Equity and equality can often be compared to food: Everyone wants a piece of it and preferably good quality. (And yes there is a difference).

Equality would be sharing everyone the same chunks of food, pineapple by pineapple. With equity, everyone who follows conditions (such as having access and has the money to afford it) gets that piece of cantaloupe. The same can be applied to healthcare; Everyone wants ACCESS to great QUALITY healthcare, a bundle package. However, people who are in disadvantaged situations can’t achieve one or either.

One could argue that everyone cannot receive equal healthcare. But even more concerning are the inequities that people experience to receive care. For example, offering fewer birth control options to one woman than another because of lack of quantity would be an inequality. However, offering an African American woman fewer options based on racial stereotypes and SES status is an inequity. Which scenario would be more disturbing to you? It may not be possible to help every individual to receive equal healthcare, but we can control the systematic and personal barriers that impede it. For that reason, the focus is on inequities versus inequality.

In today’s class, we discussed one of my favorite topics; the social determinants of health (SDoH). In sum, SDoHs are factors or conditions in communities that either leads to a risk of disease or better health outcomes. Some determinants include transportation, religious practices, natural disasters, and race.

As a country that is prone to volcano explosions, floodings, earthquakes, and had a war not too long ago (in the 1970s), Nicaragua is just one of many countries facing these SDoH.

In rural areas, horseback riding and motor vehicles are the modes of transportation. Yet, rainwater inundates some of the pathways, leaving the driver to wait until the water clears. This is tragic if say a person requires emergency care and needs a ride to a facility. Yet in an area with more resources in the US, sewage systems generally exist to drain water quickly and more modes of transportation exist. Thus, transportation is an SDoH in rural Nicaragua that leads to a risk of illnesses. Rural Nicaraguans don’t experience equity because, under such conditions, they often may not have access or receive care for basic health needs. So, they likely won’t receive a piece of that longed-for cantaloupe like some of their US counterparts. This inequity also exists between rural and urban areas of Nicaragua, thus it is not simply a “1st world” vs. “3rd world” issue. Here are other SDoH in rural areas:

– Access to healthcare (walking at least 2 hours to a facility)

– Machismo culture (gender roles in community/society)

– Cost of medication

– Quality of care

– Lack of medication

These present as barriers to economic, social, and health improvement.

AMOS, in collaboration with Ministry of Health (Government) and local communities, make a continuous effort to improve community access to resources. Trained health promoters (someone who is trusted in a community) educate locals about how to care for themselves, families, and neighbors. Some of these include what to do in emergency situations, how to maintain their homes, and proper use of health equipment. Clinics also provide services such as birth control and checkups for example. AMOS allocates these resources based on populations most vulnerable: for example pregnant women, children, and those with chronic conditions.

The road to equity is a long one, but that can be continuously improved. We can’t always provide the same healthcare systems, delivery mechanisms, or medications the same way, but can identify and reduce barriers to receiving essential healthcare needs. SDoH, such as transportation and cultural norms (albeit more difficult) present challenges. Thankfully there are countless individuals, communities, and organizations that help improve conditions globally and continuously such as:

International Monetary Fund (IMF) : An organization with 189 member countries. It encourages countries to cooperate in international funding and trade.


World Bank: Provide financial assistance for countries in impoverished conditions and helps to achieve financial sustainability.


United Nations: Organization well-known for establishing Millenial Development Goals and Sustainable Development Goals. Some include focusing on maternal health, hunger and education.


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