Health Equity Has Declined-What Now?

Frederick J. Zimmerman, PhD

A new study has found that several measures of health equity have declined over time.

Particularly concerning is a very large increase in income-related disparities, according to the study, published in JAMA Network Open.

Black-white disparities tend to be decreasing over time, indicating improvements in health equity on that particular measure. 

The study examined 25 years of data on over 5 million Americans and found that “despite near-universal lip-service to the goal of health equity, we are simply not making any progress,” says lead study author Frederick J. Zimmerman, PhD, professor of Health Policy & Management in the Fielding School of Public Health at the University of California, Los Angeles.

“It seems that adding to our other forms of inequality in society health, too, is increasingly allocated in ways that benefit the privileged,” Zimmerman says.

The researchers had access to data from the CDC on several measures of self-reported health. They converted these to continuous measures and then looked at the average health of the population on a year-by-year basis, as well as the distribution of health within each year.

“We assessed the difference in average health across racial/ethnic groups as well as across income groups,” Zimmerman says. “We also calculated two new overall measures. One is a measure of health justice-which is the inverse of how much social identity predicts health. In an ideal world social identity (race, ethnicity, income, gender) would be uncorrelated with health outcomes. The other measure is of health equity-how much the average person's health departs from the optimal possible health in that year.” 

“As healthcare executives turn to population health perspectives of their mission, it is important to monitor and act upon not only the average health of a population, but also the distribution of health within a population,” says Zimmerman.

“We were frustrated that while health equity is an often-evoked goal, there is no single, national indicator that allows us to measure health equity. This study provides a single measure as well as three other sub-domain measures. With these new measures we are better able to see what is happening with health equity.”