Table 1 Concepts, definitions, and considerations on what the literature says about health equity

• When differences are noted in health outcomes, between two groups based on a specific characteristic such as race, income, among other social or structural attributes of the population

• Not all health differences warrant focused attention but health differences adversely affecting socially disadvantaged groups are particularly unacceptable because ill health can be an obstacle to overcoming social disadvantage [10].

• “Not all health differences are health disparities;” Paula Braveman suggests that health disparities are concerned with social justice (i.e., justice with respect to treatment of more advantaged vs. less advantaged socioeconomic groups in terms of healthcare) [1]

• Kawachi, I., and colleagues consider health inequality as a “generic term used to designate differences, variations, and disparities in the health achievements of individuals and groups.” [11]

• Whitehead, M., suggests that “inequalities” in the European context have the same connotations of unfairness and injustice as the terms “inequities” [12]

• Health disparities are differences that adversely affect socially disadvantaged groups; they are a specific subset of health differences that are relevant to social justice because they may arise from intentional or unintentional discrimination or marginalization and are likely to reinforce social disadvantage and vulnerability [7]

• Health disparity is a more charged term; “to many a disparity implies an inequity or an injustice rather than a simple inequality” [13]

• Health disparities emerge and persist through complex mechanisms that include socioeconomic, environmental, and system-level factors [14]

• According to Kawachi, I. and colleagues, the term health inequity refers to those inequalities in health that are deemed to be unfair or stemming from some form on injustice [15]

How to determine whether a difference in health outcomes between groups is a disparity or not (in other words, are they unjust and unfair?)

• Which differences are inevitable, unavoidable, unnecessary, and unfair, will vary from country to country and from time to time [16].

• “Determining when a difference becomes a disparity may be problematic because a disparity is not measured directly, but rather as a residual or a difference between two groups, often only after other factors that might contribute to that difference have been statistically controlled for (more specifically in the context of racial and ethnic disparities” [13]

• “Equality is providing everyone with the same tools and resources. Equity is providing tools and resources based on needs that allow everyone the opportunity to be as healthy as possible.” [17]

• “Health equity is the principle underlying a commitment to reduce, and ultimately, eliminate disparities in health and in its determinants, including social determinants.” [1]

• “Health disparities and their determinants are the metric for assessing health equity, the principle underlying a commitment to reducing disparities in health and its determinants; health equity is social justice in health.” [7]

• “Attainment of the highest level of health for all people. Achieving health equity requires valuing people equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities” (Healthy People, 2020)

• Equity in health care is the equal access to available care for equal need; equal utilization for equal need; equal quality of care for all [16].

• The crux of the distinction between equality and equity is that what we identify as a health inequity, depend on our own theories of justice, what we believe is society, and our reasoning on why we think health inequities exist [11].