In Pursuit of Health Equity: Comparing U.S. and EU Approaches to Eliminating Disparities
Significant health differences across population subgroups have persisted for nearly 30 years since first officially documented in the United States. These differences have been subject to attention in health policy and philanthropy circles for more than a decade.
Despite the activity focused on this problem in the United States and other developed countries, there remains surprisingly little consensus about the meaning of terms such as “health disparities,” “health inequalities,” and “health equity.” Consequently, some in the field emphasize the practical implications of the terms we use, as in the case of the updated definition proposed by Braveman and Gruskin specifying that a disparity must be potentially amenable to redress via policy solutions:
“A health disparity/inequality is a particular type of difference in health or in the most important influences on health that could potentially be shaped by policies; it is a difference in which disadvantaged social groups (such as the poor, racial/ethnic minorities, women, or other groups that have persistently experienced social disadvantage or discrimination) systematically experience worse health or greater health risks than more advantaged groups.”
Beyond the issue of definition, there are evident differences in approaches used to assess and address health disparities. Notably, health disparities measurement has reflected an implicit assumption that relevant differences are those between better- and worse-off social groups, selected a priori based on who has been more- or less-advantaged in society. A major difference in assessing disparities relates to how policymakers focus on the health disparities of particular disadvantaged groups—in the case of the United States, racial and ethnic minorities—or take a broader view of the range of (often interrelated) socioeconomic factors that contribute to producing disparities. Based on the definition adopted above, either formulation of the disparities problem would qualify for policy attention.
However, in the United States, the large differences in health between the economically successful and unsuccessful have been largely ignored, at least as part of the disparities agenda. Moreover, we are at risk of allowing the shortcomings of our health care system to distract us from attending to the most important causal determinants of health disparities.
In this paper, we compare and contrast the U.S. public policy approach to tackling the problem of health disparities with the European approach. We begin by providing an overview of the ways in which the issue of health disparities has been framed in American and European policy discourse. We next compare how health disparities have been addressed in policy statements produced by the U.S. Department of Health and Human Services (HHS) and by the European Commission, the executive body of the European Union (EU). In so doing, we seek to illuminate implicit choices that stand to have a bearing on the outcomes of these initiatives.
