Defining Health Equity: Beyond Disparitarian and Derivative Approaches

Abstract: The concept of health equity (and its inverse, health inequity) is often invoked by public health policymakers and scholars to justify government action. Because health equity is so central to the operations of public health agencies, its meaning is highly consequential for public policy. Many agencies follow Margaret Whitehead’s influential definition, according to which health equity is achieved when everyone has the fair opportunity to realize their full health potential, and health inequities are health disparities that are avoidable and unfair. However, Whitehead’s definition has been subject to compelling critiques, including that it wrongly focuses on health disparities, is indeterminate, and ignores non-social processes as sources of inequities. Other scholars, including Norman Daniels and Seth Berkowitz, offer alternative, derivative conceptions of health equity according to which health inequities are health outcomes caused by injustice. But these approaches lack the resources to deal with residual health harms - i.e. health harms not caused by injustice (as defined by theories of justice such as Rawls’s which do not directly consider health). My goals in this paper are to: (1) provide a new definition of health equity that avoids the problems with these disparitarian and derivative approaches, and (2) develop a justificatory framework public health scholars and policymakers may use to show that specific health outcomes are inequitable. I argue that health inequities are health harms that are amenable to intervention and unfair, and specify the factors that contribute to the unfairness of health harms.

Keywords: Health equity, health justice, social determinants of health