Equitable Health is Not Found in Outcomes, But in Real Lived Experience (RLX)

Introduction

In health systems across the world, the pursuit of equity is typically channeled through the language and logic of outcomes, guided by metrics, statistical parity, and standardised models of fairness. In this logic, health equity initiatives are framed by questions of access, resource allocation, and endpoint disparities: who survives, who recovers, who receives what kind of care. While crucial, these efforts are increasingly inadequate to grasp or redress the deeper asymmetries and injustices that constitute people’s lived experience of health.

This article argues for a fundamental reorientation: that equitable health cannot be found solely - nor even primarily - in measured outcomes, but must be sought in the real lived experience (RLX) of individuals and communities. Equity must be felt, perceived, and participated in. It is embedded in the moment-to-moment unfolding of health as it is lived, and not simply observed from above.

The Limits of Outcome-Oriented Equity

Nearly all health systems are designed around outcome metrics: morbidity and mortality rates, service access, readmission frequency, Quality Adjusted Life Years (QALYs) and others. Such metrics enable comparison, prioritisation and planning but strip away the very realities they aim to measure. A person may survive a cancer diagnosis but emerge socially isolated, disfigured, and disempowered. Another may receive state-of-the-art care but feel unheard, unseen, and unvalued in every clinical interaction.

Equity then, when reduced to outcomes, flattens the complexity of people’s lives. It presumes universality where there is particularity, and closure where there is ongoing becoming. Worse, it risks reinforcing the very inequities it claims to solve by rendering invisible the experiential depths where exclusion, pain, and marginalisation take root.

Real Lived Experience (RLX): A Transformative Frame

To reimagine equitable health, we must begin from a different ground: the real lived experience (RLX) of those within health systems, and not just patients, but carers, clinicians, and communities too. This means:

• Perceiving experience as emergent, not predetermined, but formed through relations, places, intensities, and histories that cannot be reduced to symptoms or checklists.

• Valuing expression and presence by listening not for the problem to solve, but for the world that is being revealed.

• Attuning to relational dynamics, including those shaped by power, culture, race, gender, class, and more-than-human actors (technologies, infrastructures, environments).

• Creating space for transformation, where health becomes a shared, co-composed possibility, not merely an individual responsibility or institutional deliverable.

When equity is anchored in real lived experience, it is no longer an abstraction but a felt difference. It is a shift in how one is met, held, and enabled to move forward. In this framing, the question is not “Did the intervention work?” but “Did the person feel heard, dignified, and free to become in relation to others?”

Health as Relation, Not Destination

This shift invites us to reconceive health itself as a relational condition that unfolds in context, not as an outcome to be achieved. In this conception, health is shaped in the spaces between people, technologies, cultures, and places. It is lived in moments of care, abandonment, misunderstanding, and mutual recognition. Equity, then, is the capacity for those relations to be supportive, attuned, and generative, not just fixed, equalised, or standardised.

The implication is profound: equitable health is not something to be delivered; it must be composed and enacted in real time, with real people, in real situations. It emerges in how a clinician responds to a mother’s hesitation, how a waiting room makes someone feel welcome or afraid, how a policy allows for choice or erases it.

RLX in Practice: From Metrics to Movements

Operationalising RLX in practice does not mean abandoning measurement, but reconfiguring it. It means developing new forms of sensing - qualitative, affective, experiential - that capture how people feel and navigate health, not just how they perform in systems. Here are five ways RLX can drive more equitable health.

Supporting the depth of felt agency in a health journey

Felt agency is not about whether someone technically has choices. It’s about whether they feel they are able to act, decide, or influence their health journey in ways that are recognised and respected. For groups who face systemic racism, poverty, or stigma, felt agency is often eroded by years of not being listened to, by care systems that make decisions for them, or by cultural norms that silence certain voices. RLX practices attend to how people come to reclaim, resist, or reorient their sense of agency, even in constrained circumstances.

