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Improving health equity in the United States is a major focus of the Affordable Care Act. Regina Davis Moss, The American Public Health Association's (APHA) associate director for Health Policy and Practice, explains that using the term inequity as opposed to disparity leads us to examine unjust practices and policies to determine "[horizontal ellipsis]what can be done so that everyone has the opportunity to attain their full health potential." To help in this endeavor, the Affordable Care Act created offices of minority health in 6 Health and Human Services agencies and established the National Center on Minority and Health Disparities as an institute at the National Institutes of Health.


Differences in quality of jobs, access to healthcare, transportation, education, and the environment can all contribute to people in the United States being at a disadvantage from birth. These inequities contribute to disparities, including shorter and less healthful lives. Moss notes that focusing on disparities examines only the differences between both incidence and prevalence of health conditions. However, examining inequities allows for a focus on policies and practice. The APHA is addressing inequities related to neighborhoods and physical activity. If a neighborhood does not have a safe and accessible area for physical activity, then health disparities can result. In addition, preventative interventions and improving innovations are being addressed through the Affordable Care Act.


In the San Francisco area, the Bay Area Regional Health Inequities Initiative is working to examine the efforts of member health departments to reduce or eliminate inequities. The group has developed a toolkit that includes surveys, focus groups, interviews, and document review guidelines. The toolkit can be used to assess what individual health departments are doing to address health inequities, skills, and capacities and identify gaps in the efforts. Using the toolkit led public health officials in King County, Washington, to establish social justice as a consideration in all decision-making processes. The county looks at policy, budget development, and community engagement through a lens of health equity and social justice.


As nurse educators, we need to be certain that our students understand concepts relevant to the Affordable Care Act. Disparity, inequity, and social justice all need to be addressed in our courses so that our nursing students understand current healthcare conversations.


Source: Tucker C. Movement for health equity spurs action nationwide: tackling disparities. The Nation's Health. January 2013;42(10):1-18. Available at: Accessed January 14, 2013.


Submitted by: Robin E. Pattillo, PhD, RN, CNL, News Editor at