Table 1 Summary of key results

Equity as a core value and understanding inequity as avoidable, systematic, unnecessary, and unfair

Informants felt equity was a core value and understood inequity as avoidable, systematic, unnecessary, and unfair.

Questionable acceptance of need to act

However, despite understanding the above aspects of health inequity and using this vocabulary, the language around “unnecessary” was found to be politically sensitive and inhibited uptake of policy aimed at improving health equity, which is further discussed below under  “questionable acceptance of need to act.”

Health equity as vague

Health equity as a concept was expressed as being vague, both in its conception and operationalization. Respondents elaborated, describing that while “health equity” was understood as a philosophical term rooted in morals or ethics, “health inequity” and “health inequality” seemed to be understood more easily due to their quantifiable nature. This could be due to the nature of Urban HEART, which requires quantitative expertise, potentially “biasing” respondent understandings in this way.

Country differences

According to key informants, this recognized vagueness inherent in the concept of health equity may be due to its rooting in social justice and in seeking to ensure health and well-being, which by nature is difficult to define, and/or that countries may understand the concept of health equity differently. This latter point about countries understanding health equity differently may also be linked to utilizing terms differently when referring to the same thing.

Health inequality, health inequity, and health equity: differences across terms

While this above point about country differences was shared by informants, they themselves used the terms “health inequity” and “health inequality” differently. These differing understandings placed: (i) inequalities as measurable and inequities as philosophical; (ii) inequalities as differences but inequities as inequalities that can be addressed; and (iii) addressing inequalities as entailing equal provision, whereas addressing inequities necessitates being unequal but fairer. Further to this, (iv) a differentiation was made between “equity” and “health equity” by two informants. However, there is a possibility that policymakers may intentionally inhibit political action by pointing to both the vagueness of health equity and debating terms like “unnecessary” to perpetuate the status quo.

Health inequities in what?

Overall, it appears there is no uniform or shared understanding of these terms across informants, and equity was referred to in terms of a similarly wide range of aspects.