Deepening the affective climate of care interactions

For many marginalised groups, the emotional tone of care interactions is often subtly or overtly hostile: a raised eyebrow, a rushed tone, a mispronounced name, a refusal to make eye contact. For them, the affective climate of care matters deeply. It determines whether someone feels safe, dignified, or threatened. RLX captures and responds to these affective signals not as noise, but as central indicators of equity.

Noticing the movement of people through life transitions

Transitions like menopause, birth, mental health crises, or a terminal diagnosis are not just clinical events, they are existential and relational thresholds. They reshape identity, meaning, and daily life. Yet for those already pushed to the edges because of race, gender identity, class, age, or disability, these transitions are often ignored, pathologised, or stripped of cultural meaning. RLX practices surface how people actually live through these moments: where they get stuck, how they find coherence, and where movement or becoming begins - often outside formal care.

Revealing patterns of relational support or disconnection

Health does not unfold in isolation. For many underserved populations, e.g. migrants, refugees, and those experiencing homelessness, formal support may exist on paper, but real relational support is fragile, fragmented, or absent. RLX practices look beyond the availability of services to explore the felt experience of being held, burdened, judged, or ignored by others.

Undoing the systemic constraints that shape lived possibilities

Health inequities are often experienced not in dramatic events, but in the slow erosion of energy, dignity, and possibility. Systemic barriers like housing insecurity, legal precarity, or access discrimination shape whether someone can even imagine a future worth caring for. RLX senses how these constraints are felt in daily life, not just noted as structural determinants.

RLX-attuned practices do not replace outcomes. They recontextualise them, making visible the experiential terrain in which outcomes arise. Equity, in this light, is about sustaining movement, possibility, and voice within this terrain.

Ethical and Political Implications

Centering RLX also demands ethical reckoning. It forces us to confront whose experiences are recognised, whose pain is believed, whose ways of knowing are valued. It challenges the medicalised gaze, which too often sees patients as data points, and instead asks: What is the world this person lives in? How is it composed? And how might it be otherwise?

This reframes equity beyond redistribution alone. It brings attention to reparation of the felt, the relational, and the invisible. It gives voice to silence, structure to neglect, and form to what has been excluded. It invites systemic transformation not through efficiency, but through attuned presence and participatory composition.

Integration, Not Rejection

The vision of RLX must not be mistaken as a call to reject everything health systems already do. Across many contexts, outcome measures have been used responsibly as part of efforts to highlight disparities, secure funding, or track change. Frameworks such as the social determinants of health, culturally competent care, and person-centred models reflect genuine attempts to better understand context and complexity. The challenge is not the presence of metrics, but their overreach.

The invitation here is not to discard outcomes, but to integrate them within a more humane, attuned paradigm, one that makes space for what cannot be quantified, for what is felt but not yet named. RLX complements and deepens existing tools. It offers a way for systems to listen differently, respond relationally, and act not just on populations, but with people, in the flux of real life.

Conclusion

Yet ultimately, equitable health is not found in outcomes, but in real lived experience. It arises not in the end result, but in the becoming. It pays attention to how people are held in transition, in rupture, in relation. To achieve equity, we must move from designing for health delivery to composing for health becoming. We must turn from systems that act upon to processes that co-compose with. And we must recognise that health justice begins in perception, in how we see, feel, and respond to the realness of others.

Only then can we build health systems that are not just fair, but deeply humane.

How Umio and Bergson.ai Support RLX in Practice

This is where Umio, with Bergson.ai, steps in to bring the RLX paradigm to life. Umio works alongside communities, professionals, and enterprises to co-compose health systems, technologies and practices that are grounded in felt experience, not just structural reform. Through relational design methods, experiential inquiry, and strategic fieldwork, Umio surfaces the hidden dynamics of experience that metrics alone cannot grasp. Bergson.ai amplifies this capacity through an experiential intelligence platform that listens to the depth of real contexts, revealing hidden affects, assemblages, tensions, and lived transitions. Together, they enable health systems to evolve toward equity that is participatory, perceptive, and profoundly human.