The COVID-19 Pandemic not only proved that humans are vulnerable to diseases and disasters, but also brought the issue of health inequity to the forefront, not only globally, but also here in the United States. To date, over 7 million people worldwide have been confirmed COVID-induced deaths. However, when accounting for likely COVID-induced deaths through excess mortality data, the 95% confidence interval suggests the pandemic resulted in between 16 and 28.2 million deaths. In the U.S., over 1.2 million deaths were confirmed since the beginning of the pandemic.

Many populations experience health inequity, including people from some racial and ethnic minority groups, people with disabilities, the aging population, women, people who are LGBTQI+ (lesbian, gay, bisexual, transgender, queer, intersex, or other), people with limited English proficiency, and other groups. These disparities sometimes persist, even when accounting for other demographic and socioeconomic factors, such as age or income.

The World Health Organization (WHO) defines health inequity as “systematic differences in the health status of different population groups.” This means that certain groups experience worse health and increased difficulty accessing quality healthcare as a result of the systems and policies that influence their lives. Health inequity occurs on a local, national, and global scale, and it affects all countries, some more than others.

The pandemic took the lives of those who had chronic health conditions and who historically faced multiple barriers to access, as well as receiving quality care. Research shows that certain racial and ethnic minority groups, people living in rural areas, White population with low incomes, and marginalized groups, such as the unhoused, people with disabilities, or facing mental illness or addiction, etc., experience higher rates of poor health and disease for a range of health conditions. These can include diabetes, hypertension, obesity, asthma, heart disease, cancer, and preterm birth.

So, health equity is the absence of unfair and avoidable differences in health among population groups, which are defined socially, economically, geographically, or demographically. To achieve health equity, we must examine and change the systems and policies that have resulted in the generational injustices that give rise to human and health service disparities. The Center for Disease Control and Prevention (CDC) defines health equity as the state in which everyone has a fair and just opportunity to attain their highest level of health. Achieving this requires ongoing national and societal efforts to:

Address historical and contemporary injustices;
Overcome economic, social, and other obstacles to health and health care; and
Eliminate preventable health disparities.

Health equity should be considered a normative, aspirational concept such as the “right to health.” Therefore, human-centered national policies and health care system practices do matter.

The Healthy People (HP) initiative is designed to guide national health promotion and disease prevention efforts to improve the health of the nation. Each decade since 1980, the U.S. Department of Health and Human Services (HHS) has released the Healthy People initiate, which identifies science-based objectives with targets to monitor progress and motivate and focus action. Launched on August 18, 2020, HP2030 features a framework that includes its vision, mission, foundational principles, and overarching goals; core objectives with targets; and research and developmental objectives.

The goals for this decade include the following:

Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury, and premature death.
Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.

Create social, physical, and economic environments that promote attaining full potential for health and well-being for all.
Promote healthy development, healthy behaviors, and well-being across all life stages.
Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.

In 1966, WHO’s International Covenant on Economic, Social, and Cultural Rights adopted the following words, “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”. Good health is also clearly determined by other basic human rights, including access to safe drinking water and sanitation, nutritious foods, adequate housing, and education and safe working conditions, which are now referred to as the Social Determinants of Health.

This year, the theme for World Health Day is 'My health, my right’. To ensure the right to health, national policies around health and the health system should ensure and include four key elements:

Access: health care must be affordable or free and comprehensive for everyone.

Availability: there must be adequate health care infrastructure and staff.

Acceptability: health-care services must be respectful, non-discriminatory, culturally appropriate and treat everyone with dignity.

Quality: all health care must be medically appropriate and of good quality.

A country with a rights-based health system should adopt appropriate legislative, administrative, budgetary, judicial, promotional, and other measures to enable everyone to fully realize their right to health and put measures in place to actively inform and promote the fulfilment of the right to health.

I implore us to engage our family, friends, neighbors, and colleagues in conversations and activities that promote 'My health, my right.’

**Dr. Clayton Chau**
Chief Strategy & Innovation Officer, NHHA

References

Braveman P. (2006). Health disparities and health equity: Concepts and measurement. Annual Review of Public Health. 27:167–194
Braveman P, Arkin E, Orleans T, Proctor D, & Plough A. (2017). What is health equity? And what difference does a definition make? Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html
Centers for Disease Control and Prevention. (2021) Impact of Racism on our Nation’s Health. available from https://www.cdc.gov/healthequity/racism-disparities/impact-of-racism.html
Institute of Medicine (US). (2002). Committee on the Consequences of Uninsurance. Care Without Coverage: Too Little, Too Late. Washington (DC): National Academies Press (US)
Jones CP. (2000). Levels of Racism: A Theoretic Framework and a Gardener’s Tale. Am J Public Health. 90: 1212-1215
Krahn GL, Walker DK, Correa-De-Araujo R. (2015). Persons with disabilities as an unrecognized health disparity population. Am J Public Health. 105 Suppl 2(Suppl 2):S198-S206
Office of Disease Prevention and Health Promotion. (2021). Healthy People 2020: Disparities. U.S. Department of Health and Human Services. Retrieved August 13, 2021, from https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities

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