From Concept to Competency: Teaching Health Equity Competencies Across U.S. Health Professions Curricula

Background

Our nation’s healthcare workers confront systemic inequities that shape patient outcomes. However, health equity-based training remains inconsistent and unstandardized in health professions education, leading to a wide variation in knowledge, confidence, and ability to translate equity into practice (Ward & Ganjoo, 2023). While there is no universal definition of health equity, think of it as everyone having a fair opportunity to live their fullest health potential (Hoyer et al., 2022). Health equity cannot be realized without a health workforce prepared to confront the structural, social, and systemic drivers of health disparities (Brownson et al., 2023). While U.S. health professions education programs are uniquely positioned to cultivate health equity competencies, there remains a gap in meaningful assessments. In addition, no standardized measure of these competencies currently exists.

Methods

To address this gap, we developed the Student Health Equity Survey (SHES). The 36-item online survey relies on adapted health equity competencies, including: health principles; policy; structure; critical thinking and analysis; communication; diversity, equity, inclusion and justice-based values; collaboration; and advocacy (Arana, 2025). These competencies are aligned to the science-informed and justice-based Health Equity Framework’s three foundational aspects: equality at the core of health outcomes, interacting spheres of influence, and life-course perspectives (Peterson et al., 2021). Data was collected between 2022 and 2025 from students enrolled across the following programs (n = 394): Doctor of Medicine, Biomedical Laboratory, Translational Health Sciences, Physician Assistant, Physical Therapy, and Clinical Research Administration. The details on the validity evidence we collected to develop the SHES are published and remain beyond the scope of this paper (Ward et al., 2025).

Findings

Survey data revealed that while students report an understanding of critical components, like health disparities impacting groups of all ages and the effect of geographical location on health, persistent gaps remain in their understanding of health equity. In particular, high percentages of students incorrectly defined and applied concepts of health equity (i.e., health disparity, health inequity, health equity), misidentified the impact of structural drivers on health, and could not use a systems-thinking approach to analyze healthcare access. Below we offer three recommendations on how faculty can teach health equity in a standardized way.

Clarifying “Health Equity”

The term “health equity,” while prevalent in academic and professional settings, is often misunderstood. In our survey, an overwhelming majority narrowly defined it as “. . .improving the health of minority populations.” If we want the workforce to advance health equity, they should be able to recognize that at its core, health equity improves the health of all groups. Clarifying the definition and application of health equity is directly related to the competencies of “health principles” and “diversity, equity, inclusion and justice-based values.”

Health equity is defined by the World Health Organization as the absence of avoidable or remediable differences among groups of people (Prentice et al., 2024). Students are often unsure whether equity is zero-sum—either improving outcomes for socially disadvantaged groups or broadly across all populations. The answer is both. Health equity is not about pitting groups against each other, but rather addressing structural inequities that explain unfair and unnatural differences in health outcomes between populations (Yearby, 2022). The misuse of the term creates a distorted perception that undermines its understanding and application.

Framing Individual Versus Structural Causes of Health Outcomes

Health disparities are socially constructed patterns of unfair health outcomes amongst socially disadvantaged groups. As such, health disparities exist because of structural inequities such as poverty, racism, and redlining that adversely impact the social determinants of health (SDOH). Healthy People 2030 defines SDOH as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (Office of Disease Prevention and Health Promotion, 2020).

A common belief corroborated by survey responses revealed a persistent misconception among future healthcare professionals: a tendency to attribute health disparities to individual behaviors rather than structural forces. When SHES respondents were asked whether “Eliminating individual risk behaviors (i.e., smoking, poor eating habits, etc.) will reduce health disparities,” over 70% incorrectly reported “true” across all 3 years of survey data collection. Individuals do not experience health disparities; populations do. The SHES instrument does include examples of population health measures such as “”Where people live determines how long they live.” Reinforcing the appropriate unit of analysis is directly related to the competencies of “policy”; “structure”; “critical thinking and analysis”; “communication”; and “advocacy.”

Interventions that focus on individual level behaviors are unlikely to succeed when environments limit opportunities for health (Brown et al., 2019). To eliminate health disparities, we need multi-level and evidence-based structural interventions. For instance, the New York University Center for the Study of Asian American Health applies the population health equity framework as a multi-level structural intervention that applies the SDOH across the lifespan as well as social marketing, community-based participatory research, and a health-in-all-policies approach to addressing racialized health disparities (Trinh-Shevrin et al., 2015). It is important for health professional students to understand this to prevent narrow, behavior-focused approaches to care.

