Patient Support & Advocacy

Knocking down barriers to health equity

The AMA’s House of Delegates adopted policy that set “health equity”—defined as optimal health for all—as a goal for the U.S. health system, but the concepts of health equity and health equality can be tough to visualize. 

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Fortunately, artist Angus Maguire did just that for a Boston-based organization, the Interaction Institute for Social Change (IISC) with his widely shared cartoon showing three boys of different heights trying to watch a ballgame from behind a fence with each standing on a box.

The tallest doesn’t need the box to see the game but just having one box to stand on is not enough for the shortest to look over the fence. But, since each kid has a box, that defines “equality.” 

In the illustration defining “equity,” the tallest—who doesn’t need a box—doesn’t have one, the medium-sized boy has the one box he needs, and the shortest gets two, finally allowing him to see the game. 

“I love that one,” says Mary T. Bassett, MD, director of the Harvard School of Public Health’s Francois-Xavier Bagnoud Center for Health and Human Rights. “An equal share does not always advance equity—which is an important point to make.” 

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The cartoon was mentioned by AMA President Patrice A. Harris, MD, MA, in her “fireside chat” with AMA staff. The IISC reports that there are now hundreds of variations of the highly illustrative illustration—including one used by Aletha Maybank MD, MPH, who has taken on the task of leading the AMA’s new Center for Health Equity. 

In presentations, Dr. Maybank shows a third frame labeled “Reality,” which shows the tallest boy standing on seven boxes and the shortest standing in a hole with his shoulders just above the ground. A fourth frame, used by Dr. Maybank and others, is labeled “Liberation.” This one shows the view without a fence and all three figures standing on equal ground. 

“The reality is that inequities are so great,” Dr. Maybank says. “Our goal is to remove the structural barriers, so we have liberation.” 

Read this story in its entirety as featured in the fall issue of AMA Moving Medicine