THEORY AND METHODS

Defining equity in health

P Braveman¹, S Gruskin²

¹ Department of Family and Community Medicine, University of California, San Francisco, USA
² International Health and Human Rights Program, Francois Xavier Bagnoud Center for Health and Human Rights, Harvard University School of Public Health, USA

Correspondence to:
Correspondence to:
Dr P Braveman, Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU-3E, San Francisco, California, 94143-0900, USA;
pbrave{at}itsa.ucsf.edu

Study objective: To propose a definition of health equity to guide operationalisation and measurement, and to discuss the practical importance of clarity in defining this concept.

Design: Conceptual discussion.

Setting, Patients/Participants, and Main results: not applicable.

Conclusions: For the purposes of measurement and operationalisation, equity in health is the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage—that is, wealth, power, or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage. Equity is an ethical principle; it also is consonant with and closely related to human rights principles. The proposed definition of equity supports operationalisation of the right to the highest attainable standard of health as indicated by the health status of the most socially advantaged group. Assessing health equity requires comparing health and its social determinants between more and less advantaged social groups. These comparisons are essential to assess whether national and international policies are leading toward or away from greater social justice in health.

Keywords: equity

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