HEALTH CARE COMMENTARY
A physician perspective on health equity
By Dr. Oren Gersten
Equity means considering fairness, impartiality, and context when choosing what is best. Equity is the close cousin of equality, which speaks more towards a comparative state between groups. We often misconstrue these two words as synonymous with “sameness.” But something does not have to be the same to be equitable. For example, the fair take-home pay for someone living in New York City versus rural New York may be different but still equitable. We must consider the cost of living, taxes, and other factors to account for what is fair.
Health Equity in the U.S.
Health equity applies these principles to human health and the health care system. When assessing equity – or lack of equity – we look at both health outcomes (rates of chronic disease, death, illness) as well as people’s experience of the system (satisfaction, access, cost).
The United States does poorly in most of these metrics. Infant mortality, longevity, access to care, and cost are all poor when compared to other countries. That in and of itself is a form of inequity. You might say all Americans are suffering from lack of good care because of where we live.
Unfortunately, the inequity goes deeper. People of color experience worse outcomes than their white counterparts, which can be attributed to institutional racism. Low-income people are less likely to have preventive care, access to medications, and access to medical advice leading to poorer health. Children are more or less likely to have vaccines available to them based on which state they are born in. These are just a few examples of the inequities in our system.
Furthermore, independent doctors such as myself are experiencing a form of inequity. The CDC has asked large hospital systems in our state to distribute Covid-19 vaccines to health care workers. Instead of devising a system based on fairness, risk, or chance, the health care systems have vaccinated their own, before coordinating vaccine administration to those outside their system.
I am not more – or less – deserving of a vaccine than any other practicing doctor who is at risk of Covid exposure as part of their job. Waiting for a vaccine would not bother me if the process were transparent and equitable. Clearly the task we have placed on our healthcare system is daunting and good people are doing their best. No one person is to blame. But, yet again, our health care system has failed us.
Public Health Examples
Other countries have done a better job with this public health task. The U.K. has a National Health Service system. Most doctors are public employees in a single system. As such, it would be very difficult to create inequity within that system. Or consider how Israel has a robust community clinic system. They have been incredibly efficient at vaccinating not only health care workers but also the citizens – who have easy access to local clinics. The U.S. has public infrastructure as well. We could utilize our fire stations, libraries, and schools in the next phase of vaccination.
In the United States we have entrusted our health care and public health to large private institutions that have failed to keep us healthy and treat us equitably. Covid has illustrated the deficiencies of our current system. It may be too late to modify our health system for this crisis, but we cannot afford to let the system continue in its current form into the next crisis.
Oren Gersten is a board-certified family doctor who brings his passion for connecting and caring for people to his private practice, Portland Direct Primary Care, at 27 Ocean Street, #3, South Portland. Reach him at (207) 618-9792 or visit PortlandDirectCare.com.