Philip - I think we have reached agreement! There is close alignment within the health professions on the meaning of 'health equity' But that language may not have the same meaning outside the health care fields, and so listening to the language and framings of those we seek to learn from and partner with is important - especially if they are outside our fields.
Thanks for listening. I think this discussion has helped clarify our shared goals and understandings.
Professor & Chair Emeritus, Department of Family Medicine & Community Health, Duke School of Medicine
Adjunct Professor, Public Health Leadership, UNC Gillings School of Global Public Health
Original Message:
Sent: 09-30-2025 12:58:29 PM
From: Philip Alberti
Subject: Health equity benefits all of us. Have we done enough to make that clear?
More than happy to continue the conversation (and eager to hear from others, too!)
To be annoyingly picayune, I was/am focused on "health equity" specifically, and not "equity", generally. (I don't consider myself to be an EDI expert or practitioner, but rather a health equity / population health practitioner. Maybe that conversation is worth a separate thread!)
The definitions of "health equity" tend to be much less varied and really do focus on opportunity and "fair chances": WHO="Health equity is achieved when everyone can attain their full potential for health and well-being", CDC="The attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health." GOOGLE "AI Overview" (just for the heck of it)= "the fair and just distribution of health resources, opportunities, and outcomes so that all people have the same potential to achieve their best possible health, regardless of their social, economic, or demographic status"
(As you could probably guess from the paper, I would definitely delete 'outcomes' from that last one (and from the GFOA excerpt you posted) - I think that's one of the greatest misunderstandings to "teach to" - but you can see the general alignment!)
To reiterate my agreement with you - it all starts from listening and respect. For me at least, that doesn't mean we can't respectfully, and over time, address our partners' misunderstanings (and also be willing to be guided away from our own misunderstandings, too, of course) Buidling common ground, much like community engagement itself, should be (among other things) bidirectional.
| Philip M. Alberti, PhD (he/him) Senior Director, Health Equity Research & Policy Founding Director, AAMC Center for Health Justice  Association of American Medical Colleges
655 K Street, N.W., Washington, D.C. 20001-2399
E palberti@aamc.org
www.aamchealthjustice.org |
| Tomorrow's Doctors, Tomorrow's Cures® |
Original Message:
Sent: 9/30/2025 9:51:00 AM
From: Lloyd Michener
Subject: RE: Health equity benefits all of us. Have we done enough to make that clear?
Philip - Thanks for listening, and for your thoughtful comments. If you are willing to continue this discussion for a bit more, I'd like to suggest that my legislative colleague is speaking from his own experience and values, that the word 'equity' has variation in meaning, and that it is important that we hear the nuances that our our own use and definitions may miss.
For example, California HHS has this definition of equity: "Equity rebalances power to groups that experience inequality and promotes a spirit of healing, justice, and reconciliation." https://www.chhs.ca.gov/wp-content/uploads/2023/01/Working-Definition-of-Equity_01302023.pdf
The Government Financial Officers Association has an extended discussion of equity in public policy: https://www.gfoa.org/equity:
Just as the principle of equality gained currency in public management in the early 1900s in response to conditions of the time (pervasive corruption), the principle of equity is coming to the forefront today because of pervasive and material differences in wealth, safety, and health among different individuals in a community. For example, the United States has the highest level of income inequality among the top seven largest industrialized democracies and several studies have shown the wealth gap between white and black families continues to grow. In addition, the digital divide continues to highlight importance of access to information and knowledge and its impact on government services.
What is Equity?
Unfortunately, the term "equity" is often used loosely, without a precise meaning, or explained using overly simplistic concepts that gloss over or ignore important nuances. The definition we put forward here is based on research on how people perceive fairness and justice. Equity is one interpretation of fairness or justice. "Equity" means people should be treated uniquely by public policy to compensate for different circumstances and consequent need for help from government. Equity is commonly associated with equality in outcomes.
What is Equality?
"Equality" means people should be treated the same by public policy to remove barriers to the individual's success. It is commonly associated with giving people equality of opportunity. Equality of opportunity is related to another interpretation of fairness called "proportionality", where individuals receive outcomes relative to the amount of effort invested.
Why is there a potential conflict?
A body of research called "Moral Foundations" shows that different people emphasize different values in making moral and ethical decisions. People with a politically liberal perspective tend to emphasize a different set of values than people with politically conservative views. Those concerned with proportionality are hesitant to accept people getting benefits they have not earned. Those favoring equity place less responsibility on the individual to earn opportunities and resources. Instead, they define fairness as everyone having the same access and, sometimes, the same outcomes.IIt is important to recognize that equity and proportionality are not mutually exclusive. Nearly everyone believes in a mix of proportionality and equity. After all, even with equal opportunities and resources, there must be efforts made to take advantage of them. When people make poor choices or show little effort, there is still broad agreement that they deserve a certain amount of help.
