical conditions. They can be linked to poverty, violence, and unsafe living conditions. They also may be influenced by environmental health hazards such as air pollution and water quality.

As a result, people of color and low-income individuals are more likely to be uninsured and experience barriers to health care. These inequities also can affect the quality of care these groups receive, exacerbating the underlying problems.

These inequities can seriously impact the health of communities and are also associated with high excess medical care costs and lost productivity. They also contribute to premature deaths.

While the Affordable Care Act and expansions of Medicaid and CHIP have significantly reduced these disparities, they remain substantial and lingering in many communities. Policymakers must consider broader trends, such as the impact of recent immigration law changes on uninsured families, to ensure that all Americans have access to health care.

Disparities in Quality of Care

Disparities in quality of care stem from a broad range of issues, including socioeconomic factors, access to healthcare services, and the quality of treatment. These differences can be addressed by healthcare policies, practices, and facilities that ensure equal treatment of all patients.

One of the most critical barriers to receiving high-quality care is cost. This is especially true for Black, Latinx/Hispanic, American Indian/Alaska Native (AIAN), Asian American, and Pacific Islander (AANHPI) individuals, who are more likely to experience high costs.

The AMA has been an active partner in addressing these disparities and has worked closely with medical societies, state medical societies, health systems, and policymakers to promote awareness of the issue. In 2004, the AMA established its Commission to End Health Care Disparities, bringing physicians from around the country to focus on these challenges.

Increasingly, studies have shown that racial and ethnic disparities in quality of care are linked to other social determinants of health and healthcare access. These include economic status, education, and social and environmental factors such as employment and housing.

Despite these factors, racial and ethnic minorities are less likely to receive routine health care than nonminority populations. This is a concern for the entire healthcare system because it affects outcomes. Therefore, it is essential to address these disparities. This includes implementing policies that make it easier for racial and ethnic minority groups to obtain insurance coverage and access healthcare services.

Disparities in Outcomes

Among the many social and economic factors contributing to health, systemic inequities also play an essential role. These inequities affect access to care and quality of care, with individuals of color and other vulnerable populations facing more significant risks than their white counterparts.

One example is asthma, which is significantly higher in Black and Latinx/Hispanic populations. This is partly because of these groups’ socioeconomic status and educational background. Still, it is also mainly due to differences in how individuals are treated in the U.S. In rural Appalachia, where asthma is common, rates are even higher than in other parts of the country (Exhibit 7).

Another example is chronic diseases like diabetes, which is much more prevalent in American Indian/Alaska Native populations. This is partly because of their geographic location in rural areas, but it is also a product of the social and economic conditions they face.

Overall, racial and ethnic disparities in health outcomes remain a significant challenge for Americans across all population sectors. These disparities stem from various social and economic factors rooted in racism.

The Affordable Care Act health coverage expansions have helped reduce the number of people without insurance. Still, the uninsured rate remains higher for racial and ethnic groups than for whites. Moreover, as policymakers have implemented the Trump administration’s actions to roll back coverage gains and reduce funding for outreach and enrollment, people of color and low-income individuals have been at increased risk of not being insured.