EQUITY IN HEALTH AND SOCIAL CARE

Written 21.09.2020

This article was ghost-written for a client to be included in a series of informative pieces on health and social care standards in the UK. 

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​​What is "equity" in health and social care?

By definition, equity is something that is considered to be fair, just, and impartial. For a health and social care system to have equity, there must be an absence of avoidable differences between social, economical, racial, or geographical groups. Health is considered to be a fundamental human right, and therefore should be offered to everyone, with no inequities in health status that would deny people from having the opportunity for quality of life.

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Why is "equity" important in health and social care?

Health and social care inequity is one of the biggest global concerns - many developing and low to medium income countries lack the resources to provide the adequate standards of care. Cost-effective solutions (such as vaccines) are often underprovided and not correctly implemented as they should be. The infrastructure of a country can also affect equity - in countries where travel over long distances is less available, accessibility is limited. For example, in rural Botswana (further north in the country), people may have to travel for an entire day to access medical care in one of their major cities, usually their capital, Gaborone, which is in the south. People who have been consistently deprived of certain aspects of health and social care due to inequalities in wealth, power, and prestige, will be significantly disadvantaged by inequities.


If health and social care inequities are left unapproached and undealt with, there are many issues that will plague the system and directly affect those who are cared for under it. This consequently means that the health or social care system is not achieving its purpose of taking care of the population relying on it. For example, a system which has a strong sense of inequity may deal with issues in biases from clinicians, directed towards those that impede their ability to offer effective care. Over time, these biases become institutionalised. A clinician may show a bias against individuals with certain mental health conditions. Over time this will become institutionalised, leading to those with severe mental health conditions being disadvantaged, and the system becoming inequitable. This often starts a difficult cycle, with patients conditions worsening, and the system becoming increasingly unable to take care of them.


It is vital to ensure that these cycles do not begin. Equity should be at the forefront of health and social care from the start.


How do you ensure "equity" in health and social care?

Due to the many uncontrollable factors that influence your health, such as genetics, it is impossible to achieve complete equity in health and social care - you can never provide the same outcome for everyone, and not everyone will require the same levels of health and social care. However, there are different models of equity that can help systems decide how best to tackle equity in their circumstances.


Equity can be viewed as vertical or horizontal. Vertical equity is where people may be treated unequally if they have unequal needs. For example, if certain individuals have a greater need, ability to benefit, deservingness or autonomy, they qualify for having a greater amount of care. Horizontal equity is where equals are treated equally. Priority is set for those who need greater care, but it is recognised that not all moral decisions will be satisfactory for everyone. The goal is consistency and consensus.


To be able to ensure equity in health and social care, equity must be made a strategic priority. Health and social care leaders need to build a clear vision for a fair and just system and have the drive to act upon this vision. Resources need to be dedicated to the management of equitable systems to ensure that after they have been established, they are maintained. Pre-existing health and social care disparities also need to be identified for improvement and, if necessary, complete reform. It needs to be recognised that some patients may need additional assistance through no fault of their own (for example, travel to and from a hospital or care centre) which should be provided to give them an equal chance of getting the attention they require.


Equity in health and social care also requires establishments to address socioeconomic factors that may be impacting those under them. It is important that the relevant and necessary non-medical information is collected. This includes factors such as an individual's employment, food security, housing situation, and education, all of which can affect a person's health and ability to access certain services. Having this information not only means that better choices can be made about treatment or help that needs to be provided, it also results in a better understanding of what other services an individual may require. People that may also need assistance under other services can be referred there when necessary in order to start rectifying the inequalities this person may be facing, to eventually improve equity and make sure people have an equal outcome when accessesing these services.


Cross-communication between different services is evidently vital when you are looking to evaluate non-medical information for understanding and possible referrals. If communication is lacking between different services, individuals who access one health and social care service but require another, or additional, services may have to wait long periods of time, or not access that help at all. Community based collaboration can also provide benefits in other areas. For evample, certain specialised services in the health and social care community can provide training or support for other establishments, help with the provision of transport for disadvantaged service users, or set up community health programs.


Overall, a strongly coordinated strategy with plans for achieving long term equity, combined with an awareness of socioeconomic factors and effective communication, will encourage more widespread equity both within a health and social care service and in the wider communities. Developing and middle income countries are identified as those most needing improvement before achieving any form of equity. To do this, they require dedicated teams of people, and an openness to revolutionising their current systems.