"Health Equity Needs to be a Part of the Public Health DNA"

Oct 21, 2011, 6:41 PM, Posted by NewPublicHealth

Hispanics are three times as likely to get pregnant as teens. Infants born to black women are up to three times more likely to die than infants born to women of other races and ethnicities. American Indians and Alaska Natives born today have a life expectancy that is 5.2 years less than the U.S. average. And lower income residents report fewer healthy days across all races and ethnicities (according to a Centers for Disease Control and Prevention report). The statistics are striking and disturbing – health disparities persist.

John Auerbach, MBA, outgoing president of ASTHO and commissioner of the Massachusetts Department of Public Health, helped to make health equity a priority for health officials with his year-long President’s Challenge to reduce disparities [read a Q&A with John Auerbach on the Challenge here]. Yesterday at the ASTHO Annual Meeting, he led a discussion with Anna Whiting-Sorrell, MPA, director of the Montana Department of Public Health and Human Service and Joshua Sharfstein, MD, MPH, secretary of the Maryland Department of Health and Mental Hygieneon progress in advancing health equity in the last year and challenges still ahead.

“Health equity needs to be part of the public health DNA – a thread that runs through the core activities we pursue in public health,” said Auerbach.

Topics in the discussion included how to talk about racism (if you’re talking about it at all, you’re headed in the right direction), and efforts to make the public health workforce better reflect the people it serves. Another major theme of the discussion was how to measure programs that address health equity.

“We have to decide what is success. Is it just how many people call the quit-line? Or is it broader health?” said Whiting-Sorrell.

The conversation showcased some of the videos and campaigns targeted at reducing health disparities. Sharfstein discussed a video his office created to address infant mortality.

“We tried to understand the striking data in infant mortality. Every year there would be 20-25 preventable deaths per year, almost all African American babies, often because of unsafe sleeping patterns,” said Sharfstein. “We decided the mothers who’d lost children were the best conduit to get the message out.”

This moving video was the result:

To address high smoking rates among American Indians living in Montana, Whiting-Sorrell and her staff developed a series of public service announcements that were targeted, while still being inclusive of different identities and ways of life within this group. “To try to be inclusive of everyone, you have to walk in both worlds – traditional and mainstream – and we have to acknowledge both, particularly in images.” The videos reflect a diverse range of people to help more people identify with the messengers:

There is also an effort to move away from individual health behavior change messages, and move toward changing our communities to make the healthier choice the easier choice. “That’s difficult to capture in a PSA,” said Auerbach. This video was developed as a training video by the state of Ohio, as an example of how we can begin to think about educational efforts that focus on social determinants:

A video from Massachusetts addresses heart disease, and was developed specifically for the Latin American population – not just translated from English – to ensure it would be culturally appropriate.

“Hopefully we’ll be able to see the health outcomes that will be the true test of whether what we’re doing is working,” said Auerbach.

This commentary originally appeared on the RWJF New Public Health blog.