Swimming Against the Tide: Challenges in Pursuing Health Equity Today.

The term "health equity" has moved from obscurity to the mainstream, creating new possibilities for those who aspire to a world in which everyone has a fair and just opportunity to be healthy. One can now talk explicitly about health equity. The newfound acceptance, however, carries a risk: loss of meaning. Recognizing the need for a common understanding of the core concepts, the Robert Wood Johnson Foundation has promoted a definition that prioritizes being sufficiently concrete to guide action. Lack of conceptual clarity is, unfortunately, not the only challenge in pursuing health equity. Another challenge is the lack of respect for fundamental ethical and human rights principles-cornerstones of health equity-displayed almost daily by those in positions of power, including the president; this lack of commitment to fundamental values has an insidiously toxic effect because many people assume that presidential views must be legitimate. Yet another challenge is lack of imagination. Pursuing health equity inevitably requires swimming against the tide of prevailing forces that exclude, marginalize, or otherwise disadvantage groups of people based on their skin color, wealth, gender, disabilities, sexual orientation, gender identity, religion, or other characteristics tightly linked with social advantage. To persist in swimming against the tide, the end goal and the reason for pursuing it must be very strong and very clear. Academic medicine can play an important role as a powerful force in setting norms and shaping the values and attitudes of medical students, attending physicians, and research faculty.