Defining equity, its determinants, and the foundations of equity science
Highlighting a gap between intention and practice
The authors of this article contend that the majority of efforts to advance health equity fall short: definitions of equity are inconsistent and passive, and actions from health and social sectors (both research and practice) do not sufficiently address the underlying causes of inequities. The article reminds readers that work intended to promote health equity often further enacts colonial and racial violence. The health and social sectors are encouraged to engage with “an active, well-established, and rigorous body of scholarship in transformative justice, liberatory, and critical theories, advanced predominantly by Black, Indigenous and other racialized scholars” (p. 1).
Expanding the definition of equity
The authors propose describing equity in three equally important ways:
- Equity as a conceptual construct. Equity is a way to make sense of how justice and fairness function through systems, structures, policies and processes, and to illuminate a shared world view associated with specific values, norms and assumptions.
- Equity as a benchmark. Equity is a destination, a guiding goal for health and social sector organizations “where people and all living things are able to live with dignity and reach their full potential, without systemic disadvantage” (p. 4).
- Equity as an experience. Equity, or the absence of equity, is felt as people “navigate society and interact with others and/or with social systems and settings” (p. 4).
Making the case for equity science and focusing on the determinants of equity
The authors make the case for health and social sector practitioners to apply an equity science that actively seeks to transform systems of power and thought (e.g., world views, mental models) and shift how resources are distributed in all social contexts.
Interestingly, the authors use a forest metaphor where the:
- forest is the entire human population;
- trees are subpopulations;
- soil is the social fabric, including structural, political and commercial determinants of health;
- surface root systems are the social determinants of health, the conditions of daily life; and
- climate systems are the determinants of equity, the essential resources (nutrients) that move through systems of power and thought.
Use this resource to
- Review evolved descriptions of health equity, determinants of health equity, and equity science
- Reflect on the forest as a metaphor for relationships between the determinants of health and equity
- Consider your own capacity for creativity and agency to advance health equity
Alignment with NCCDH work
The NCCDH supports the public health community to act on interrelated structural, social and ecological determinants of health. To do this, public health practitioners must understand — and work with others to disrupt — inequitable power relationships. Responding to this need, the NCCDH has published documents and podcasts on (a) redistributing power for health equity and (b) taking meaningful action on the determinants of health.
The metaphor used in this article shares some common features with the tree image included in the NCCDH resource Let’s Talk: Determinants of health, where the root systems also depict conditions of daily life and the soil also represents structural, political and commercial determinants of health.
See other resources on structural determinants and health equity.
Reference
Plamondon, K. M., & Shahram, S. Z. (2024). Defining equity, its determinants, and the foundations of equity science. Social Science & Medicine, 351, Article 116940. https://doi.org/10.1016/j.socscimed.2024.116940
Tags: Structural determinants, Power, Document, Commentary