Health Equity: Updates from the Field

Nov 5, 2012, 2:02 PM

A host of sessions focused on health equity at this year’s American Public Health Association meeting. Panel topics varied greatly, from the effects of health inequity on education outcomes to creative marketing strategies for reaching vulnerable populations; but overall, a few key themes emerged:

  • Health inequities must be addressed as locally as possible
  • Prevention is crucial
  • Organizations must strive for greater diversity, especially in leadership
  • In fiscal crunches, health equity requires creativity and commitment

Read more about these themes below.

Inequities in health must be assessed and addressed on a local level, whether by region, city, neighborhood or even block-by-block.

The California Endowment started the conversation by covering the conference halls with images from their Health Happens Here campaign, which draws attention to the vast differences in life expectancy that can exist from one zip code to the next. [Read more in a Q&A with California Endowment president Robert Ross.]

The Boston Public Health Commission shared how it’s working on a “micro-neighborhood” level to identify and prevent violence in the areas where it is most prevalent. It’s also working block-by-block to make it easier and appealing for community gardens to grow nutritious produce, rather than just decorative plants. In the same session, Angela Glover Blackwell of PolicyLink emphasized the link between regional development patterns and health inequities, noting that much of what was achieved through litigation during the civil rights movement had been undone by development choices. She cited as an example how the housing that people of color gained access to lost its value as incentives pushed jobs to the suburbs and public transit systems deteriorated.

Alex Briscoe of Alameda County’s Health Services Agency highlighted the potential that lies within hyperlocal solutions to inequity. His county’s Asthma Smart program goes home-by-home to identify simple asthma triggers and equips renters to demand changes from their landlords. It’s reduced emergency department utilization by over 80 percent while empowering residents to create grassroots change.

Prevention is crucial, especially among vulnerable populations, whose outcomes can be greatly improved when early indicators are observed and acted upon.

In a session on the role of philanthropy in health equity, Dr. Diana Bontá of The California Wellness Foundation named women’s veterans as an example of a newer, emerging vulnerable population. She noted that with unprecedented numbers of women returning from war now and in the near future, identifying the unique needs they’ll have and working quickly across sectors to set up supports for them will be crucial.

In another session, Terri Wright and Leslie Sessom-Parks of the American Public Health Association’s Center for School, Health and Education presented the dropout crisis as a preventable public health problem. They noted that “dropout danger factors,” many of which stem from social determinants of health, can be identified in students as early as third grade; yet, often nothing is done until middle school or later. Sessom-Parks and others advocated for the identification and resolution of at-risk students’ needs much earlier in life.

>>Read the Center for School, Health and Education’s issue brief on the dropout crisis as a public health problem.

To effectively work on health equity issues, organizations themselves must strive for greater diversity, especially in leadership positions.

Dr. Bontá commended her foundation for having a board whose membership is two-thirds people of color, but she and Angela Glover Blackwell, among others, echoed the need for more people of color in positions of leadership in public health and beyond. They highlighted pipeline programs, from public health electives in high school to mentoring programs and quality, affordable community colleges, as key to building a talent pool of people interested in these issues.

Debbie Allen from the Boston Public Health Commission noted that there’s also work to be done with employees of all ethnicities to foster open conversations about, and accurate understandings of, issues like racism and equity in their work and workplaces.

>>Read more on diversity efforts presented at APHA.

Health equity efforts in hard fiscal times require broad creativity and deep commitment.

Dr. Auerbach of the Massachusetts Department of Public Health and Alex Briscoe of Alameda County’s Health Services Agency both made the case that while it’s easy to abandon equity work in hard economic times, it’s imperative and feasible that governments remain committed to it. Dr. Auerbach offered agencies the simple step of creating health equity indices or score cards from data they already have. Such reports can name and publicize the problem, and target the use of limited resources.

Both Auerbach and Briscoe also underscored the ability that agencies have to leverage the power of public sector money, for example, by writing equity into contracts with vendors, as another means for integrating equity into existing efforts.

Finally, Briscoe emphasized the need for creativity and an unending entrepreneurial spirit when it comes to finding funding. He told the audience that the imperative he feels to tackle even the trickiest financial hurdles stems from his belief that, “Health care is truly the best payer for social justice."

>>Read more about the innovative work Alex Briscoe is doing to achieve equity through his health agency in Alameda County, the second most diverse county in America. Also watch a series of video interviews with Briscoe.

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