Health Equity Relies on Moving from Concept to Action: It Also Relies on You!

By Dr. Dwinita Mosby Tyler

The U.S. (well, the whole world for that matter) has experienced dramatic change over the past year and a half and some of those changes have us wondering how much progress we have made in advancing and achieving health equity.

You know the spiel…

Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, death; severity of disease; and access to treatment (Centers for Disease Control and Prevention, 2021).

One of the most important things we can do right now is assess what we’ve done; what we’ve advanced, up to this point. We have been at diversity, inclusion, equality, and equity work for a very long time. With that said, have we achieved health equity? Have our actions brought about the shifts we have wanted to see?

The answer lies in our understanding of what we have been working on. My take? We haven’t really been working on equity as much as we might think.

I often talk about The Continuum of Equity below. It is meant to illustrate the fluidity of the work. It acknowledges the fact that we move up and down this continuum, depending on what we’re working on. Sometimes our work creates a keen focus on inclusion (or belongingness) strategies. We want to make sure our staff and patients/clients/partners we serve experience the feeling of being a part of the system in an authentic way. Sometimes we are focused on diversity – the work that centers on valuing differences. All kinds of differences. We typically are working to increase or change, statistically, a demographic or identity group. things as every other group. This is the area, in the U.S., where we have spent the most time. Everything from the Civil Rights Movement to the Women’s Movement are examples of equality.

There are also times when we focus on equality – the intentional work of level-setting, providing access and providing one group with the same things as every other group. This is the area, in the U.S., where we have spent the most time. Everything from the Civil Rights Movement to the Women’s Movement are examples of equality.

Lastly, there are times, like now, where we are focusing on equity. In this case health equity. Unlike diversity, inclusion and equality, equity calls for big commitments:

• You must commit to investigating your own systems • You must commit to dismantling systems of inequities

Health equity relies on deep equity work. Equity calls for systems and structural work. It is about creating systems where everyone gets what they need to thrive. In effect, the systems we know all too well must be challenged. Within these systems exist the inequities that keep us from achieving health equity.

To achieve health equity, we venture into areas of discomfort and sometimes fear, including the need to discuss race and its implications on health equity.

Historically (from the 1950’s to now), we have focused our organizational work on diversity, inclusion and equality. This has helped us to make substantial and important change. We have passed equality laws that provide access to those who didn’t have it, we have opened the door to the richness of diverse workplaces and systems, we have focused on creating welcoming environments. These are all important achievements and yet, we are still challenged with inequities and not achieving health equity?

Why? I’m glad you asked.

It is because we really haven’t been working on equity over the years. We’ve been working, almost exclusively, on diversity, inclusion, and equality.

None of these get you to the deep system interrogation investigation and change needed to actualize health equity. They change the access and infrastructure without dramatically shifting the system.

In other words, we are early on in our equity work.

Our collective challenge is to be extraordinary navigators in this work. We should each know where we are on The Continuum of Equity at any given time. Not everything we do is equity work, so our careful articulation of the “what” we are doing is important. This helps us to set reasonable and realistic expectations about outcomes. No need to get frustrated when your work still leaves you with a preponderance of inequities. It may be that your tactics for dealing with the inequities were not laser focused. I often see us using diversity or inclusion (D&I) tactics in hopes of achieving equity. The reality is D&I won’t bring you equity. Equity is its own systematic strategy.

So…is health equity even possible?

Yes. It is. It will be evolutionary work with defined strategies and each of us has a role to play in advancing it. I can confidently say to you that I see equity in our sightline. This is extraordinary.

I’m also a realist. It may be that I won’t see total equity and health equity in my lifetime. It reminds me of my favorite books, ‘The Cathedral Within’, by Bill Shore. The book reminds us of the great cathedral builders of the world. The builders knew the whole time they were building that they would never live to see the finished product. This fact never compromised how hard they worked and how committed they were.

So…maybe it is true that health equity is the next “great cathedral.”

I’m honored to be one of the builders. Aren’t you?

About the Author

Dr. Dwinita Mosby Tyler is the Chief Catalyst and Founder of The Equity Project and founder of The HR Shop. She is the former Senior Vice President and Chief Inclusion Officer for Children’s Hospital Colorado and former Executive Director of the Office of Human Resources for the City and County of Denver.