Shared Models and Shared Meaning

Last week I visited a health system to discuss the system’s initiatives to achieve health equity.

Is equity a synonym for equality?

No.

‘Equity’ is very similar to ‘equality’ in spelling and share the same Latin root aequus.  The terms are easily confused.

The picture from the Robert Woods Johnson Foundation shows the difference: in the picture, equality means everyone gets the same bike, ‘a human-powered vehicle’.  Equity means people have a human-powered vehicle that’s appropriate to their physical stature and abilities.

The picture makes it easy to distinguish the two words. That’s helpful when we start thinking and acting to address current inequity in health outcomes and experiences.

For example, there’s important evidence that health outcomes and experiences in the U.S. are worse for people who are black Americans, after accounting for other factors like education and income.   The cover story of The New York Times magazine two weeks ago makes the case that the ‘answer to the disparity in death rates [for black mothers and babies] has everything to do with the lived experience of being a black woman in America’.

What would it take to have equitable outcomes in mother and baby health in the United States?  If you think that’s a loaded question, I share your view.   Developing a good answer means we need to understand the lived experience of racism in our country rooted in a legacy of laws and policies.  The understanding you bring to the question almost surely will differ, too, depending on your race.  As a white person, it’s clear to me that I don’t have the same understanding of racism in this country as my black colleagues, so I will have to bolster my empathy with study of history in preparation for serious project work.

Tie to visual management

Proponents of Lean emphasize the core role of visual management as a foundation for reliable work:  Visual management is “[t]he placement in plain view of all the tools, parts, production activities, and indicators of production system performance, so the status of the system can be understood at a glance by everyone involved.” (Lean Lexicon: a graphical glossary for Lean Thinkers, 4th edition, Lean Enterprise Institute, March 2008, p. 112).

The Robert Wood Johnson Foundation picture is a tool for equity initiatives.  If shared and kept ‘in plain view’, we can look for analogies to equitable bicycles as we dive into the hard work of creating a world without inequity in health outcomes and experience.