Key Language and Concepts

Section

Toolkit Home Brief Orientation Key Language and Concepts Key Literature Community and Partner Engagement Reflectivity in Research Practice Implementation Science Frameworks Measurement and Evaluation Data Collection and Analysis Implementation Trials

Section lead: Kelly Aschbrenner, PhD

Health equity is associated with other concepts (e.g., health disparities, health care disparities, health inequalities, health care inequalities) that are sometimes used interchangeably in the literature, which can lead to confusion and slow progress in research. In this section (Table 1), we provide an overview of key terms and concepts used in health equity IS to inform efforts to integrate health equity into IS. This list is not exhaustive, nor does it capture all the nuances of these terms. Rather, it is intended to serve as a starting point for planning health equity-focused IS research projects. We also provide links to external resources with health equity guides and glossaries of key terms and concepts to help investigators use relevant language and concepts in their research.

Table 1. Overview of Key Terms and Concepts Applied in Health Equity-Focused Implementation Science

Term Definition and Meaning Examples of Application to Health Equity Focused Implementation Science
Health equity Health equity is the absence of avoidable, unfair, or remediable differences in health among population groups defined socially, economically, demographically, or geographically or by other means of stratification.1,2 Health equity is a principle underlying a commitment to reduce, and ultimately eliminate, a health disparity and its determinants, including social determinants.3 Health equity has been applied in addressing health disparities—a particular type of health difference that is closely linked with economic, social, or environmental disadvantage. Health disparities have been used as a metric to measure progress toward achieving health equity.3
Health inequities Health inequities are differences in health (or health care) that are systemic, avoidable, unfair, and unjust.4 Health inequities are affected by social, economic, and environmental conditions.5 Apply health inequities when referring to unjust differences in health outcomes.
Health disparities Health disparities are differences in outcomes or disease burden between groups. With a health disparity, there is a higher burden of illness, injury, disability, or mortality in one group relative to another.6,7 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, gender, age, or mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion. Health disparities are a metric used to measure progress toward health equity. A reduction in health disparities (in absolute and relative terms) is evidence of moving toward health equity.7
Moving toward greater equity is achieved by improving the health of those who are economically or socially disadvantaged.8
Health care disparities Health care disparities are differences between groups that are closely linked to economic and social disadvantage, including differences in health insurance coverage, access to and use of care, and quality of care. 9,10 Apply health care disparities when trying to understand and address inequities in health care between groups, when such inequities are closely linked to economic and social disadvantage.
Social determinants of health (SDoH) Social determinants of health are interrelated economic and social conditions that influence health.11 Social determinants of health (SDoH) have a major impact on people’s health, well-being, and quality of life. Examples of SDoH include:
  • safe housing, transportation, and neighborhoods
  • discrimination and violence
  • education, job opportunities, and income
  • access to nutritious foods and physical activity opportunities
  • access to health care
  • polluted air and water
  • language and literacy skills
 An example of health equity-focused implementation research is trying to understand the influence of social determinants of health on equitable implementation of clinical and public health evidence-based practices, interventions, or policies.
Structural racism Structural racism has been defined as “the totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice. These patterns and practices can reinforce discriminatory beliefs, values, and distribution of resources.”12 Apply to understand the broader context in which health inequities are embedded, shaped, and reinforced, and to consider it a determinant of equitable and inequitable implementation of evidence-based interventions and implementation strategies.13,14
Social justice Several organizations provide a similar definition of social justice. Here are two:

“Social justice may be broadly understood as the fair and compassionate distribution of the fruits of economic growth.” United Nations

“Social justice is the view that everyone deserves equal economic, political and social rights and opportunities.” National Association of Social Workers
Equity-oriented implementation research Equity-oriented implementation research occurs “when strong equity components— including explicit attention to the culture, history, values, assets, and needs of the community—are integrated into the principles, strategies, frameworks, and tools of implementation science.”15 Apply to address structural and social determinants of health or other factors that shape inequitable implementation, reach, and adoption.


