SPECIAL COMMUNICATIONS: Letters to the Editor-in-Chief
We appreciate receiving the letter from Dr. Nuzzo (1). His letter is consistent with the purpose of our paper (2), one of which is communication—raising awareness of the issue and magnitude of health inequities and conveying the power of physical activity in promoting health equity. We believe that the best way to address and reduce disparities in health-promoting behaviors, disease, and disability outcomes is through a dialogue and open discussion about health disparities, equity, and social determinants of health. This exchange is an initial opportunity to engage in a dialogue among members of the American College of Sports Medicine (ACSM) that we hope expands to a broader national dialogue in the United States and, if and where appropriate, in other countries as well.
On the point that equity is political, we agree. We chose to use this term because it is in fact policies set by local, state, and government entities that shape physical activity opportunities at the population level. Where community parks are built and maintained is determined by local officials. Whether or not a school district mandates physical education and recess is set by state legislatures and boards of education. Access to quality healthcare where patients can participate in the Exercise Is Medicine® initiative (3) is currently being influenced by the federal government. Just as the U.S. government recognizes its role in shaping physical activity and health of the American public (e.g., 2008 Physical Activity Guidelines for Americans , Step it Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities , and Healthy People 2020 ), so does ACSM. We are calling for equitable opportunities to enable all Americans to achieve the recommended levels of physical activity.
We disagree, however, on Dr. Nuzzo’s definition and operationalization of the term health equity. To define equity in terms of “good” and “bad” is an oversimplification of the issue. Moreover, how Dr. Nuzzo has described equity is a conflation of the terms equality (everyone receives the same resources) (7) and equity (when all people have “the opportunity to ‘attain their full health potential’ and no one is ‘disadvantaged from achieving this potential because of their social position or other socially determined circumstance’”) (8). Equity does not imply resources will be taken from one group and given to another but rather resources tailored to each community’s needs will be provided and community-specific barriers will be addressed. In the examples described by Dr. Nuzzo, those issues might be true when equality-based approaches are used to address disparities. That type of approach implies a reallocation of available resources, or provision of similar resources to everyone to increase physical activity, irrespective of baseline levels of physical activity. By contrast, equity-based approaches refer to providing different types of physical activity resources at multiple levels (individual, interpersonal, organizational, communities, and policies), at different time points across the life span (childhood, adolescence, midlife, and older adults) to increase and maintain physical activity participation in diverse communities. Using this approach, ACSM believes that achieving equity in physical activity participation is an attainable goal.
Rebecca E. Hasson
Schools of Kinesiology and Public Health
University of Michigan
Ann Arbor, MI
David R. Brown
Physical Activity and Health Branch
Division of Nutrition, Physical Activity and Obesity
Centers for Disease Control and Prevention
City College of New York
New York, NY
Department of Clinical Medicine
College of Medicine
University of Central Florida
Gramercy Research Group
Department of Exercise and Wellness
School of Nutrition and Health Promotion
Arizona State University
Indiana University Center for Aging Research
Regenstrief Institute, Inc.
1. Nuzzo JL. Equity in physical activity is a misguided goal. Med Sci Sports Exerc
2. Hasson RE, Brown DR, Dorn J, et al. Achieving equity in physical activity participation: ACSM experience and next steps. Med Sci Sports Exerc
3. Lobelo F, Stoutenberg M, Hutber A. The Exercise is Medicine Global Health Initiative: a 2014 update. Br J Sports Med
4. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans
. Washington (DC): U.S. Department of Health and Human Services; 2008.
6. U.S. Department of Health and Human Services. Healthy People 2020
7. Braveman P, Arkin E, Orleans T, Proctor D, Plough A. What Is Health Equity? And What Difference Does a Definition Make?
Princeton (NJ): Robert Wood Johnson Foundation; 2017.
8. Braveman PA. Monitoring equity in health and healthcare: a conceptual framework. J Health Popul Nutr