Building a healthy future for all

Healthcare equity is the principle that every person should have an equal chance to enjoy optimum health and that no one should be hindered from attaining good health due to their social status or any other social determinant. Studies have repeatedly shown that inequities in healthcare not only exacerbate existing social inequalities but also lead to poorer overall health and well-being for both individuals and populations. Consequently, achieving healthcare equity is not simply a moral imperative; it is vital for supporting social justice, human rights, and the sustainable development of communities.

The recognition of equity’s importance in healthcare is not new. In 2000, landmark reports in the United States (US) by the National Academy of Medicine, ‘To Err is Human’ and ‘Crossing the Quality Chasm,’ instigated a movement for patient safety and healthcare quality improvement. Notably, ‘Crossing the Quality Chasm’ cited equity as one of the aims of quality healthcare. The report defined equitable healthcare as care that transcends personal characteristics and ensures equal access to the highest quality services. This groundbreaking report cemented the understanding that high-quality healthcare and equity are inextricably linked. Fast forward to 2021, and the National Academy of Medicine revisited this issue. Reflecting on past progress and charting the future of healthcare quality, the Academy’s healthcare leader task force delivered a powerful message: “For healthcare to be considered high quality, it must be equitable.” This unwavering commitment emphasized that building a healthcare system where social determinants do not dictate health outcomes is the cornerstone of truly high-quality healthcare for all.

However, inequity remains a major issue in healthcare systems globally. In the US, ethnic minorities have worse healthcare outcomes. A 2022 report by the Agency for Healthcare Research and Quality stated that Black people have a 30% higher incidence of venous thromboembolism during pregnancy and a 33% higher risk of stroke mortality. The report also noted that Asian people have 11% less access to medical care when needed. In addition, the Canadian healthcare system has serious inequities, with poorer Canadians experiencing a 33% delay in accessing healthcare, spending 44% less time with doctors, and having 42% less involvement in their care decisions than wealthier individuals.¹ In the United Kingdom, socially disadvantaged people have a healthy life expectancy of 12 years less than those who are the least disadvantaged. In addition, individuals of Pakistani origin have health-related quality of life scores that are 23% lower than the White British population.²

Although studies in Saudi Arabia are limited, it is clear that inequities lurk. One study reported a stark correlation between lower income and higher out-of-pocket healthcare spending among patients with chronic illness.³ Furthermore, data from the World Health Survey published by the Ministry of Health in 2019 showed that females were 7% more likely than males to be dissatisfied with the quality of inpatient services and that poorer patients experienced 26% more discrimination in the healthcare system than wealthy patients. The report also revealed that the population in the lowest income quantile reported poorer responsiveness of inpatient care services during their most recent hospital stay.

While achieving healthcare equity remains challenging, numerous frameworks have emerged to guide healthcare systems towards a fairer future. In 2016 the Institute for Healthcare Improvement published a white paper that identified 5 key components to maximize equity in healthcare: prioritizing equity, building supporting structures, addressing determinants of health, tackling institutional racism, and forging community partnerships.⁴ A paper published in the Journal of the American Medical Association in 2022 recommended that healthcare systems leverage existing resources—developed to measure, improve, and ultimately incentivize quality—to make these systems more equitable. This would involve focusing on 3 areas: data, leadership and governance, and payment.⁵ In July 2023 the Joint Commission modified standard LD.04.03.08, which addresses healthcare disparities. The Commission elevated the standard to a new National Patient Safety Goal (NPSG), defined as Goal 16: Improve healthcare equity. The NPSG standard and 6 elements of performance encourage a focus on improving healthcare equity as a quality and safety priority.

These frameworks, along with evidence from successful interventions, offer valuable lessons. The evidence demonstrates the power of targeted actions, raising awareness, addressing language barriers, and implementing culturally sensitive care in achieving significant improvements. For example, interventions led to a 75% reduction in central line bloodstream infections among Hispanic children in Cincinnati, and a 26% increase in peritoneal dialysis utilization among immigrants attending Parkland Health. These reports encourage optimism, confirming that healthcare equity is not simply an aspiration, but is achievable.

Saudi Vision 2030 paints a vibrant picture of a future where all citizens of Saudi Arabia can enjoy a rich and fulfilling life. Healthcare, the cornerstone of that prosperity, must be transformed by bridging the equity gap. However, a risk looms amidst the healthcare sector’s rapid transformation. Progress could bypass socially disadvantaged populations, widening the disparities they already face. To prevent this, we propose a national action plan that ensures an equitable healthcare journey for all.

1. Shining a light: The journey begins with understanding. We call for a national white paper, sponsored by the National Regulator, that comprehensively maps healthcare disparities in Saudi Arabia. This document would serve as a beacon, illuminating the causes and scope of inequity, and guiding further action.

2. Equity as the North Star: Healthcare equity must be more than an aspiration; it must be woven into the fabric of the transformed healthcare sector. Its integration as a strategic priority within every policy and program will ensure that healthcare progress serves all.

3. Raising awareness: The fight against inequity starts with awareness. Healthcare regulators must lead initiatives to educate both healthcare providers and the public on healthcare equity. Educational campaigns, training programs, and community outreach must be implemented to break down barriers and foster a culture of equity.

4. Standards for equity: Healthcare delivery should be guided by standards for both quality and equity. National accreditation agencies must embed clear, measurable equity mandates into their frameworks. This will hold healthcare providers accountable, ensuring equitable access and quality of care for all.

5. Beyond numbers: Healthcare performance metrics cannot be blind to social determinants of health. Expanding current frameworks to capture and report on determinants like income, education, and geographical location will provide a more nuanced understanding of healthcare equity, paving the way for targeted interventions.

6. Value-based equity: Shifting healthcare reimbursement towards value-based models provides a crucial opportunity. These models can break down financial barriers and promote equitable access to quality care by incentivizing providers to improve health outcomes for all, regardless of background.

7. The quest for knowledge: Research is the fuel that drives progress. Regulators must actively support research efforts aimed at identifying and dismantling the remaining barriers to healthcare equity. Investing in evidence-based solutions will allow continuous refinement of our approach and will ensure that no one is left behind in the pursuit of a healthier future.

Bridging the healthcare equity gap is not merely a policy imperative; it is a moral obligation. This national action plan serves as a roadmap, guiding us toward a future where Saudi Vision 2030’s promise of a rich and fulfilling life for all extends to every citizen, regardless of social status. Together, we can build a healthcare system that upholds the human right to health, leaving no one behind on the path to a healthier, happier Saudi Arabia.