-Inequalities are staring us in the face now, but will be shouting at us after MDGs-year 2015. (C. Gore)
-Once and for all: There is no such a thing a ‘moderately equitable’ or ‘equitable inequalities’.
1. Equality is achieved in situations in which all persons in a society enjoy equal (the same) access to available goods and services necessary to fulfill their basic human needs. By extension, equality seeks ‘equality for all persons in their dignity and their human rights’. So, to achieve equality, note that dignity and indignation have a common etymologic root!
Equity is achieved in situations in which everyone is treated ‘fairly’ (not necessarily the same).* Equity is related to distributive justice, to being just, to being fair or impartial.
*: But beware: What is fair is not necessarily equal and what is equal is not necessarily fair. Everyone knows what is equal, but no one, under the circumstances, knows likewise what is fair.
2. Equality entails processes that stand for dignity and for non-discrimination (a human rights principle).
Equity entails processes that stand for fairness and justice (a concept of justice).
3. Since equity operates within the realm of ethics and justice, only occasionally does it operate through legal force. Human rights (HR), to a greater extent do operate in the realm of international HR law and of government policy. As we know, internationally recognized bodies are mandated to monitor compliance.** Nevertheless, legal enforcement of equality and human rights remains woefully inadequate.
**: Caveat: At times, the legal basis for human rights may be viewed as a potential weakness, if it results in exclusive reliance on the courts to redress injustice. (This caveat notwithstanding, the legal nature of human rights concepts and instruments is a precious and unique resource).
4. There is an important difference between equality of opportunities and equality of results. In the case of the former, everybody has the same chance; in the latter, everybody achieves the same level. To use an example, all this boils down to having the right-to-equal-access-to-health-care-services versus having the-right-to-be-healthy.*** What is important is ‘having an initial opportunity to finally end up with an achievement’.
***: As a corollary, let us not be fooled: Equality does not come cheap. Achieving equality does require resources.
5. Furthermore, disparity refers to inequality between, among other, income groups, social classes, the genders, ethnic groups.
Disparity reduction entails the reduction of disparity between people who are rich and people who are poor. (The target of our actions is thus double: people who live in poverty and people who are rich). In other words, poverty reduction is to be achieved through disparity reduction since this is what really contextualizes poverty within the processes of exploitation, of domination and of power imbalances. (Urban Jonsson)
6. Inequity refers to the presence of systematic and potentially remediable difference in the justice or fairness towards population groups defined socially, economically, or geographically. [Inequity is thus not the same as inequality, which is a much broader term used in the human rights field to describe differences among individuals, some of which are not 100% reversible].
7.Consequently, the work of HR activists entails striving to reduce or to get-rid-of potentially reversible inequalities and their sociopolitical, economic and cultural determinants.
8. Some languages do not make a distinction between equity and equality, which may lead to confusion and a need to clarify the exact meaning in different contexts. Some people use the term “unfairness” as a proxy for inequity, but unfairness is not measurable and is, therefore, not a useful term for policy or for evaluation.
9. Inequity can be horizontal or vertical.
Horizontal inequity indicates that people with the same needs (unfairly) do not have access to the same resources (or fail to get equal-resources-for-equal-needs).
Vertical inequity exists when people with greater needs are not provided with greater resources (or fail to get equal-resources-for-equal-needs; or fail to get more-resources-for-greater-needs).
For example, in population surveys, similar use of services across population groups can still signify inequity, because different population subgroups have different needs, some more than others. In this case, what may be considered equitable (equal-use-across-population-subgroups) is, in fact, inequitable.
10. Most industrialized countries have reasonably achieved both horizontal and vertical equity in the usufruct of primary services (health, education, housing), meaning that people with greater needs eventually receive more of the primary services. Although some countries have further achieved horizontal equity in the use of specialist health services or higher education, very few have achieved vertical equity, because socially-deprived populations**** have less access to these than their needs require. (Barbara Starfield)
****: Equity demands that poorer households not be disproportionately burdened with expenses for social services as compared to richer households.
Non-discrimination is really inseparable from equality.
Work to fight discrimination includes not only countering intentional bias, but also actions against unintentional discriminatory bias.
11. Discrimination consists in offering different treatment to two persons or group of persons when both are in comparable situations; conversely, it also means treating two persons or groups of persons equally when both are in different situations.
12. Globalization may be on its way to blur national distinctions, but it is far from having reduced discrimination. Under Globalization, discrimination is more overt and sometimes actually exacerbated. Furthermore, globalization has favored the expression of new forms of discrimination that are undermining social cohesion and democracy. (CETIM)
Inequalities in health are socially determined
13. It is no news that differences in health vary according to levels of social advantage, with worse health found among the disadvantaged.
14. Equity in health cannot be achieved solely by pursuing more equitable distribution of medical care, but also requires pursuing equity in the social conditions that powerfully shape health and health inequalities. These Readers have been saying this for ever.
15. Rather than simply achieving some minimal level of ‘absence of disease’, HR-based solutions bring the marginalized and discriminated to levels of health enjoyed by the most socially advantaged groups.
16. The right to the highest attainable standard of health is thus operationalized as part of providing equal opportunities to achieve the standards of health enjoyed by a society’s socially privileged persons.*****
*****: Closing of this gap is accomplished by what Margaret Whitehead and Göran Dahlgren have called ‘leveling up’.
17. Because of all of the above, in human rights work, we strive to level the playing field between claim holders and duty bearers through their respective empowerment; only thus can we carry out the processes needed to value persons equally. In short, we are driven by the belief that something needs to be done to achieve equal results –and we struggle hard for it.
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org