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 iteration)

• 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
    1. a continuous effort focused on elimination of health disparities, including disparities in health care and in the living and working conditions that influence health, and
    2. 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 all instances.
  • The word "rural" was replaced with "geography" because the former did not recognize potential disparities in urban populations.
  • 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 exclusion."

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).

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 sectors.
• 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 progress.