Equity is defined as the quality of being fair, unbiased, and just. In other words, equity involves ensuring that everyone has access to the resources, opportunities, power and responsibility they need to reach their full, healthy potential as well as making changes so that unfair differences may be understood and addressed.
It might be helpful to think about equity as a door. A door that is closed can be intimidating. It prevents us from entering, being included, and enjoying opportunities and experiences that might be behind the door. In contrast, a door that is open is inviting. It welcomes us to enter, to join in, and to encounter possibilities that were not available to us on the other side of a closed door. Like an open door, equity is about providing a welcome invitation and making sure that the door stays unlocked and open for everyone.
At the same time, it is important to appreciate that equity is not about creating or opening a single door. Different women and men may need to go through different doors to get what they need to be healthy. Consider two senior women, who both live in the country and need regular access to health care for a chronic condition, such as arthritis or diabetes. Because there is a doctor in a nearby town and the roads are usually in good condition, we might think that access to health care is not a concern for either woman – until we look more closely at their lives.
|Woman #1||Woman #2|
These women face different barriers to health and care and consequently need different solutions.
When thinking about equity, we need to consider how opportunities and barriers are influenced not only by personal circumstances and within households, but also by systems, policies and societies. These women not only face personal barriers to care, such as not having ready access to a car, but they also experience systemic barriers, such as the lack of public transit in rural settings and the limitations of respite care programs.
In a country such as Canada, where we have publicly-funded health care, it might be easy to assume that the doors are open to everyone. But as we saw in the modules on sex, gender and diversity, there is a great deal of variation in the health status of people living in Canada. Some sub-populations, such as Aboriginal people and people living in poverty, are significantly less healthy, on average, than the population as a whole.
Sometimes the likelihood of developing an illness cannot be changed, as when someone is exposed to a germ or has a family history of breast cancer. But often the risk of ill health can be reduced or even eliminated by addressing factors that are open to change, such as where and how people live, work and play. For example, one person with a cold might get better quickly while another person with the same cold develops pneumonia. The difference itself may not be caused by inequity. But if some people recover from a cold because they can afford medicine as well as time off work, while others develop pneumonia because they will lose their jobs if they take time off, or because they cannot afford medicines, the difference is unfair and unjust. When we fail to address factors that can be changed, we may be creating and/or perpetuating inequity.
The Pan American Health Organization has nicely summed up the meaning of equity:
“Achieving health equity requires that women and men, girls and boys have fair opportunities and access to conditions and services that will help them achieve optimal health. Equity in health demands that we care about the range of human experiences and work towards making health care and policies responsive to all people, by paying attention to their diverse identities as people, and by paying attention to the diversity in their daily lives.”