Last week we discussed the meaning of a number of critical public health terms in our staff meeting. Of particular note in my group were the paired terms inequality and inequity. With guidance from ghU coordinators, we found a compelling difference from an ethics perspective.
Equality means equal distribution. I have 10 eggs, you have 10 eggs. This may sound fair, but this assessment doesn’t take into account differing needs. For example, you may have two children that need to be fed, while I live alone. Equitable, on the other hand, implies that the distribution of resources be equally distributed according to need. While equality may sound great, in many situations, it is equity that is needed.
This distinction is becoming increasingly important in an economic context, as well as our public health one. Occupy Wall Street protesters claim inequality in American wealth distribution. Their now iconic protest “We are the 99%”, emphasizes the wealth disparity between America’s newest generation of the ultra-wealthy and the middle class. However, this wealth inequality does not intrinsically imply inequity. The more important issue is whether or not the middle class has enough wealth to meet its needs, especially given recession and cuts to social programs that will occur in the next few years. Look at it this way: the late 90s also had enormous wealth disparity in America, but because the economy was good, it wasn’t an issue. Inequity is the issue that needs to be discussed.
Another great example is in the recent Republican Debates. Many candidates seem to be favoring the “Flat Tax”, a low flat percentage income tax on all brackets with few deductions. This is certainly equal – no one can argue against that. But it is terribly regressive, and brutally inequitable to the nation’s poor. While someone making $100,000 can certainly live on $90,000, someone scraping by on $10,000 may not make it on $9,000. Especially disconcerting is the proposed system of covering the difference – by increasing the federal sales tax. Since there are certain necessities everyone needs regardless of income bracket, this increased sales tax disproportionately affects the poor. Clearly, a “Flat Tax” is not equitable. I should make it clear, to avoid a heated political debate, that I do favor tax reform. In fact, the “Flat Tax” and OWS are both confronting the problem of wealth distribution and public debt. They represent two extremes, and in my opinion a better path will found in the middle.
There’s a clear and crucial distinction between equality and equity, one that should not be muddled by protesters or politicians. To do so can place groups at severe disadvantage, be it in terms of healthcare or economic well-being.