Equity: more to achieve the same #005

By January 20, 2019 February 14th, 2019 Advocate, Caregiver, Clinician, Consumer, ePatient, Episode, Leader

Diversity, equality, and equity are not the same. Diversity = the inclusion of differences. Equality = leveling the playing field. Equity = People have the same opportunity to achieve best physical, mental, and spiritual health no matter their social circumstances, biology, genetics, or physical environment. Bias impacts them all. Reaching for equity requires moving toward systems designed and built for inclusion and best health outcomes.

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Best health: Getting there together

00:40 I’m obsessed with the puzzle and opportunity of best health. My mission, after all, is: Empowering people as they travel toward best health. Best health includes physical, mental and spiritual health. I define best health as operating at peak performance as often as possible over time.  Another way to look at it is that Best health is living the best life possible given our genetics and biology, social circumstances, and physical environment. While much of these determinants of health are out of our control, we do have some limited control. I can’t change my genetics, but with great difficulty, I could move somewhere else (physical environment). With less difficulty, I could increase my mobility with a handicapped public transportation pass (social circumstances). The other determinants impacting best health we consider more often: medical care and personal behavior. This week my thoughts are about equity and best health. Equity = People have the same opportunity to achieve best physical, mental and spiritual health no matter their social circumstances, biology, genetics, or physical environment.

I had a great conversation this week about equity with Ame Sanders, founder, and president of the State of Inclusion.

Not same: Diversity, equality, and equity

02:18 Speaking with Ame, I found that I was confused by the concepts of diversity, equality, and equity. I have used them interchangeably, but they’re not. I appreciate the diversity of people with their varied religious and gender orientation, culture, attitudes, skills, abilities, backgrounds, appearances. I’ve built teams with an eye to diversity. I firmly believe that there’s strength in diversity. I learned about equality which I’ll define as leveling the playing field, from the work my civil rights activist parents’ did in the Fair Housing movement in the ’60s. My parents sold their house in a redlined upper-class white neighborhood to a family of color. I’ve learned about equity working with people with disabilities and now as a person with my own disabilities. Here, I think, equity means more for those who need it. More for those who need it. A person in a wheelchair needs more to be able to access a bathroom in an airplane. A teen just arriving to a public high school in the US from a Syrian refugee camp needs more to be able to graduate. An 18-year old with multiple chronic illnesses need more to succeed in college. They all need more to achieve the same as everyone else. Another way to think of it is that a stadium is being built. If they build bathrooms with equal numbers of stalls in bathrooms where people sit to pee as urinals where people stand to pee.  That’s equality. That all people who sit to pee use the same bathroom is diversity. But people who sit take longer to pee. They need more stalls than urinals.  That’s equity.

Bias impacts equity impacts health

04:34 OK, now back to equity and best health. Bias impacts equity which impacts best health. There are different kinds of bias: there’s system bias, clinician bias, and patient bias. They all impact equity which impacts best health. System or institutional bias is the inherent tendency of a process in a system to support a particular outcome.  What does that mean? Some examples of system biases include: inaccessible design (instructions only written in English or only available by smartphone), lack of diversity in management or staff (management has different cultural backgrounds than staff or nobody on staff speaks the predominant language of the patients or live in the neighborhoods of the patients), occupational stress (an imbalance of job requirements on the one hand and resources and time to do the job on the other). Another system bias could be a policy that interferes with the clinician-patient relationship (policy to prevent opioid abuse restricts clinician’s ability to prescribe sufficient pain meds for a person in a sickle cell crisis).  Clinician biases could include associating non-compliance with personal characteristics (Not following instructions because of how a person looks or their age), selective absorption of evidence (not accepting that women may have different symptoms of heart disease than men), suspicions of social media (don’t use Dr Google), and selective listening (if it’s a woman in pain, it must be in their heads). Patient biases could include lack of trust of doctors or insurance companies, fear of hospitals, thinking we know more than we do, accepting whatever we read about health on social media in spite of what our clinicians tell us.

Equity for best health. How?

07:06 Now that we understand equity a bit more, we have to figure out what to do about it.  Ame Sanders suggests that reaching for equity requires moving toward systems designed and built for inclusion and best health outcomes. Let’s continue this conversation with Ame. She and I are planning to interview each other soon for our respective podcasts. Stay tuned. Equity. More to achieve the same.

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Please contribute to my blog and podcast

Please help me maintain this ad-free blog and podcast. I appreciate your readership and listener-ship. My blog and podcast will remain free to anyone who subscribes or visits. While a monthly contribution is best for me, I gratefully accept anything you can contribute. No swag offered, just thanks from the bottom of my heart.

Support my blog and podcast. CONTRIBUTE HERE

Photo by HelpStay.com Team on Unsplash

Music by permission from Joey van Leeuwen, New Orleans Drummer, Composer

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Danny van Leeuwen

About Danny van Leeuwen

Patient/Caregiver activist empowering people as they travel toward best health

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