Health—the central focus of nursing practice and the key construct in the domain of nursing science—has been recognized by sages throughout human history as a special good that has intrinsic value to individuals and the groups they are part of as well as providing an instrumental resource for life (Anand, 2002). In good health, a sense of physical, emotional, social, and spiritual well-being is experienced, and valued activities of life can be pursued. In a just world, all people have an equitable opportunity for health. However, from practice and research, nurses, nursing scientists, and their colleagues know that the ideal of health equity is far from being met.
The World Health Organization referred to “equity in health” as differences in health that are unnecessary, avoidable, unfair, and unjust (World Health Organization Regional Office for Europe, 1985), so that:
Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and more pragmatically, that none should be disadvantaged from achieving this potential, if it can be avoided. Equity is therefore concerned with creating equal opportunities for health, and with bringing health differentials down to the lowest level possible. (Whitehead, 1992, pp. 433–444)
Often, there is no agreement on the inequalities that are unnecessary, avoidable, unfair and unjust, and inequitable. Therefore, equity in health should be related to the promotion of the actualization of optimal health for all (Mooney, 1987). This is especially important for the disadvantaged and underserved, which may, but not necessarily, bring health differences down to the lowest level possible.
Contributing factors of health inequities and health equity are often viewed in relationship to differences between social groups that have different levels of underlying social advantage or disadvantage, also referred to as “position within social hierarchies” (Yamin, 2009). Social position varies according to economic resources, power/control, and prestige or social standing. These are often reflected by characteristics such as average within-group income, accumulated wealth, education, and occupational status; rural versus urban residential location; and racial/ethnic, tribal, religious, or national identity. Groups defined by gender, sexual orientation or age also reflect underlying advantage or disadvantage.
Equity in health is also concerned with passing a value judgment on the equal or unequal health status of individuals, families, communities, or whole populations. The goal of promoting the actualization of optimal health for all, given their health potential, should always be the context for passing a value judgment.
How health equity is defined can have important implications when determining research approaches to investigate and measure activities and outcomes related to health equity. A fundamental appraisal of health equity can be viewed as a biological one. When there are variations in health status and there are no reasonable biological explanations, then equity is in question. Evidence-based inquiry can help to determine what other social, cultural, racial/ethnic, and environmental factors affect health status when health inequalities are inequitable and what interventions are effective and economical in mitigating inequities.
The ethical principle of distributive justice should serve as a guiding theme when conducting health equity research (Ruger, 2004). Health benefits and resources should be evaluated and measured for equal distribution among different individuals, communities, and populations. Effectiveness and efficiency of equal distribution can also be examined as an issue related to distributive justice and health equity.
Health equity research may also draw upon human rights concepts where pursuing health equity may mean removing obstacles for groups of people, such as the poor, disadvantaged, racial/ethnic groups, women, or persons who are not heterosexual. Historically, these are the people who have faced more obstacles to actualize their rights to optimal health (Braveman & Gruskin, 2003).
Social determinants of health can help to shape and guide directions for health equity research (Marmot & Allen, 2014). Health represents both physical and mental well-being—not just the absence of disease. Examining various influences, such as conditions in homes, neighborhoods, workplaces, and communities, can provide valuable information. In addition, the allocation of healthcare resources, actual receipt and utilization of services, their quality, and how they are financed should be evaluated. Technological advances and various advances in specific areas of science, such as epigenetics, should also be considered as impacting health equity. Evidence-based approaches should also apply to ongoing surveillance to assess the magnitude of the health gaps and how they change over time in relation to policies and conditions in all sectors that influence health (Anand, 2002). Mere surveillance of the health of the public is not enough or sufficient to reduce health inequities. Without monitoring the amount and size of health inequities between more and less advantaged individuals and groups change over time in relation to policies, resources, or services, there is a lack of accountability for the differential effects of policies on various vulnerable populations.
Because achieving health equity is a critical issue of our times, Nursing Research is initiating a new, ongoing series on health equity research. Papers will be reviewed as they are received—there is no submission deadline. Accepted papers will be published under a “Health Equity Research” banner.
Papers considered for the new ongoing series should report findings of original research across the scope of health equity. Topics include, but are not limited to, research implications of definitions, concepts, and measurement of health equity; cross-cultural and longitudinal validity of health equity indicators; using toolkits and other technical resources to support community capacity building; and models for describing, guiding, and testing progress toward health equity. Topics related to interventions are especially welcome, such as how to effectively build community capacity to implement, evaluate, and sustain programs and policies to promote health equity; how to reduce persistent, population-specific health inequities by using a health equity framework; design and testing culturally tailored interventions for high-risk communities; how to address social determinants of health in an intervention framework; and using culturally appropriate evaluation strategies for targeted interventions to establish best practices and support evidence-based approaches to achieve health equity. Findings from studies focused on research capacity building to facilitate integration of health equity into programs of research for beginning and seasoned investigators are welcome, as are papers reporting new methods for studying health equity. Individual, family, community, national, or global perspectives in biopsychosocial systems (health services, political, and economic) frameworks may be used.
Nurses and nursing scientists have longstanding commitment to health and resolving health disparities and ensuring health equity as the largest segment of the global health workforce—uniquely poised to take action to advance health equity for all. The series on health equity research is an opportunity to disseminate new findings at the forefront of science needed to advance this critical work. Consider submitting a manuscript about your health equity research, read papers in the series, and take informed action for health equity.
Anand S. ( 2002). The concern for equity in health. Journal of Epidemiology and Community Health
, 56, 485–487. doi:10.1136/jech.56.7.485
Braveman P., Gruskin S. ( 2003). Poverty, equity, human rights and health. Bulletin of the World Health Organization
, 81, 539–545. doi:10.1590/S0042-96862003000700013.
Marmot M., Allen J. J. ( 2014). Social determinants of health equity [Editorial]. American Journal of Public Health
, 104, S517–S519. doi:10.2105/AJPH.2014.302200
Mooney G. ( 1987). What does health equity mean? World Health Statistics Quarterly
, 40, 296–303
Ruger J. P. ( 2004). Health and social justice. Lancet
, 364, 1075–1080. doi:10.1016/S0140-6736(04)17064-5
Whitehead M. ( 1992). The concepts and principles of equity and health. International Journal of Health Services
, 22, 429–445. doi:10.2190/986L-LHQ6-2VTE-YRRN
Yamin A. E. ( 2009). Shades of dignity: Exploring the demands of equality in applying human rights frameworks to health. Health and Human Rights
, 11, 1–18.