Revised definitions for health disparities and health equity
Dr. Fielding said the definitions of health equity and health
disparities were one area where there had been extensive discussion. He
asked Dr. Ronald Manderscheid, Chair of the Subcommittee on Health
Equity and Health Disparities, to explain recent changes to these
definitions. Dr. Manderscheid said external reviewers of the Committee’s
draft definitions had offered comments in several key areas, as
summarized below. He shared and explained the updated versions of these
definitions. (Bolded font denotes changes to definitions from last
- Health equity: Some external reviewers
suggested the definition should focus more on healthcare. The
Subcommittee, however, believed the definition should address both the
determinants of health and healthcare. It did not adopt the suggestion
to narrow the definition of health equity.
- An introductory sentence was added to highlight health
equity as being oriented toward achieving the highest possible
level of health for all groups.
The word goal was broadened to "goal/standard" to broaden health
equity as a standard.
Revised definition: "Health equity entails
special efforts to improve the health of those who have experienced
social or economic disadvantage. It is a desirable
goal/standard that requires
- a continuous effort focused on
elimination of health disparities, including disparities in health
care and in the living and working conditions that influence health,
- a continuous effort to maintain a desired state of equity
after particular health disparities are eliminated."
- Health disparities: Comments suggested
that the definition be broadened to include any differences in health
status. Dr. Manderscheid said the subcommittee has tried to convey that
disparities are a particular type of difference that exists due to
problematic treatment of individuals in the past, especially with
respect to the determinants of health and healthcare. The definition was
not broadened to include all differences because we currently lack the
technology to explain how some differences lead to disparities in health
status (e.g., genetic factors).
- The word "cause" was replaced by the words "closely
linked" because it is hard to prove these factors are causal in
The word "rural" was replaced with "geography" because the
former did not recognize potential disparities in urban
Revised definition: A health disparity is a
particular type of health difference that is closely linked with
social or economic disadvantage. Health disparities
adversely affect groups of people who have experienced greater
social or economic obstacles to health based on their racial or
ethnic group, religion, socioeconomic status, ender, mental
health, cognitive, sensory, or physical
disability, sexual orientation, geography, or
other characteristics historically linked to discrimination or
Additional Substantive Changes
The Action Model for Healthy People 2020
Dr. Fielding presented a revised version of the Healthy People
2020 Model. It was recently updated to show the role of interventions in
affecting determinants and yielding various outcomes. The new model shows
a feedback loop in which needs assessment, monitoring, and dissemination
lead to the subsequent revision of interventions. Dr. Fielding thanked Dr.
Shirki Kumanyika, Committee Vice-Chair, as well as the Models Subcommittee
for their hard work on the new model. He asked the Committee whether
anyone believed the model should not be submitted in its present form. No
objections were raised.
IV. Discussion of Final Draft, Phase I Report
External Reviewer’s Suggested Revisions to the Mission Statement
Dr. Fielding asked the Committee members to turn to the report’s
updated mission statement (shown below).
To improve policy and practice by:
- Increasing public awareness and understanding of the determinants
of health, disease, and disability;
Providing nationwide priorities and measurable objectives and goals;
Catalyzing action using the best available evidence and information;
Identifying critical research and data collection needs.
Dr. Fielding explained that in this updated statement, the words "and
information" had been added to the third bullet in response to concerns
that Dr. Lawrence Green, one of the report’s reviewers, had raised in his
written comments. Dr. Fielding also read aloud written remarks that had
been received that morning from Dr. McGinnis. Dr. McGinnis suggested the
following changes to the mission (shown in bold below):
- Increasing public understanding of the determinants of health,
disease, and disability—and the opportunities for improvement.
- Marshaling national attention to the magnitude of health gains
achievable with current knowledge.
- Catalyzing action directed by the evidence and engaging multiple
- Enhancing the focus and capacity for monitoring health progress on
key dimensions at the national, state, and local levels.
- Identifying and initiating research activities needed to accelerate