World Nutrition Volume 5, Number 6, June 2014
[Feedback] World Nutrition June 2014, 5, 6, pp?
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World Nutrition Volume 5, Number 6, June 2014
Journal of the World Public Health Nutrition Association
Published monthly at www.wphna.org/worldnutrition/
The equality/equity controversy
Access May 2013 WN column of Geoffrey Cannon here Insert link to Geoffrey’s May column here
Insert a new photo here
From Claudio Schuftan, Ho Chi Minh City, Vietnam
I refer to a paragraph in Geoffrey Cannon’s Column in World Nutrition this May.
“Inequalities in health’ strikes me as an odd concept. It is common sense that there always have been, are, and always will be, inequalities in health – and in all other aspects of life also. Surely what is meant is ‘inequity’, which is an ethical concept – inequalities that are unfair or unjust. By itself ‘equality’ is sort-of mathematical. So why do most people concerned with public health and public goods persist in using the term ‘inequality’? Could ‘inequalities in health’ be a term originated in bad faith?”
I beg to disagree with him (and I can respond the two questions he poses). Here is why.
First, I quote Association member Urban Jonsson, an expert on the topic:
Equality and Equity
Equality and equity are important concepts used in describing societies. Unfortunately they are often used interchangeably and people, including recognised scholars and researchers, do not seem to understand their important differences.
Equality is a human rights principle and is scientifically defined as ‘the same’. Equity is a justice concept, meaning ‘fairness’. This is where the ambiguity of the term ‘equity’ becomes obvious. Originally a law concept, created exactly for the reason to allow judges that particular ambiguity, ‘equity’ has now been adopted in development discussions, which raises the question of ‘fair according to whom?’
‘Equity’ is not even mentioned in either the UN Charter or the Universal Declaration of Human Rights. There is no single definition of equity. Any interpretation reflects a value judgment. The difference between ‘equality’ and ‘equity’ is best illustrated by the following example. Two individuals doing the same job with the same result should have equal pay, while individuals doing different jobs, requiring very different skills, should have different pays in the name of fairness; an equitable pay. While in the first case a scientific comparison can be done, that is not possible in the second case. There is no scientific way to assess ‘fairness’, because it is based on a judgment.
A common misconception about ‘equality’ is the perception that just because equality can never fully be achieved it is not a useful concept in development planning and practice. However, development, democracy, justice, freedoms and human rights are all equally important, but also share another characteristic – they all represently un-achievable goals in practice! But that does not mean that these hegemonic aspirations are not in one way or another guiding most people and countries in their development efforts. Few would claim that we should give up the idea of democracy just because of the fact that no country has achieved or is likely to ever achieve complete democracy.
Finally, a new way of thinking about ‘equity’ and ‘equality’ would be to interpret these two concepts within the re-construction of ‘development’ in the Outcome and the Process dimensions, which allows for the definition of four types of uses, namely (1) equity of the process; (2) equity of the outcome; (3) equality of the process; and (4) equality of the outcome. Affirmative Action is a concept first used in the efforts to achieve gender equality, in for example higher education, when women have been given advantages in the selection of students in certain areas (medicine, law, etc.). Such ‘affirmative action’ would then mean the use of an equitable (morally defendable un-equal) process to achieve equality in outcomes.
With these new definitions, both equality and equity are important in development, but should each be applied where and when each of them is the appropriate choice, based on their different meanings in different contexts. For example, while equality plays an important role in the human right-based approach, equity is also often required in the process of development (affirmative action) in order to progressively achieve equal results. In conclusion, it is not either justice or human rights – It is both! It is not either equity or equality – It is both!
Equality of opportunity vs. equality of results
The difference between ‘equal opportunity’ and ‘equal result’ has been discussed since the age-old debate between Aristotle and Plato. Obviously there is some relationship between ‘equality of opportunity’ and ‘equality of result’, but exactly how this relationship manifests itself and how strong it is, has created two different schools of thought. The different interpretations reflect ideological differences.
