HEALTH CAPABILITIES VERSUS HEALTH ACHIEVEMENTS
Optimal environment versus current environment
WHAT IS IT?
Health capabilities highlight what individuals are actually able to do and be in an optimal environment under optimal conditions. Health achievements encompass how they actually perform in their current environment under current conditions.
WHY IS IT IMPORTANT?
Structures, institutions, and systems must work to foster health capabilities among everyone. It is unjust that some people have access to optimal environments and conditions for achieving health capability and flourishing, and others do not.
Assessing health achievements alone blinds us to the insight that, at the same moment in time, some people have the freedom to achieve their potential while others do not. Thus, prioritizing health capabilities for all is critical to advancing justice in health policy and public health.
WHAT DOES IT LOOK LIKE?
It does not look like equalizing health achievements for everyone. Different individuals and population groups each face unique barriers that prevent them from achieving optimal health. As a result, equalizing maximal health levels achievable by everyone is an unrealistic goal and unachievable.
Rather than equal health outcomes, global and domestic health equity involves equal realization of individual and collective health potential. Different individuals and population groups may convert the same access to resources into different health goals and achievements. Thus, we need to understand the conditions necessary for individuals and groups to reach their health potential and ensure those conditions for all individuals and groups.
Ensuring health capabilities requires 1) promoting health agency, 2) developing individual and collective capabilities, and 3) equipping different individuals and communities with the resources and conditions they need to achieve their valued health outcomes.
HOW DO WE DO IT?
Understanding the relationship between health capabilities and health achievements will allow us to better achieve health equity worldwide. Ensuring health capabilities for all requires promoting individual and collective health agency, seeking positive individual and collective health outcomes, and equipping different individuals and communities with conditions and resources needed to achieve their valued health outcomes.
For example, Black people in the United States face structural inequalities and disadvantages in insurance coverage, chronic health conditions, mental health, access to quality health care, mortality, social and economic conditions, and more. Alleviating these disparities will require a consistent effort to address poverty, segregation, racial discrimination, medical mistrust, and other historic and current structural barriers that impact the Black community. This means creating the conditions – the structures, institutions, systems, policies, and practices – for optimal health among the Black community. The health and flourishing of Black people must be prioritized.
For another example, transgender individuals in the United States and around the world suffer significant health disparities and often lack access to quality health care and other resources. Discrimination within the current health care sphere can negatively impact transgender individuals’ health capabilities – their desires and abilities to seek out appropriate care. Improving the health capabilities of the transgender population requires eliminating social stigma, increasing providers with expertise in transgender medicine, reducing financial and socioeconomic hardship, and more.