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My double life in education and health care: Do we want equality or equity?

April 25, 2017 | By: Paula Bussard

My double life in education and health care: Do we want equality or equity?

This picture depicts the difference between equality and equity.

The illustration is quite familiar to those in public education, including me, since I am president of my local school board. Increasingly, these concepts also resonate in my professional life at The Hospital and Healthsystem Association of Pennsylvania.

As educators, health care professionals, policymakers, and engaged citizens we have some important questions to ask ourselves.

Do we want to give all children equal opportunity to see over the fence, to learn how the game is played? Do we want to foster their health and well-being, and help them develop their interests, knowledge, and skills to play along?

Who Needs Equity? Why?

In our school district in mid-state Pennsylvania, about 40 percent of children qualify for free or reduced meals because they come from families with incomes at or below the level used by the federal government to identify need.

Now picture yourself as a child in one of these families—headed by a single mother with a high school degree, working two jobs (neither of which provides health insurance), with two children. Mom is trying hard to cover all the bases.

Healthy meals that fit the demands of her schedule and budget are a challenge. TV and video games are on a lot. Books, and time for reading and stories, may be scarce.

What Does Equity Mean? An Example

Let’s think about the youngest child, Jim, who is just beginning kindergarten and who suffers from asthma. What might equity look like for Jim?

In school, entering kindergarten

In health care, at the clinic

Everyone in the class is offered healthy breakfasts at their desks so that everyone, including Jim, is ready to learn.

Jim and others are 6–12 months behind in vocabulary and reading readiness, so these students get literacy coaching to help them catch up.

Jim gets a healthy lunch at no cost. 

On Fridays, Jim goes home with a backpack containing food from the local food pantry, for weekend meals.

Because many students have circumstances like Jim’s, this class has been assigned a highly qualified, experienced teacher, who also has been trained in the best ways to communicate with families experiencing intergenerational poverty.

Early in the year, Jim’s school hosts an ice cream social—complete with childcare services—to get to know students’ families, including Jim’s mom and big sister.

Jim has a good school year. To make sure his reading and math readiness stays strong during the summer, his school connects Jim, his mom, and his big sister to free programs at the summer playground and local library.

Jim’s family goes to the local community clinic, a federally qualified health care center, for health care.

The clinic’s outreach staff help Jim’s family enroll in insurance coverage: CHIP for the children, subsidized (and hence affordable) coverage through the health insurance marketplace for mom.

Clinical staff closely track Jim’s development and make sure he gets recommended vaccinations, screenings, and other routine and preventive care.

 

The whole family learns how to help Jim manage his asthma. Jim’s mom gets his medication refilled at no cost during his checkups.

After an asthma attack brings Jim to the local emergency room, a community health worker visits Jim’s home to:

  • Identify potential asthma triggers
  • Help Jim’s mom reduce the chance of another attack

The clinic takes to heart its role as Jim’s health care home. The family knows that here they will find help with any problem or issue that is undermining their health or well-being.

Do we invest in equity? Or focus on funding equality?

In both health care and education, I see a tug of war between policies that invest to help avoid the limitations and harm that can be caused by socioeconomic circumstances and policies that tend toward a more narrow definition of equality.

Again, we must ask ourselves questions. Which approaches are fairer? How do we measure success, and for whom?

I reflect on these considerations during debates about school vouchers and school funding formulas. Vouchers may well help some parents afford the education they want for their children. But will the vouchers be enough to help Jim’s family get him into the school of their choice, or merely take needed funding away from his public school?

Recent health care proposals have suggested less flexibility (in other words, more equality) for tax credits designed to help make coverage affordable. Will a more “one-size-fits-all” approach work when older adults are more likely to need more health care and have higher insurance premiums?

I watch hospital leaders cobble together the donations and grant funding needed to address the root causes of patients’ poor health and frequent hospitalizations. Hospitals are connecting patients with healthy food sources, safe housing options, and job training. But where are the predictable, sustainable funding and payments to support that work?

Why equal opportunity requires equity

If we believe in equal opportunity, I believe we must also think about equity. Otherwise, in both education and health care, are we just providing false promises and false hopes?

In my experience, most educators and health care professionals think this way. That’s the reason 1,500 hospitals across the nation—72 of them here in Pennsylvania—have pledged to make sure that every person in their community receives high-quality, equitable, and safe care. Many other hospitals are working toward this goal independently.

I encourage those who serve in schools, hospitals, and other health care settings to join the equity conversation. Speak up. Your voices can be powerful, grounded as they are in your work with all kinds of students and patients.

Ask yourself:  What do you want to see when you peer over the fence into the future? What will be the state of play? Will it be equitable?

Image Source: Interaction Institute for Social Change | Artist: Angus Maguire
www.Interactioninstitute.org | www.madewithangus.com

Paula Bussard
Written by Paula Bussard

Paula Bussard is HAP’s chief strategy officer. Paula has more than 25 years of experience in health care policy and administration. Paula assists with creating organizational direction, and executing, communicating, and sustaining high-priority and strategic initiatives for HAP and its member hospitals and health systems.




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