One position is that the State should only ensure equal opportunities, because if people have equal opportunities, what they make of those opportunities is their responsibility. If they end up worse off, the State should not intervene to help them. Equality of opportunity is seen as only requiring the elimination of barriers to advancement that are in some sense arbitrary. Equality of opportunity means that a law must not unfairly disadvantage anyone in their opportunity to seek a variety of social goods such as education, employment, housing, etc. Equality of opportunity is believed to result automatically in equality of results. The neo-liberal political position ‘that our society should guarantee equality of opportunity, but not equality of result’ is increasingly heard in the current development debate. If individuals lack the capacity to act independently and to make their own free choices, it is their own fault. This is the explanation why the World Bank and many other conservative organisations prefer to define ‘equity’ as ‘equal opportunities’.
The second position favours equality of results, by arguing that the condition of equal opportunities can never fully be achieved in practice, and that there is no clear relationship between equality of opportunities and equality of results. A higher degree of equality of opportunity may be helpful, but is seldom a sufficient condition for equality of results. This is why the government must take specific actions to ensure the latter. This reflects a social-democratic position.
Second, I quote a key reference from the current literature on equity and equality.
EQUALITY: The principle of equality is a part of human rights. It is a principle that recognizes that the same rights apply to all citizens. Equality is the right of every individual to receive the same treatment. It is the principle behind all economic, social and cultural rights, with its opposite being discrimination. Wikipedia offers a definitions of inequality: “the unequal or discriminatory treatment of an individual by another due to their social or economic status, religion, sex, race, among others.” Inequalities are much greater than just ‘difference’. People are essentially equal; differences arise secondarily. Equality results from equity just as inequality results from inequity. A reduction of social and health inequalities is limited by capitalism and the structures specific to capitalism. Inequality is a lack of sameness in access, an exclusion from enjoyment, a disparity in the quality of life, while inequity is the lack of equity, that is to say, the inherent characteristic of a society which hinders the common good, hinders fairness. Inequity is injustice producing inequalities. Inequalities are measured, inequities are judged. Equality is not a substitute for equity. Doing more for disadvantaged people is not the same as addressing inequalities!
EQUITY: Equity is a justice concept, meaning ‘fairness’, i.e., natural justice, as opposed to the letter of the law. It denotes the willingness to give to each that which they deserve. Equity is a core legal concept and intimately linked to the notion of justice. ‘Equity in health is a measure of the degree of social justice prevailing in a society.” (health as merely the absence of disease limits our conception of health care services). The objective of health equality is to be seen in the context of a wider search for social justice. Inequity implies unfair and avoidable differences. A human rights analysis can determine if a given distribution is equitable or otherwise. Achieving health equality requires social policies of empowerment and a redistribution of social wealth. Inequity refers not only to injustice in distribution and access, but to processes which generate this injustice; inequity is about how the social structure determines social inequalities. Inequity arises from the appropriation of power and wealth, which leads to discrimination. Inequity and inequality change historically.
The expression social justice has come into play more recently. It refers to the search for equilibrium between unequal parties that respects their differing needs. Equity and equality are not equivalent, nor can they be reduced to simple risk factors, as currently understood by many. (Social and health equity and equality: The need for a scientific framework. Adriana María Correa Botero, MSc; María Mercedes Arias Valencia, PhD; Jaime Carmona-Fonseca, MSc, Social Medicine (www.socialmedicine.info), Volume 7, Number 1, December 2012).
This should set the record straight despite what strikes Geoffrey as odd. It also should help our readers get clear on these terms often used indistinctly which is here proven wrong.
Claudio
Schuftan
Ho Chi Minh City, Vietnam
Email: cschuftan@phmovement.org
Please cite as: Schuftan C. [Feedback]. Counterpoint: The equity/equality controversy, World Nutrition June 2014, 5, 6, xxx-xxx.