Defining racial health equity

Abstract

OBJECTIVE: Current literature lacks an established and adoptable definition of "racial health equity." This study aimed to catalog and evaluate, via thematic analyses, of definitions and terminology related to racial health equity across the specific studies from the Robert Wood Johnson Foundation and Cochrane-US (RWJF-Cochrane) "Centering Racial Health Equity in Systematic Reviews" project, and to propose a working definition based on study findings.

STUDY DESIGN: We employed an integrative review framework to analyze current definitions of racial health equity terms identified within published studies from the RWJF-Cochrane project. Definitions of racial health equity were identified via dual reviewer screening of all identified studies and interview transcripts, which included recent systematic reviews (published since 2020), theoretical and conceptual health literature, and listening exercises with interest holders involved in systematic reviews addressing health equity. Identified definitions were analyzed via thematic coding using the Braun and Clarke framework.

RESULTS: We reviewed 157 systematic reviews, 29 interviews, and 16 articles related to racial health equity for the presence of racial health equity definitions. This review resulted in 32 definitions of racial health equity from theoretical and conceptual health literature (n= 16) and interest holder transcripts (n= 16). No systematic reviews contained definitions of racial health equity. Retrieved definitions emphasize equality in health or healthcare, including outcomes, processes, or care; themes of discrimination in healthcare settings; and acknowledgments of the intersections of social determinants of health with health equity. Definitions varied on the role of improving healthcare access in achieving racial health equity. A working definition of racial health equity is proposed using common themes identified across definitions.

CONCLUSION: Our findings highlight that a clear and consistent definition of racial health equity will assist researchers, practitioners, and policymakers with developing metrics and interventions aimed at reducing racial health inequities. Thus, we propose a working definition for racial health equity, which emphasizes 1) fairness and justice in health, 2) equality in health outcomes and access across racialized groups, 3) a recognition that social consequences of one's race and/or ethnicity may influence health or the quality of healthcare received. We also note areas of variability in understandings that require further discussion.