One of the most painful weaknesses of the health care system is its failure to provide care of equal quality to everyone, regardless of race, age, gender, ethnicity, income, geographic location, or any other demographic detail. That’s why equity is one of the “Aims for Improvement” in the Institute of Medicine’s 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century
, which describes the immense divide between what we know to be good health care and the health care that people actually receive.
If one measure of a society’s success is how it treats its members who are most in need, many countries — including those considered to be “developed” — have achieved precious little success. In the United States, for instance, the life expectancy of a black child in Baltimore, Maryland, is seven years shorter than that of a white child in the same city. “It’s not an overstatement to say that the health care delivery system doesn’t consistently provide high-quality care. Or said another way, many people simply do not benefit from what medicine has to offer,” says William C. Richardson, PhD, chair of the committee that produced the Chasm report. Monetary expense is often cited as the primary barrier to equal care, perhaps in part because so many improvement initiatives focus on high-tech changes (information technology, computerization of processes, and the like). But very often, low-tech changes can do a lot to improve access and care. Many of the concepts and methods to improve access, patient flow, and care management can be successfully adapted to all patient care settings, even those with the fewest material resources.
“Inequity is un-quality,” says Donald M. Berwick, MD, MPP, former President and Chief Executive Officer of the Institute for Healthcare Improvement and one of the Chasm report’s architects. “A system, such as ours today, which continues to house racial and ethnic gaps in health status cannot be called in its essence a high-quality system.” Equity is about consistency across all settings and all nations. It requires nothing less than a commitment to a single standard of quality and excellence for all patients, in all corners of the global health care system.