From Disparity to Equity Through National Health Reform
by Ronald W. Manderscheid, PhD
Health equity will be a key factor in future assessments of progress being made by our society to improve the health of all Americans. According to the Secretary’s Advisory Committee on Healthy People 2020:
“. . . health equity is a very desirable goal that requires (1) continuous efforts focused on elimination of health disparities, including disparities in health care and in the living and working conditions that influence health, and (2) continuous efforts to maintain any gains in equity after particular health disparities are eliminated.”
The concept of health equity was developed to address differences in social factors among populations that may affect individual health. Social factors may include:
• Sex
• Age
• Race/ethnicity
• Discrimination
• Poverty
• Education level
• Housing/living circumstances
• Access to health care
This concept reflects fundamental human values:
• All people are valued equally.
• Good health is valued highly for everyone.
• Resources needed for good health should be distributed fairly.
• Every person should be able to achieve the highest level of health possible.
For us in the behavioral health and substance use fields, the concept of health equity is vitally important. It requires that we address disparities that reach across health fields as well as those unique to behavioral health and substance abuse. Let me explain with a couple of examples.
“Common” disparities, including discrimination, mean that female, minority, and elderly people have more—and more serious—mental health, addiction, and access to care problems than other groups. To address this disparity and achieve health equality, we will need:
• Improved data to pinpoint the actual disparities that exist in healthcare access and health status.
• Realignment of human and financial resources.
o Near-term resource realignment will improve access to palliatives, including good mental health, substance use, and primary care for disparate groups.
o Over the longer term, resources can address and prevent the discrimination and inequity in the health determinants that led to the disparities in the first place.
Disparities unique to behavioral health and substance use care revolve around two factors:
• The stigma that often attaches to persons with these disorders.
• The relatively low level of people and resources committed to treat these disorders, relative to the size of the population involved.
The Wellstone-Domenici legislation passed in 2008 to require insurance parity for mental health and substance use care is an important milestone in efforts to promote health equity for behavioral health and substance abuse treatment. Using it, and the resources available to us, we can address the disparities among service recipients in our fields.
However, we must work with others to address the more common health-related disparities—the broader discrimination and inequity that continues to drive disparities in health today. The national health reform effort gives us that opportunity.
Ronald W. Manderscheid, PhD, worked for more than 30 years in the federal government on behavioral health research and policy. He is the Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors as well as a member of Behavioral Healthcare's Editorial Board.
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