Health equity is a term we’re hearing regularly now—not only in regard to medical care, but also related to housing, government, education, law enforcement, employment opportunities and other societal topics. The term describes a vision in which everyone has an opportunity to live their healthiest lives possible. But, in truth, this does not reflect the world in which we live here in the U.S. Our reality is that, for many conditions, there is great disparity in health outcomes and access to treatment at a societal level.
The maternal mortality rate for Black women, for example, is two to three times higher than for white women, according to the Centers for Disease Control & Prevention (CDC). And in cancer research, “Black patients, Latinx patients, people from underserved communities, and also the elderly are not adequately represented in clinical research studies, are not receiving the care they need, and are experiencing worse outcomes,” says Cary Gross, MD, director of the Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center at Yale. What’s more, incarceration has unique impacts on health, and disproportionately affects Black and Latinx people and the poor. And when COVID-19 arrived, it hit hard communities that were already at a disadvantage.
The outsized impact of the pandemic on these vulnerable populations was entirely predictable, given what we know about health disparities—and serves as an illustration about why this is such an important focus for health research going forward. “The disproportionate impact of COVID-19 experienced by people of color highlighted longstanding disparities in underlying conditions that we know are linked to severe COVID-19 illness,” explains Carol Oladele, PhD, MPH, director of research at the Equity Research and Innovation Center (ERIC) at Yale.
Socioeconomic status and ethnicity play a significant role in determining one’s health in this country (and most others). “I think a statistic people often find surprising, maybe even staggering, is that if we think about what contributes to your health, only a small piece of that pie has to do with health care—somewhere in the order of 20%,” says Marcella Nunez-Smith, MD, MHS, associate dean for Health Equity Research, and now also leader of the Health Equity Task Force for the Biden administration.
“’Health’ means more than simply getting the medicine or surgery that you need,” says Dr. Gross. Jobs with a fair income, stable housing, educational opportunities, and access to healthy food all play a sizable role in shaping health.
“In order to get us all living our best life, we have to attend to all the structures and institutions that put people at a disadvantage to start,” explains Emily Wang, MD, Director of the SEICHE Center for Health and Justice, whose research focuses on health and incarceration.
Issues involving health equity should be at the forefront of medical research. Community engagement, representation and inclusion in clinical trial data, plus asking different kinds of questions, are all key to advancing health equity research. “How do we make our health system work for those that are most disenfranchised, most vulnerable to poor health outcomes?” asks Dr. Wang. “This is the task at hand.”
In this video, Yale experts discuss how health equity research has the power to “make the invisible visible,” says Dr. Nunez-Smith, ultimately leading to transformation and change in our health care systems.