Systems-Level Thinking on Healthcare Access

The U.S. government spends trillions on healthcare annually and one would assume that these funds are directly correlated with improved population health outcomes (Hartman et al., 2024). However, the U.S. health system continues to lag far behind other nations when it comes to meeting citizens’ basic health care needs (Rice et al., 2020).

When SHES respondents were asked “If the U.S. spends more money on healthcare, it will automatically improve life expectancy,” around one-fifth of students incorrectly agreed, pointing to a lack of baseline knowledge about the relationship between healthcare spending, resource allocation, and population health outcomes. The key to this question lies in the word automatically, as healthcare spending does not inherently improve health equity unless it is intentionally directed toward upstream and structural causes of disparity. Emphasizing systems-level thinking and change directly relates to competencies on policy; structure; critical thinking and analysis; collaboration; and advocacy. Research suggests that investing in structural health policies would achieve more long-term, widespread improvements (Chelak & Chakole, 2023). All health outcome trajectories are shaped by disparate SDOH such as education, income, and social support, which cannot be fixed without targeted systems-level change.

Competency-Based Curriculum Recommendations

Through our pedagogical recommendations, we strive to address previous concerns to facilitate expanded, high-level health equity knowledge capacities and outcomes amongst health professions students:

First, faculty must be clear on the definition of health equity to ensure their students understand that everyone has a fair and just opportunity to achieve their highest level of health rather than assuming it only applies to minoritized populations. Without this clarity, health equity remains misunderstood or perceived as optional—especially when there is a U.S. federal ban on over 300 words related to minoritized social identities (Amon, 2025). Not only is it erroneous to limit the aims and benefit of health equity to minoritized groups, it adds unnecessary fodder to an increasingly divisive political climate. Now more than ever, faculty and students must recognize how everyone benefits from health equity (Alberti, 2025), especially when such efforts are led by public health science and justice-based theoretical applications. This understanding will allow faculty to treat health equity as a lens that they can apply to any topic, thereby threading it across the curriculum.

Second, faculty must be supported in their use of critical pedagogy (Young, 2025). Our findings underscore the need for curricula that explicitly reinforces the difference between individual choice and structural factors. A pedagogy rooted in justice means that faculty must be comfortable and supported in addressing colonialism, patriarchy, white supremacy, and other forms of historical oppression. It is imperative that any form of critical pedagogy that advances health equity-based competencies shifts focus away from individual blame and rightfully names systemic inequities. They can do so through the use of case studies that emphasize how macro social ills shape health outcomes. Similarly, using data-driven examples of healthcare spending with outcomes will demonstrate to learners that increased funding does not automatically improve health outcomes without first addressing the broader structural drivers of health.

Finally, these competency-based recommendations are enhanced within curriculum models proven to improve health equity knowledge. For example, embedding a longitudinal equity curriculum, which included integration with clinics and community-based organizations along with modules, increased self-reported knowledge among medical students (Denizard-Thompson et al., 2021). Similarly, a strategy of “teachable moments”—embedding health equity content into existing lecture content, created improved knowledge scores and self-reported confidence in addressing disparities (Treacy-Abarca et al., 2021).

Challenges

Despite the importance of our proposed recommendations, several challenges continue to impede progress. An evaluation of social justice curricula across U.S. medical schools found that although students gained knowledge, shifts in attitudes and behaviors remained inconsistent (Draper et al., 2022). This points to the difficulty of addressing ingrained beliefs, and aligns with research on clinician implicit bias. In education frameworks, bias reduction strategies must be enforced for longstanding change (Niranjan, 2018). Additionally, a review of reforms in medical school curricula highlighted limited time, lack of training amongst faculty, and resource allocation as major obstacles to implementing comprehensive health equity education (Nguemeni Tiako et al., 2025).

Conclusions

The findings from the SHES make it clear that persistent conceptual misunderstandings about health equity and structural drivers of health will not be resolved through fragmented effort. By embedding a shared set of health equity competencies across all levels of health professions education (didactic, clinical, and experiential), health equity will increasingly be at the forefront of each clinical decision. When health equity becomes foundational rather than optional, the future health workforce will be equipped to not only treat illness, but transform systems.

Amid growing social and political pressures, continued investment by philanthropic foundations and industry leaders provides critical support for curricular reform and research on structural racism and health disparities. We also remain hopeful when our professional membership associations collaborate with strategic partners to restore access to trusted public health data. Documenting who remains on the right side of history provides a blueprint for this uncharted terrain in higher education. In the meantime, we remain hopeful that there are faculty committed to using their classrooms to advocate for human rights while building health equity competencies amongst their learners.