By Cori McMahon, Psy.D, NCCE, Vice President for Clinical Services
American women often talk about gender gaps. Understandably, we want equal pay for equal work and equal opportunity for all. However, our healthcare needs are distinctly different than men’s healthcare needs, making equality a much more difficult challenge to address. When it comes to our health and well-being, we need equity rather than equality.
According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death (21.8 percent) for women in the United States, with cancer coming in a close second (20.7 percent). In addition, each year about 700 women die during pregnancy or in the year following, and another 50,000 women each year experience severe pregnancy complications that can cause serious consequences for a woman’s health.
Despite overall improvements in health in the last century, black women continue to experience excess mortality in comparison to other U.S. women, including shorter life expectancies and higher rates of maternal mortality. They also show a disproportionate burden of chronic conditions such as anemia, cardiovascular disease, and obesity.
Any comprehensive population health strategy must include some context around women and women of color in order to get the full picture. By not segmenting these groups and examining their unique needs, stakeholders miss the opportunity to realize significant gains in health in the community.
Health equality vs. health equity
Often mistakenly used interchangeably, the concepts of equality and equity are not the same. They are, however, inextricably linked.
The Equality and Human Rights Commission defines equality as the distribution of the same resources and opportunities to every individual across a population. Equity, on the other hand, is defined by the World Health Organization (WHO) as the customized distribution of resources and opportunities across a population to ensure no subset of groups are at a particular disadvantage over others in achieving their maximum potential. More specifically, WHO defines health equity as the absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other stratifiers (e.g. gender, ethnicity, disability, or sexual orientation).
In other words, health is a fundamental human right. Health equity is achieved when everyone can attain their full potential for health and well-being.
Women experience health barriers
What is it that causes inequities in health in general and in engagement with the healthcare system? This must be understood in order for improvements to be made in the way that healthcare is designed and delivered.
In developed and developing countries, women are more likely to report poorer health than men. An analysis of World Health Survey Data showed that adult women reported themselves as less healthy than men across all age groups, and internationally, the evidence shows that social, cultural, economic, and biological factors all impact negatively and more substantially on the health of women compared with men.
As stated in an article in the International Journal for Equity in Health, at a population level, in most countries of the world, women have more limited access to resources. They also have less control over their bodies and lives than men. And this contributes to women suffering more negative health consequences by comparison.
According to the American Hospital Association, as healthcare delivery transformation moves toward a population health model that incentivizes keeping people healthy, health systems are recognizing the significance of addressing social determinants of health. Research has shown that only 20 percent of health can be attributed to medical care, while social and economic factors account for 40 percent. Therefore, in order to improve the health of the communities they serve, healthcare systems must also address the behavioral, socio-economic, and environmental factors that contribute to health.
Various healthcare systems nationally are thinking outside the box and taking steps to address social determinants of health in order to try to improve overall health. They realize that basic needs, like stable housing and access to healthy food, must be met, in order for overall health to be achieved.
For example, Kaiser Permanente has launched various initiatives to improve health outcomes by creating stable housing for vulnerable populations. “We know that differences in health are striking in communities with poor social determinants of health such as unstable housing, low income and unsafe neighborhoods,” said Richard Isaacs, MD, CEO and executive director of the Permanente Medical Group.
Internationally, there are calls for collaboration between public policy and healthcare systems in order to make an impact on women’s health. Gender inequalities and other social and economic determinants of health must be addressed in order for any improvement to be appreciated in the health of women.
As our delivery system becomes ever more proficient at analyzing and acting on data, the actions we take must be viewed through the lens of caring for patients as individual human beings with unique needs. Equality and equity efforts must be applied in a thoughtful way that takes into account the place from which each individual person is addressing their health today as well as where they want to be tomorrow.