Last month, we talked about ​social determinants of health,​ which are the conditions in which people are born, grow, live, work, and age, and how those conditions shape health outcomes.

Health equity builds directly on that idea.

Health equity is the principle that everyone should have a fair and just opportunity to attain their highest possible level of health.

That definition is simple, but the deeper you dig, the more you realize how complex the solution is.

To understand health equity is to understand that everything is public health.

Equity is Not the Same as Equality

Equity and equality are not the same. The difference is subtle, but important.

Equality is about sameness, while equity is about fairness.

Because people start from different places, the same resources don’t always lead to the same outcomes. For example, do you and your friend eat the same foods, get the same amount of sleep, have the same body type, or have the same health history? Equity recognizes these differences and responds to them, aiming for fairness rather than uniformity.

Health Equity Means Removing Barriers to Health

A core part of health equity work is identifying and removing obstacles that prevent people from being healthy.

These obstacles, many of which we covered in our earlier newsletter about social determinants of health, include things like:

• Poverty
• Discrimination
• Limited access to care and resources
• Policies or systems that advantage some groups while disadvantaging others

If we use access to healthcare as an example, people in rural communities often have to commute long distances to access care, and often that care is limited. Rural health clinics often have a hard time getting cutting-edge medical advancements. An equity framing would advocate for rural communities to be prioritized in getting more comprehensive and easily accessible care, and that public health resources should be spent focusing on this issue.

Health equity also requires valuing all people equally. That means ensuring everyone has access to effective research, treatment, and opportunities for good health, and addressing historical injustices that have shaped health outcomes over time.

Health Equity is About Conditions, Not Just Care

Health equity goes far beyond access to healthcare. In fact, health is shaped long before you ever enter a doctor’s office.

It’s shaped by the conditions you are born into and live within. This includes factors like whether housing is stable, neighborhoods are safe, jobs pay a living wage, schools are well-resourced, and food is affordable and accessible.

These conditions are influenced by political, legal, and economic systems, as well as by social norms and institutional practices that determine how power and resources are distributed.

Health equity work focuses on changing these underlying conditions, not just treating the outcomes they produce.

Health Equity and Health Disparities

Health equity and health disparities are closely connected.

• Health equity is the ethical principle and goal that we should all receive fair and just opportunities for health.
• Health disparities are the ways inequities manifest in the real world.

A health disparity is the higher burden of disease, injury, or early death experienced by certain population groups compared to others. These differences are linked to social determinants of health such as income, education, housing, discrimination, and access to care.

Importantly, these differences are preventable, which is why they are such a central concern in public health.

We measure progress toward health equity by looking at whether or not these disparities are shrinking.

Understanding Health Equity in Action

Health equity can be understood in two ways:

• As a process: actively working to reduce health disparities and the conditions that produce them.
• As an outcome: the elimination of avoidable and unjust differences in health and opportunity.

Achieving health equity requires improved access to the resources that strongly influence health, like good jobs with fair pay, quality education, safe housing, supportive social environments, and high-quality healthcare, especially for groups who have historically lacked access.

What This Means for Public Health Programming

Health equity doesn’t just change what public health programs focus on; it changes how they’re designed and how success is measured.

An equity-focused approach looks beyond symptoms to the conditions that are driving them. Instead of asking only how to improve health overall, it asks how to reduce the gaps that leave some groups consistently worse off than others.

This means building partnerships with housing agencies, schools, employers, transportation systems, or community organizations, because health is shaped in all of these places, not just in healthcare settings. As we mentioned earlier, public health is woven into nearly every facet of public life.

It also changes how we define success. A program can improve average health outcomes and still leave the same groups behind. From an equity perspective, progress isn’t just about whether health improves overall, it’s about whether the people facing the greatest barriers have improved health outcomes.

Public health programming grounded in equity asks different questions from the start:

• Who benefits from this program?
• Who might be unintentionally excluded?
• Are gaps between advantaged and disadvantaged groups actually shrinking?

When these questions guide planning and evaluation, programs are better positioned to create change that is not only effective, but fair and lasting.

At CHIRP, health equity is not an abstract concept, it’s a guiding principle. We work with community-based organizations to build programs that reflect lived experience, address real barriers, and create fairer opportunities for community health.

In future newsletters, we’ll explore how health equity shows up in specific contexts, including wealth, racism, sexism, ableism, mass incarceration, and more. For now, this foundation matters.

Because when everyone has a fair chance to be healthy, communities are stronger, systems work better, and public health truly serves the public.