Health Equity Without Division: Building a System That Leaves No One Behind

As I read through Project 2025, one of the most striking aspects of the healthcare section was the sharp contrast drawn by Republicans regarding their approach to healthcare. The central message seems to emphasize creating a system that works for everyone—one based on equality. In contrast, the Democrats' approach is framed as pursuing equity, where care is tailored based on demographic differences, which critics argue could lead to unequal treatment among groups.

I can see why this distinction is being made. The concept of "health equity" is often portrayed as prioritizing the needs of specific groups—such as the LGBTQ+ community—over others, like low-income white men struggling with rising rates of suicide and addiction. However, this framing misses a crucial point. Recognizing the unique struggles of one group doesn’t have to mean neglecting another. In fact, the acknowledgment of white men facing "deaths of despair" (Tilstra et al., 2021) highlights the importance of health equity rather than undermining it. Both issues—the mental health crisis in the Rust Belt and discrimination against LGBTQ+ individuals—are pressing and require nuanced, tailored solutions (Braveman & Gruskin, 2003). The real problem lies in adopting a scarcity mindset that assumes we can only address one at the expense of the other.

This brings us to a fundamental truth understood across professions: tailoring solutions to the unique needs of individuals and groups improves outcomes. Every marketer, salesperson, plumber, doctor, or preacher knows their work is most effective when adapted to the audience or client they’re serving. A plumber works differently with a hotel owner than with a homeowner. A preacher speaks differently to someone new to faith than to a lifelong churchgoer. While individuals have unique needs, there are also patterns of behavior and shared challenges that allow for targeted, effective interventions (Lane et al., 2017). In fact, this understanding has driven advancements in fields like personalized advertising, which feels eerily precise for a reason—it works.

Healthcare should be no different. We are now at a point where products, communication, and services can be tailored to meet individuals' needs, even as we address systemic inequities. This requires understanding where specific groups are falling behind and intervening strategically (Regidor et al., 2008). For example, if an underemployed population with limited education lacks access to nutritious food, they are more likely to face declining lifespans. This is a reality highlighted in Project 2025, and it's one we must confront head-on.

A historical example underscores the importance of such initiatives: the Black Lung Benefits Program (BLBP), established under President Nixon in 1969. As part of the Federal Coal Mine Health and Safety Act, the program provided financial and medical support to coal miners suffering from pneumoconiosis (black lung disease). This health equity initiative responded to the specific, measurable needs of coal miners, who faced significant health risks due to their work environment (Estacio, 2019). Despite detractors, bipartisan support ensured these workers received the care they needed—because it was clear their unique situation required tailored intervention.

This example illustrates why reframing the concept of health equity might be necessary. The term "health equity" has, for some, accumulated political baggage, but the idea itself is straightforward and essential. Tailoring healthcare programs to address the measurable needs of specific groups should not be controversial. Whether it’s addressing the alarming rates of suicide and substance abuse among young white men or ensuring that elderly LGBTQ+ individuals have access to supportive housing, tailored solutions benefit everyone (Gamliel & Péer, 2010). A healthcare system robust enough to support those at the margins will inherently be strong enough to care for the broader population.

Ultimately, health equity isn't about choosing between groups or fostering division. It’s about recognizing that different needs require different approaches. By building a system capable of addressing these nuanced challenges, we can create a healthcare system that truly serves all.