Fair isn't Equal: Mental Health Equity

Written by Step Above Stigma's SASIP Coordinator, Delaney-Rose Hunsdale.

In 1977, the World Health Organization (WHO) introduced the movement called “Health For All by the Year 2000”. In this movement WHO proposed that every person should achieve a level of health in all aspects of life, including medically, mentally, socially, and economically. Health For All (inclusive of mental health) is something I firmly believe in and wish to see achieved, however, there is still much to be done. In Canada, and many other countries, there are mental health inequities which create disparities in mental illness and overall mental well-being amongst populations. In this post I am going to breakdown my understanding of what mental health inequity is, factors that contribute to it, and ways to narrow the gap.

The words inequality and inequity are often used interchangeably, yet they do not have the same meaning. Equality is to treat everyone the same, whereas equity is to treat everyone fairly. I used to get confused as to how treating people equally and treating people fairly meant different things until I put it into context. In terms of health, treating people equally would mean to give everyone the same type and amount of resources, whereas treating people equitably would mean to ensure every individual is given the appropriate amount of resources they need to achieve health. Through an equitable way of thinking, it does not matter that person A needs more resources than person B, because they both were able to achieve the same goal, thus they were treated fair, not equal.

Mental health is a complex issue that can be impacted through individual, social, and environmental influences. Mental health inequities come into play when there are unfair differences in the quality of and access to mental health resources amongst populations. These unfair differences can be connected to the social determinants of health. According to WHO “the social determinants of health [and therefore mental health] are conditions in which people are born, grow, live, work, and age”. Some conditions can advantage us, whereas other conditions can disadvantage us. These many conditions, such as employment, race, housing, gender, and socioeconomic status, all accumulate advantageously or disadvantageously, and interconnect to create our lived experiences. Unfortunately, your disadvantaged conditions accumulate, the more likely you are to experience mental health inequities. For example, a significant predictor of mental well-being is socioeconomic status, wherein the lower your socioeconomic status, the poorer your mental health, and the higher your socioeconomic status, the better your mental health is. This is partly because of the cost of mental health services, where nearly 1/3 is paid out of pocket by Canadians. Only those that can afford mental health care can receive it in a timely manner.

So what can be done about these disparities? We will never all be born, grow, live, work, and age in identical conditions, nor will we all make the same individual choices, therefore, inequalities are uncontrollable and will likely always exist, however, as previously stated we don’t need to treat people equally, we need to treat people fairly. For mental health access and resources, this could take the form of proportionate universalism, which essentially means ensuring everyone is given resources, but the amount they are given is proportionate to the amount they need. We may be far past the year 2000, but it is not inconceivable to want to achieve health for all. As a mental health advocate, and a passionate supporter of mental health equity, I do not believe health for all can be achieved until we start treating people fairly, but not equally.

Sources:
https://cmha.ca/ending-health-care-disparity-canada https://www.nwhu.on.ca/ourservices/Pages/Equity-vs-Equality.aspx https://www.who.int/social_determinants/sdh_definition/en/ https://deadwildroses.com/2020/06/08/thoughts-on-inequality-and-justice/ Kastrup MC. Inequity in mental health: An issue of increasing public health concern. World Soc Psychiatry 2019;1:36-8. Jessica Allen, Reuben Balfour, Ruth Bell & Michael Marmot (2014) Social determinants of mental health, International Review of Psychiatry, 26:4, 392-407

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