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02/21/13 – Making Sense of Health Differences, Disparities and Equity

by Jeanine Draut

Communications Officer, The Colorado Trust
Jeanine Draut, Communications Officer, The Colorado Trust
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A video of Dr. Paula Braveman's Health Equity talk is available

When is a difference in health status considered a health disparity, and what makes it a health equity issue? According to Paula Braveman, MD, a national expert on health equity and guest speaker at The Colorado Trust's January 31 learning lunch, the differences are important and not always easy to define.

There can be health differences that do not need our attention because they are unavoidable. Skiers are much more likely to become injured than those who don't ski, and young adults are healthier than the elderly.

There can also be health differences that may warrant attention, but are not "disparities" because they are not a result of injustice. If wealthy people in New York are suffering from a health problem at a greater rate than wealthy people in California, it might be a difference worth investigating but not a health disparity.

A health disparity is a difference that is fundamentally unjust and avoidable. It is unjust because it is connected to a social characteristic that has historically put a group at a disadvantage. No society can guarantee good health to all of its citizens because there are too many factors beyond its control. But a disparity is clear when income level, race or ethnicity has so strong an influence that it determines health outcomes despite individual differences among the people in the group.

What about the term "health equity"? These words signal the intent to move beyond decreasing differences and equalizing health outcomes, to linking these disparities with social and economic disadvantages. They are the words we use to recognize that solutions limited to clinical health care will be insufficient to address the underlying problems.

T.R. Reid, Dr. Paula Braveman and Dr. Ned CalongeWho determines what is unfair and avoidable? How do we know when a problem is likely caused by social determinants such as income, race, ethnicity, education or zip code? Braveman says that these answers are not always obvious. That is why we plan to continue the health equity conversation - to decide as a community what "health justice" in Colorado looks like and what it will take to get there.

The Affordable Care Act gives Colorado some resources to meet the needs of vulnerable Coloradans (see How the Affordable Care Act Can Help to Advance Racial and Ethnic Equity in Colorado for more information). But much is still left for us to decide. What does fairness in health mean to us? What are we willing to do about injustices in health? These questions are too important to be left to others to decide. We invite you to join the conversation as The Colorado Trust explores these important questions through lectures, discussion groups, issue briefs and fact sheets that will be part of our Health Equity Learning Series throughout the year.

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