The “Cryptovortex” Millions Need for Better Health

Health equity is a matter of social justice.

Who had heard the phrase “bomb cyclone” before the great winter storm that pummeled the eastern United States in the first days of 2018? Out of the blue it seemed like it was everywhere, supplanting the “polar vortex” that became part of everyday lexicon a few years ago.

How about cryptocurrency or superbug?

Every so often a new word or phrase emerges that captures a moment. Typically, they have been around in limited use, perhaps by experts of insiders, but something happens to ignite awareness among a wider audience.

In my world, among global health thinkers and practitioners, we also have words or phrases that come into common use. Whereas we once talked mostly about combatting disease, today we more often talk about strengthening health systems.

Here is another phrase that has risen to the top of our lexicon: “health equity.” It is not a new term, but it is increasingly a key goal for the work we do. Health equity means that everyone, no matter their situation, has the opportunity to attain their highest level of health.

• Health equity is when no one lacks access to care based on race and ethnicity, gender, age, geographic location, socioeconomic status or other characteristic — when rural communities aren’t downgraded to a lower standard of care, for example.
• Health equity is when even those without insurance can access high-quality health care.
• Health equity is when life circumstances are taken into consideration — when a mother in the slums of India doesn’t have to spend a month’s wages on bus fare for “free” vaccinations for her child. The cost of free care, to her, is insurmountable.

Health equity is a matter of social justice. It says that we value all people and, when designing a health system, take into account the circumstances in which patients live, learn and work. It isn’t enough to ensure that my child and a child in rural Liberia receive the same slate of early childhood vaccines, for example, when the Liberian child may live without clean water and adequate nutrition.

This is a little nerdy, but bear with me: it is important to draw a distinction between health equity and health equality. Equality means everyone is treated the same. Equity recognizes this is not enough — disparities exist that leave too many behind. Equality is everyone having a health insurance card in their wallet; equity is ensuring those insurance plans cover essential services and come with affordable co-pays and deductibles. Equity drives us to think about underlying causes of poor health outcomes and work more systemically to address them.

That’s one of the reasons why at Americares we are increasingly focused on working alongside local health centers that serve communities affected by poverty and disaster. Local health staff are in and of these communities. A nurse who grew up with similar burdens will more likely understand the underlying causes of poor health among her patients, including the challenges of the local environment and society. That understanding, coupled with our resources, has the best chance at creating sustainable change.

In U.S. communities where we have been providing care to low-income, uninsured people for over 20 years, we know the many obstacles our patients face. Tight budgets. Long work hours. Differing levels of literacy. We’ve employed health coaches who know it is not enough to tell their patients with diabetes and high cholesterol to eat healthier and exercise more often — the coaches guide them through a personalized action plan. We know our patients will be more likely to shop for groceries differently and start a new exercise routine if they meet health coaches in a culturally sensitive environment and receive guidance in their first language.

That’s equity. And that should be our goal.