According to the CDC, health equity is "is the state in which everyone has a fair and just opportunity to attain their highest level of health" (CDC, 2022). This requires societal change, as well as acknowledging social determinants of health, healthcare disparities, and historical and contemporary injustices.
Health equity is not equality. It is the access of resources according to need. Health equity requires understanding and working with the differences between people and communities to ensure they receive the care they need, not care that is the same as someone else who may have different needs is getting. Health equity requires understanding an individual's needs and treating them as a single person with unique life experiences who lives inside of an unequal system. To achieve health equity on a day-to-day basis, healthcare providers must work with their patients to understand their specific needs and how to meet them.
Poverty is considered one of the social determinants of health. It can influence someone's health at each stage of their life. It can be considered an upstream social determinant, which means that it leads to other behavioral determinants. Behavioral determinants are aspects of health that individuals have more control over, such as smoking or drug use, and are influenced by a person's environment and life circumstances. These behavioral determinants can be influenced by chronic distress caused by social determinants, including poverty. Chronic distress can also have negative health outcomes of its own accord, including hypervigilance and depression. Chronic stress is referred to as an allostatic load, but can also be described as wear-and-tear on individuals throughout their life (Price et al., 2018).
Poverty also impacts other areas of health that individuals have less control over (Price et al., 2018). For example, waste products are often disposed of in areas with higher poverty levels. These often are also places where more people of color live. These waste products then impact the community's overall health outcomes.
When working with patients, it is worthwhile to consider how every aspect of their life can impact their health - and living in poverty can have a major impact on many parts of an individual's life.
Percentage of Population Below the Federal Poverty Level, United States, 2000 and 2013-2017 (3,143 Counties) from the Health Resources and Services Administration
Even those who are not currently experiencing poverty can have their long term health impacted by childhood poverty. Children who grow up in poverty are more likely to experience psychological stressors - adverse childhood experiences can include child abuse, violence, and family conflict, for example (Price et al., 2018).
Other risk factors can include a lack of access to nutritious food and safe housing in neighborhoods with access to resources (Lee et al., 2021).
Also, children whose parents are considered working poor and do not have paid sick leave are far less likely to receive medical care as children. When they do receive care, its quality may be limited (Price et al., 2018). Poor children are twice as likely to not receive healthcare in a given year than children in higher income families (Simon, n.d.).
Even when treating adult patients, it is worthwhile to be aware of any effects childhood poverty may have had on their current health, or on their health outcomes.