“Health disparities” and “health equity” have become increasingly familiar terms in public health, but rarely are they defined explicitly. Ambiguity in the definitions of these terms could lead to misdirection of resources. This article discusses the need for greater clarity about the concepts of health disparities and health equity, proposes definitions, and explains the rationale based on principles from the fields of ethics and human rights.
If you look up the word “disparity” in a dictionary, you will most likely find it defined simply as difference, variation, or, perhaps, inequality, without further specification. But when the term “health disparity” was coined in the United States around 1990, it was not meant to refer to all possible health differences among all possible groups of people. Rather, it was intended to denote a specific kind of difference, namely, worse health among socially disadvantaged people and, in particular, members of disadvantaged racial/ethnic groups and economically disadvantaged people within any racial/ethnic group. However, this specificity has generally not been made explicit. Until the release of Healthy People 2020 in 2010, federal agencies had officially defined health disparities in very general terms, as differences in health among different population groups, without further specification.1,2 This article argues for the need to be explicit about the meaning of health disparities and the related term “health equity,” and proposes definitions based on concepts from the fields of ethics and human rights.
WHY EXPLICIT DEFINITIONS ARE NEEDED
Not all health differences are health disparities. Examples of health differences that are not health disparities include worse health among the elderly compared with young adults, a higher rate of arm injuries among professional tennis players than in the general population, or, hypothetically, a higher rate of a particular disease among millionaires than non-millionaires. While these differences are unlikely to occupy prominent places in a public health agenda, there are many health differences that are important for a society to address but are not health disparities. For example, if the health of an entire population seemed to be getting worse over time, or if there were a serious disease outbreak in an affluent community not seen in less affluent communities, these health differences would merit attention, but for reasons other than relevance to health disparities or equity. None of these examples reflects what is at the heart of the concept of health disparities: concerns about social justice—that is, justice with respect to the treatment of more advantaged vs. less advantaged socioeconomic groups when it comes to health and health care.
Ambiguity about the meaning of health disparities and health equity could permit limited resources to be directed away from the intended purposes. For example, if these terms remain vaguely defined, socially and economically advantaged groups could co-opt the terms and advocate for resources to address their advantaged social group’s health needs.