Is it more important to be Equal or Equitable?

Written by:  Luana Yoshikawa-Scanlan, MBA, PRIME Consultants
Is it more important to be Equal or Equitable?Dominykas Niaura, a writer on the staff of ‘BoredPanda.com’ posted a story shared by a teacher logged in as ‘aloneindarkness7’ (2019).  This teacher starts her school year off with a simple lesson in equity for her 8-year-old students:
​
I have students pretend they got hurt and need a band-aid. 
I ask the first one where they are hurt. If he says his finger, I put the band-aid on his finger. Then I ask the second one where they hurt. No matter what the child says I put the band-aid on their finger exactly like the first child.  I keep doing that through the whole class.  No matter where they say their injury is, I do the same thing I did with the first child.
After they’ve all received band-aids, in the same spot, I ask if that actually helped any of them other than the first child.  They’ll try to get me to understand that they were hurt somewhere else. I act like I’m just now understanding what they needed.
Then I explain, “there might be moments this year where some of you get different things (in the classroom) because you need them differently, just like you needed a band-aid in a different spot.”

 
While equal and equitable may sound alike, achieving equity can lead to significantly better results for people who need resources, and opportunities, in a different way from others.

Equality means everyone is treated the same way as if they have no individual differences or needs, and in so doing they should share the same experiences and the same results from their efforts.

Equity means treating people according to what they need to achieve the same experiences as others and the same results from their efforts. All people do not need the same things.

Social barriers like racism and wealth, personal barriers like disabilities, age, and gender can make it difficult for people to access resources and opportunities.  For example, free healthcare may make a hospital visit equally available for everyone, but those without transportation to the hospital may not receive that healthcare in a fair way.  They may need additional assistance such as a bus pass or taxi fare in order to access the hospital.  The issue is the inherent lack of something, which in many cases is the lack of access to the opportunity to even try, that others may not have to deal with in their quest for healthcare.

Are policies fair to all people?  Are resources accessible by all people? 
Equity in policy and government is needed to ensure that people from diverse backgrounds and with diverse limitations, can attain their goals by providing opportunity and access to everyone fairly according to their circumstance. The U.S. Centers for Disease Control defines health equity as a process and equality as an outcome of that process (cdc.gov/minorityhealth). In this article we focus on health equity as a process, and access to COVID-19 vaccination as the outcome. 
Kaiser Permanente is one of the largest nonprofit healthcare provider systems in the U.S. with over 12 million members.  Kaiser defines health equity as the ‘fair and just treatment, access, opportunity, and advancement for all people in pursuit of their health and well-being.’ (Kaiser Permanente COVID-19 Vaccine Equity Toolkit, 2021) Kaiser provides examples of ‘enablers of vaccine equity’ including flexible hours at vaccine sites, multilingual site staff and information materials, transportation to the sites. These enablers meet the diverse needs of people wanting access to a life-saving vaccine.

The people of American Samoa, regardless of status have been given equitable access to COVID-19 vaccination. Not only were shipments of vaccines received immediately from the CDC, but the local healthcare system set up ‘vaccine enablers’ like multiple vaccine sites throughout the islands, with transportation to and from sites, and multilingual healthcare providers available to answer questions.    This is one of the few times that we, as a community, have experienced health equity.
Unfortunately, this is not the case in other countries. The unequal distribution of COVID-19 vaccines throughout the world prompted the (WHO) World Health Organization’s Director-General to declare, “Vaccine equity is the challenge of our time.” (https://news.un.org). 
Less than ‘one-percent of the population in low- and middle-income countries’ is vaccinated as of August 3, 2021 according to the Global Dashboard for COVID-19 Vaccine Equity https://data.undp.org/vaccine-equity/. 
Wealthier countries like the U.S. have committed to shipping vaccines to poorer countries.  However, the lack of infrastructure and manpower to administer vaccines in many of these underdeveloped countries require an average 57% increase in health budgets to vaccinate 70% of their population (WHO).  The shipping of vaccines to these countries (providing equal numbers of vaccine shots) does not achieve access or equitable vaccination in these countries. It is simply the ‘band-aid’ for the problem.

In 2019, Samoa experienced an unprecedented outbreak of measles, resulting in 5707 cases and at least 83 deaths.  Simply sending measles vaccines to Samoa was not enough to stop the disease.  Lt. Governor of Hawai’i, Dr. Josh Green, assembled a cohort of 65 doctors and nurses to join 150 immunization teams from New Zealand and Australia to immunize 50,000 people in Samoa.  The WHO-backed mission was described as ‘organized chaos’ [1] by reporters as volunteer healthcare providers managed to keep vaccines cold without proper containers, assess sick children without being able to speak the Samoan language, and distribute vaccines with limited resources. 
Based on the medical team’s experiences, if the vaccines had been simply shipped to Samoa it would have taken longer to reach the vaccination goal and possibly resulted in more deaths.  While Samoa would have had vaccines in hand (equality with other countries), it lacked the infrastructure and manpower to vaccinate 50,000 people in one week (the enablers for vaccine equity). Equality meant the vaccines were in Samoa. Equity meant that vaccines were in the arms of the people. The ultimate goal is to ‘liberate’ our world from disease. But until such time, we should strive for equity beyond equality.


[1] https://www.civilbeat.org/2019/12/hawaii-medical-team-delivers-vaccines-to-measles-ravaged-samoa-2/