Equity Isn't One Thing

I was recently talking to a friend who is an executive at a child-serving agency. We are part of a discussion group, and had been working through a set of articles on equity. “I can’t believe it,” she said, exasperated. “It’s the same thing in every one of these.”

In each of these articles, the authors described ‘listening to staff’ as the beginning of their process for improving equity. Yet when they described the concerns staff raised, and the solutions enacted, a familiar pattern emerged. Staff consistently raised inequitable pay as a key issue. And the ‘solutions’ enacted each glossed over the issue of inequitable pay.

As these brave (and frustrated) staff persons noted, much of inequity boils down to dollars and cents. Inequity is perpetuated by laws and norms that make it ‘okay’ for one group of people to profit from another group’s labor without providing them with just compensation. This legacy of inequity lives on in healthcare. However uncomfortable this is, we need to address it.

Though there’s a temptation to describe inequity primarily in terms of health outcomes, it isn’t just one thing. Inequity occurs when families and youth have a less positive experience of care, and when they get less value out of treatment than other people. Inequity ALSO occurs when staff do not have the same opportunities to advance, or access to fundamentally just pay for the work they currently do. Inequity is all of these things, and the beliefs and behaviors underlying them.