Might add that my colleague comes from the conservative, financial world, as do so many other legislators. Listening to and respecting their perspectives and word choices is, I think, part of our role, and essential to finding common grounds for going forward.
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Lloyd Michener, MD
Professor & Chair Emeritus, Department of Family Medicine & Community Health, Duke School of Medicine
Adjunct Professor, Public Health Leadership, UNC Gillings School of Global Public Health
Original Message:
Sent: 09-30-2025 08:54:33 AM
From: Philip Alberti
Subject: Health equity benefits all of us. Have we done enough to make that clear?
Thank you, Lloyd, for the kind words and the thoughtful response.
I hear you. And I think it's a "yes, and".
While I'd never suggest leading with words that are likely to shut down engagement before it even begins, I do think that as relationships evolve and strengthen, "teaching" or "guiding" toward accurate definition and understanding is important. The 4 recs I made in the paper are in service of that.
As you know, your legislator is 100% incorrect when he says that equity means "...someone wants something he has, to give to someone else". Deep in the false zero-sum narrative on that one! No, we don't jump in with "you're wrong" and yes, we start with language that lives in the common ground (your legislator's "give everyone a chance" = health equity's "fair and just opportunity"), but for me personally, in 2025, the time has come to stop ceding our words and the truth to misinformation and misunderstanding. Further, if we use different words with different groups, then those groups are unlikely to come together and form the broad coalition we need to spark change. We are in essence reinforcing our divides.
That said, I agree 100% with your rec of "listening and translating", with the nuance that we "translate toward truth" and not in ways that concretize false narratives and acquiese before dialogue even begins.
Another critical point is that I have heard from dozens and dozens of people (communtiy members, scientists, academics, students, etc.) across the US (NC included) that the more our organizations shift their words to comply, the more community trust diminishes even if community members understand (and they do!) the existential threat posed by not shifting. Complaince and Trustworthiness are at odds.
I don't have a solution to that tension. Maybe a slow and steady process of "listening and translating toward truth" is part of the answer...
Always happy to engage! Always appreciate your wisdom and "push back"!
| Philip M. Alberti, PhD (he/him) Senior Director, Health Equity Research & Policy Founding Director, AAMC Center for Health Justice  Association of American Medical Colleges
655 K Street, N.W., Washington, D.C. 20001-2399
E palberti@aamc.org
www.aamchealthjustice.org |
| Tomorrow's Doctors, Tomorrow's Cures® |
Original Message:
Sent: 9/29/2025 2:53:00 PM
From: Lloyd Michener
Subject: RE: Health equity benefits all of us. Have we done enough to make that clear?
Philip - it is a wonderful article! I particularly appreciate your point of that "definitions, measurement, framing, and community engagement efforts build narratives, messages, and relationships" need to be inclusive, especially of those who do not see themselves as within the health equity tent. I wonder, though, about standing by a term that can be viewed as divisive by those who we are trying to engage. I am reminded of a comment by a highly respected rural legislator in NC, who deeply cares about his community and eveyone in it, that when he hears "equity' he knows that someone wants something he has, to give to someone else. Rather than attempt to teach him, which might be seen as a sign of disrespect, it has seemed wiser to listen to the language he uses, about respecting everyone, and giving everyone a chance. Since language use varies, even within a state, that means our job is less teaching, and more listening and translating. I'd argue that is a form of cultural humility. I'd still use the language of equity in other settings and with other audiences, and hope that we can create a menu or playbook of narratives, messages and stories that resonate with different audiences. I see and hope the Center for Health Justice doing just that, and appreciate that core, central, essential work. And then the rest of us can help share these narratives with the many groups with which we work and interact.
Please feel free to push back. I really appreciate and value your work and this discussion.
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Lloyd Michener, MD
Professor & Chair Emeritus, Department of Family Medicine & Community Health, Duke School of Medicine
Adjunct Professor, Public Health Leadership, UNC Gillings School of Global Public Health
Original Message:
Sent: 09-22-2025 04:02:37 PM
From: Philip Alberti
Subject: Health equity benefits all of us. Have we done enough to make that clear?
For more than two years, I've started every talk with the same message: "Health equity benefits all communities." Those of us who work in health equity know it's true, but that message does not always resonate, particularly with White communities who are also deeply impacted by the same systems we seek to change.
In my latest piece for The Milbank Quarterly, I reflect on why that gap in understanding persists - and what we can do to close it. It's a call to researchers, advocates, and policymakers to refine our framing, broaden our engagement, and strengthen the coalition needed to create communities where everyone can thrive. I offer four specific actions to make health equity feel relevant and urgent to more people, and to remind all of us that the fight for opportunity and fairness is not a zero-sum game.
Read the full article here. I'd love to hear how others are thinking about this, too. How are you making the case that health equity is for everyone - not just in theory, but in practice?
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Philip M. Alberti, PhD
Senior Director, Health Equity Research and Policy
Founding Director, AAMC Center for Health Justice
Association of American Medical Colleges
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