Additional information 

Equity is defined as the quality of being fair, unbiased, and just. In other words, equity involves ensuring that everyone has access to the resources, opportunities, power and responsibility they need to reach their full, healthy potential and make changes so that unfair differences may be understood and addressed.

It might be helpful to think about equity as a door. A door that is closed can be intimidating. It prevents us from entering, being included, and enjoying opportunities and experiences that might be behind the door. In contrast, an open door is inviting. It welcomes us to enter, join in, and encounter possibilities that were not available to us on the other side of a closed door. Like an open door, equity is about providing a welcome invitation and ensuring that the door stays unlocked and open for everyone.

At the same time, it is important to appreciate that equity is not about creating or opening a single door. People may need to go through different doors to get what they need to be healthy. Consider two senior women who live in the country and need regular access to health care for a chronic condition, such as arthritis or diabetes. Because there is a doctor in a nearby town and the roads are usually in good condition, we might think that access to health care is not a concern for either woman – until we look more closely at their lives.

Woman 1	Woman 2
Has a driver’s license; and Is well enough to get to appointments on her own;	Has a driver’s license; Is well enough to get to appointments on her own; and Has a car;
BUT	BUT
Does not have access to a car because her partner uses it to get to work in a different direction.	Cares for her sick partner, whom she cannot leave alone for more than an hour or so at a time.

These women not only face personal barriers to care, such as not having ready access to a car, but they also experience systemic barriers, such as the lack of public transit in rural settings and the limitations of respite care programs. When thinking about equity, we need to consider how opportunities and barriers are influenced by personal circumstances within households, but also by systems, policies, and societies. These women face personal barriers to care, such as not having ready access to a car. Still, they also experience systemic barriers, such as the lack of public transit in rural settings and the limitations of respite care programs.

In a country such as Australia, where we have publicly funded health care, it might be easy to assume that the doors are open to everyone. But there is a great deal of variation in the health status of people. Some sub-populations, such as people living in poverty, are significantly less healthy, on average, than the population as a whole. 

Sometimes the likelihood of developing an illness cannot be changed, as when someone is exposed to a germ or has a family history of breast cancer. But often, the risk of ill health can be reduced or even eliminated by addressing factors that are open to change, such as where and how people live, work and play. 

For example, one person with a cold might get better quickly while another person with the same cold develops pneumonia. The difference itself may not be caused by an inequity. But some people may recover from a cold because they can afford medicine as well as time off work, while others develop pneumonia because they will lose their jobs if they take time off or cannot afford medicines. In this case, the difference is unfair and unjust. When we fail to address factors that can be changed, we may be creating and/or perpetuating inequity.

Distinguishing Equality and Equity

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, Australia’s publicly funded health care system 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 they have what they need to achieve and maintain health and well-being.