The terms equity and equality are sometimes used interchangeably, which can lead to confusion because while these concepts are related, there are also important distinctions between them.
Equity, as we have seen, involves trying to understand and give people what they need to enjoy full, healthy lives. Equality, in contrast, aims to ensure that everyone gets the same things in order to enjoy full, healthy lives. Like equity, equality aims to promote fairness and justice, but it can only work if everyone starts from the same place and needs the same things.
Let’s think for a moment about runners sprinting around an oval track during a competition.
The concept of equality would have us treat the runners in exactly the same way, ensuring that they all start at the same place on the track. On the surface, this seems fair.
But we know that runners in the inside lanes have a distinct advantage over runners in the outer lanes because the distance they have to travel is shorter. As a result, equality – starting at the same place – doesn’t result in fairness.
The concept of equity, in contrast, would lead us to stagger the starting positions of the runners in order to offset the disadvantages facing those in the outer lanes. In this case, different or tailored treatment is a surer path to fairness and justice than the same treatment.
The same distinction between equity and equality can be seen when it comes to health and care. For example, Canada’s publicly-funded health care system is based on the concept of equality. It is designed to ensure that everyone has the same access to health care providers and services regardless of their ability to pay for care. Again, this seems fair. But it only goes so far in promoting justice because it ignores other factors – such as language, place of residence, sexual orientation and gender – that can also act as barriers to care.
At the same time, ensuring the same access to care for everyone assumes that everyone has similar health status and similar health care needs. We know this is not the case. Some people, like the runners in the outside lanes of the track, live with social, political and economic disadvantages that contribute to poor health. For instance, women and men, boys and girls who live in poverty are frequently less healthy than those with more resources. As a result, they may need additional services and programs – rather than just the standard ones – to offset the impact of substandard housing, limited access to fresh, nutritious foods, and exposure to unsafe environments. This is equity: making sure that have what they need to achieve and maintain health and well-being.
Once everyone enjoys a similar level of health and well-being, we can focus on preserving fairness by giving everyone the same things: this is equality. As the Pan-American Health Organization puts it, equity is the means, equality is the outcome.
Understanding the differences between equity and equality helps us to recognize and respond to differences in health and well-being that are unfair, avoidable and changeable.