CDE Appendix 1 Literature Review - Central East Local Health ...

The Culture, Diversity and Equity Project: Literature Review
PART 1
HEALTH EQUITY FRAMEWORKS & POLICIES
1.0 TOWARDS A DEFINITION OF HEALTH IN/EQUITY
1.1 Defining the Problem: Health Inequity, Inequality, Disparity
The academic and grey literature on health disparities contains numerous, competing, overlapping, yet distinct,
terms for its subject of study, variously termed health disparity, health inequality, health inequity and/or, positively
conceived, health parity, health equality, and/or health equity. A necessary starting point for this review is the
untangling of the different meanings and uses of these terms, not only for the sake of conceptual clarity but because
of the significant policy implications and consequences deriving from such varying definitions, as discussed in
subsequent sections.
While health inequity, health disparity and health inequality are sometimes used interchangeably in the literature,
each term tends to carry its own distinct set of implied meanings. Terminologies, and their distinct conceptual
orientations and connotations, tend to vary along national lines, reflecting differing national political/policy
contexts. Health disparity, for instance, is the term commonly used in the US literature, whereas in the UK and
European contexts health inequality is the more commonly used term.
All three terms appear in the Canadian literature, though there is a relatively more frequent and intentional use of the
term health in/equity and/or health disparity. While each of these terms have a national valence partially reflecting
differing national approaches, they are also used differently in different (e.g. academic vs. government) contexts,
which makes any such exercise in conceptual definition and clarification at best tentative and partial.
In a formative Discussion Paper entitled Reducing Health Disparities: Roles of the Health Sector, prepared by the
Health Disparities Task Group of the Federal/Provincial/Territorial Advisory Committee on Population Health and
Health Security for the Public Health Agency of Canada, health disparities is defined as “differences in health
status that occur among population groups defined by specific characteristics” (2004). The paper goes on
to define “the most useful characteristics [for] policy purposes”, in keeping with its population health approach, as
being “those consistently associated with the largest variations in health status”, which in Canada, it is argued, relate
to “socio-economic status (SES), Aboriginal identity, gender, and geographic location” (Health Disparities Task
Group 2004).
In the US context, there is a much greater focus on race/ethnicity and health care-specific issues, owing in part to the
greater significance and pronounced history of racial cleavages there, and the large numbers of persons without
health insurance (45 million in 2003). The Institute of Medicine’s landmark (2003) report, Unequal Treatment:
Confronting Racial and Ethnic Disparities in Healthcare, for instance focuses on healthcare disparities (in accord
with this US tendency), defining the latter as “differences in the quality of health care that are not due to accessrelated
factors or clinical needs” (Smedley et al., 2003). By screening out access-related factors attributable to
socioeconomic status, this definition and report foregrounds the significant contributing role of racial and ethnic
disparities attributable to cultural incompetence, bias, prejudice, and stereotyping in the US healthcare system as a
major explanation for healthcare disparities.
Exworthy et al. (2006) use the term health disparities in their (2006) article to refer, comprehensively, to “both
disparities in health care and inequalities of health status (unless there is a specific instance referring to inequalities
of health and health care).”
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