Equity in healthcare & access to care
In this second edition of our blog series, we will explore the problems of equality and equity in society and healthcare. We define and give an example of the differences between equality and equity and explore the impact of inequality in healthcare. We aim to outline some practical steps that are already been taken, or we can take to improve this outlook.
Starting off with the global equality problem
Most people are familiar with the word equality; It has been at the forefront of much of the civil rights movement, gender identity movement and, sadly, many of the wars experienced globally over the last 400 years. Equality is essentially the access to ‘equal’, whether that being equal education, equal work, equal pay, equal rights or equal healthcare; it is a right to not be disadvantaged in the availability of opportunities. 
Many countries of the world protect equality, specifically regarding healthcare provision. Yet there still is a growing gap between the healthcare outcome of those from disadvantaged communities. This difference equates to a life-expectancy difference of 10-15 years when compared across socioeconomic backgrounds.  However, this problem is not new; in 1966, Dr Martin Luther King Jr proclaimed “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane because it often results in physical death.”  So why does this problem persist?
What is equity, and how does it differ from equality?
Equality is entrenched in the belief that if everyone was given the same opportunities, they could achieve the same outcome or result. This is the American dream archetype, wherein our success relies on our desire to take advantage of opportunities available to all. Yet, we have learned from decades of equality measures that this more simplistic view doesn’t translate into comparable results, as it unconsciously ignores social biases and historical inequalities. The data suggests, surprising to those championing equality, that even with the same advantages or opportunities, historical inequalities and prejudice continue to determine the outcome for those in discriminated communities. 
Equity, however, is a step toward social justice and is defined as the “absence of avoidable or remediable differences among groups of people”. Basically, measures to be taken to level out the playing field and give everyone the same chance to succeed, typically by providing additional support or help to those at the greatest disadvantage.  In health terms, it is the difference between ensuring access to care for all and ensuring care is delivered to all that need it. Social justice is a step further in which the constructs of social imbalance are corrected, which mitigates the need for equity measures by ‘fixing the system’ to ensure long-term equitable access. 
Imagine you were building a new hospital to serve two communities. One community was affluent and had jobs that provided good health insurance coverage. The other community was less affluent with fewer jobs and no health insurance coverage available. In a system of inequality, it’d be reasonable to locate the hospital near the first community, closest to the more significant number of people with health insurance coverage.
What happens when we focus on equality? We choose to build the hospital inbetween these communities. We may even grant both communities free insurance to use the facilities. The issue is that it would fail to consider (among other things) each community’s ability to access the facility.
- The access, availability and ownership of transportation will determine the disadvantaged communities’ likelihood or ability to attend this new hospital. 
- The insurance provided for ‘free’ carries a co-payment or deductible, which not all patients will have the means to pay. Preconditions drive the deductible, which is more likely to be present in disadvantaged communities. 
The third way is to build the hospital equitably. In doing so, hospital location matters less, provided there are mechanisms to ensure fair distribution of its services based on needs. Equity looks like programs which automatically offer free transportation to the facilities on a schedule that suits a patient appointment time, or outreach services that directly deliver care to the home of disadvantaged people. Plus, an increasingly popular solution is to provide ‘free clinics’ or permit essential services to operate without the mandate for insurance or co-payments. In a heart failure context, this solution has been proven successful in benefiting patients’ quality of life and preventing readmissions. 
The historical problem and policy steps
Apart from social and moral responsibilities to tackle injustice and inequality everywhere, health care costs of racial health disparities cost health insurers $337 billion between 2009 and 2018. This resulted from delays in treatment, preventable admissions, adverse events or complications and avoidable development of advanced diseases.  This indicates that equity strategies, such as free clinics, are more cost-effective to deploy due to the prevention effects of more expensive procedures or hospital attendance downstream.
Public policy has taken strides toward equality solutions protected in law but generally lacks language or steps toward equity solutions; policymakers are typically responsive to public opinion and the movement of responsible corporations lobbying for change. An overwhelming majority of healthcare institutions make health equality a core focus, achieved through partnership with innovative solutions providers and community organisations for a more holistic approach to care provision. 
What can medical companies do about it?
The role that healthcare companies can play is ensuring they have an equity first stance in inventing, developing, testing and deploying technology and solutions. It is no longer acceptable to use the mantra that ‘once we are successful, we will focus on equality’ or believe it’s a corporate luxury or overhead to invest in disadvantaged communities or subsides or fund studies in underdeveloped countries.
A first-of-its-kind initiative was announced by Becton Dickinson (BD) which has offered long-term support for the ‘Americares’ National Programme for Health Equity. This project is not an aid or a charity mission but actually, supports the collection of real-world data on the impact of ‘Free Clinics’ to be used to better plan healthcare provision. 
What is in it for BD? They have made equity a core competency of The BD organisation and want to be at the forefront of the equity shift and ‘not settle’ for good enough in their mission to improve continuously.
How does this apply to my company?
Even if you are not an organisation with $500,000 of grant funding to distribute, there is a difference you can make. If you have an established product then you can think of how to adapt and grow your business more equitably. Equally, if you’re just starting up an enterprise, then how can you ensure is developed or tested in a way that gets it to those most in need first? Whatever the starting point on the equity journey there are four simple questions that you can ask yourself:
- How can we invent a product, technology or service that advances equity
- How can it be developed or adapted to keep underserved communities in mind
- How can we evaluate or monitor the performance to ensure it works for all people
- How can we ensure that this technology is fairly deployed to those who need it most
The bottom line of Healthcare Equity
Being ‘Equity First’ will positively impact the lives of the patients in disadvantaged communities and affect the relevance of a Medical company for years to come. Time and again in healthcare it is the case that the most effective intervention is the one that impacts the core of disease and inequality, generally of higher initial cost but prevents exponentially more downstream complications. Start-ups should make this a core competency, and they will become the leaders of tomorrow and among the most desirable companies.