Seeking heath equity means striving to give everyone a fair opportunity to be as healthy as possible by working to eliminate health disparities and determinants that adversely affect certain groups. An alternative framework is to define health equity by quality of outcomes. Numerous family medicine organizations have argued that health equity is central to the practice of medicine, adding convenience, cultural humility, structural competency, community engagement, and collaboration to the core tenets of primary care. Many family medicine educators have embraced a focus on health equity within practices as foundational to training future physicians. Aspects of the health care system that perpetuate inequity include fee-for-service payment models (which create untenable expenses for patients and pressure on clinicians to increase volume) and capitation models (which can lead to the underprovision of care for patients). Practicing care that is trauma- and violence-informed, culturally safe, and contextually tailored predicts better outcomes for patients and can help reduce moral injury for the clinician. Family physicians are uniquely positioned to work with patients, communities, and partners to create a more equitable health care system.
Case 4. You joined a rural community health center after finishing your family medicine residency 6 months ago. Although you are committed to health equity, being new to the practice has made it difficult to do anything outside of office-based patient care. The regional medical school reaches out and asks you to become a rural preceptor for medical students who must complete a community project during their time with your practice. At a recent community event, you learn that many refugee families are settling in the area, but you have not seen any of these patients at your practice. You suggest that the medical students’ community project involve understanding what refuge families are doing for health care.
Health Equity Theory
Health equity is a term used widely and in various contexts, including at nonprofit and for-profit organizations in health care and beyond. In medical literature, the term is frequently used but rarely defined, leading to confusion or misunderstanding.1
One definition of health equity is that “everyone has a fair and just opportunity to be as healthy as possible… For the purposes of measurement, health equity means reducing and ultimately eliminating disparities in health and its determinants that adversely affect excluded or marginalized groups.”2 Under this definition, working toward health equity requires addressing barriers (eg, discrimination, powerlessness, poverty) and the resultant challenges (eg, safe living and working conditions, high-quality education, good employment, access to housing and health care). Healthy People 2030 defines health equity in terms of equality in health outcomes as “…the attainment of the highest level of health for all people” and states that “Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”3 These definitions are steeped in medical ethics, and they most closely align with the ethical principle of justice. Distributive justice, more specifically, relates to fair distribution of health care resources to each person according to need.4
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