Links to External Resources that Focus on Key Language and Concepts in Health Equity

Centers for Disease Control and Prevention
Health Equity Guiding Principles for Inclusive Communication
https://www.cdc.gov/healthcommunication/Health_Equity.html

Centers for Disease Control and Prevention
Health Equity Style Guide for the COVID-19 Response: Principles and Preferred Terms for Non-Stigmatizing, Bias Free Language
https://www.cdc.gov/healthcommunication/Health_Equity.html
(See pg. 8, Table 4, in the Health Equity Style Guide for additional resources/guidelines.)

American Medical Association Center for Health Equity
Advancing Health Equity: A Guide to Language, Narrative and Concepts
https://www.ama-assn.org/about/ama-center-health-equity/advancing-health-equity-guide-language-narrative-and-concepts

US Department of Health and Human Services
Health Equity and Health Disparities Environmental Scan
The Health Equity and Health Disparities Environmental Scan explores how health equity and health disparities are defined and communicated within the field of public health.
https://health.gov/sites/default/files/2022-04/HP2030-HealthEquityEnvironmentalScan.pdf

Stanford Innovation Review
Bringing Equity to Implementation
https://ssir.org/supplement/bringing_equity_to_implementation

American Public Health Association
What Is Health Equity?
https://www.apha.org/topics-and-issues/health-equity


References

Health equity:

  1. World Health Organization. A conceptual framework for action on the social determinants of health. Geneva, Switzerland: WHO Production Services; 2010.
  2. Gómez CA, Kleinman DV, Pronk N, et al. Addressing health equity and social determinants of health through Healthy People 2030. J Public Health Manag Pract. 2021;27(Suppl 6):S249-S257. doi:10.1097/PHH.0000000000001297
  3. Braveman P. What are health disparities and health equity? We need to be clear. Public Health Rep. 2014;129(Suppl 2):5-8. doi:10.1177/00333549141291S203

Health inequities:

  1. Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429-445. doi:10.2190/986L-LHQ6-2VTE-YRRN
  2. Gómez CA, Kleinman DV, Pronk N, et al. Addressing health equity and social determinants of health through Healthy People 2030. J Public Health Manag Pract. 2021;27(Suppl 6):S249-S257. doi:10.1097/PHH.0000000000001297

Health disparities:

  1. Gómez CA, Kleinman DV, Pronk N, et al. Addressing health equity and social determinants of health through Healthy People 2030. J Public Health Manag Pract. 2021;27(Suppl 6):S249-S257. doi:10.1097/PHH.0000000000001297
  2. Braveman P. What are health disparities and health equity? We need to be clear. Public Health Rep. 2014;129(Suppl 2):5-8. doi:10.1177/00333549141291S203
  3. Whitehead M, Dahlgren G, World Health Organization. Levelling Up (Part 1): A Discussion Paper on Concepts and Principles for Tackling Social Inequities in Health. WHO Regional Office for Europe; 2006.

Health care disparities:

  1. Nelson A. Unequal treatment: Confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666-668.
  2. Dehlendorf C, Bryant AS, Huddleston HG, Jacoby VL, Fujimoto VY. Health disparities: definitions and measurements. Am J Obstet Gynecol. 2010;202(3):212-213.

Social determinants of health:

  1. Braveman P, Gottlieb L. The social determinants of health: It’s time to consider the causes of the causes. Public Health Rep. 2014;129(Suppl 2):19-31. doi:10.1177/00333549141291S206

Structural racism:

  1. Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: Evidence and interventions. The Lancet. 2017;389(10077):1453-1463. doi:10.1016/S0140-6736(17)30569-X
  2. McNulty M, Smith JD, Villamar J, et al. Implementation research methodologies for achieving scientific equity and health equity. Ethn Dis. 2019;29(Suppl 1):83-92. doi:10.18865/ed.29.S1.83
  3. Shelton RC, Adsul P, Oh A. Recommendations for addressing structural racism in implementation science: A call to the field. Ethn Dis. 2021;31(Suppl 1):357-364. doi:10.18865/ed.31.S1.357

Equity-oriented implementation research:

  1. Loper A, Woo B, Metz A. Equity is fundamental to implementation science. Stanford Soc Innov Rev. 2021;19(3).
    Available from: https://ssir.org/articles/entry/equity_is_fundamental_to_implementation_science