By Megan Gaydos
‘Health equity’ is taking root as a core part of public health work
In the past decade, there’s been growing attention to the concept of health equity and addressing the root causes of health inequities in the United States. Health departments, hospitals, service providers and many others are figuring out how to make meaningful change in areas that impact health, even outside their own “swim lane.”
Examples of this growing movement in the United States:
- 85% of public health employees across the US believe that their agency should be somewhat or very involved in affecting health equity (PHWINS 2017)
- 85% of state and territorial health departments have a strategic plan addressing health equity issues (OMH 2016)
- Almost two thirds of local health departments (including 9 out of every 10 large health departments) are supporting community efforts to change the causes of health disparities (NACCHO 2016)
- More than two thirds of the standards for public health accreditation (in the current Version 1.5) reference or address health equity (HIP 2018)
Recent studies like one of state chronic disease directors are finding that public health leaders who have strong commitments to health equity are more likely to be perceived as high quality and effective at managing change, as well as more likely to have more diverse partnerships. (NACDD/PRC 2017)
Various health equity leadership training programs exist — like our Health Equity Awakened Fellowship program, the Atlantic Health Equity Fellows, and state and local leadership training programs across various states in the US — to support public health leaders in being bolder and strategic in their health equity actions.
Health departments are beginning to name power and oppression in their analysis
At HIP we’ve developed a theory of change about how to advance health equity work within health departments. This theory of change built on an environmental scan of best practices by health departments, insights by health equity thought leaders, and on HIP’s experiences providing research, advocacy and capacity building support to health departments and community organizers across the US over the past decade.
HIP’s Theory of Change for Health Departments
Power imbalances, racism, and other forms of oppression are at the root of health inequities in the US. Health departments hold real power to address health inequities, but to act upon that power, they must pursue a wall-to-wall transformation that:
- Builds internal capacity and a will to act
- Works across and changes government and that
- Meaningfully partners and strategizes with community.
Like the World Health Organization, the American Academy of Pediatrics, the Institute of Medicine and others, we name that racism and other forms of oppression are at the root of health inequities. We also explicitly name power imbalances as a root cause of inequities and we lift up the power that health departments and other health organizations can hold to pursue transformation.
Two years ago, we launched the Health Equity Guide, a resource to make concrete this theory of change. Today, the Health Equity Guide contains a set of strategic practices that collectively implemented achieve transformational change, over 150 resources and over 25 case studies of local and state health departments advancing equity.
It’s exciting for us that the website has been so well received, with over 35,000 visitors and thousands of people registering for related webinars and emails. Last year, we conducted an evaluation of the Health Equity Guide and found that:
Our theory of change resonates with many health department staff
61% of health department respondents in our evaluation stated that our theory of change resonated “a lot” with how they were already approaching health equity work personally (N=263).
The Health Equity Guide is impacting how health departments’ approach equity work
- 85% of local and 70% of state health department staff reported that the Health Equity Guide had impacted or influenced their personal approach to health equity work.
- 61% of local and 48% of state health department staff reported that the Health Equity Guide has also influenced how their agency or organization is approaching health equity.
We’re also delighted to hear from webinar, training, and other evaluations that there is so much resonance with our focus on power being a lever to address oppression and its impacts on health.
‘Getting our own house in order’
In our evaluation survey, we found that the majority of health departments’ health equity activities were internally focused (see table below). This makes sense as health departments work to get all staff on the same page about what is health equity (and how that is different but building on past health disparities and minority health work), why the health department should invest in health equity across the organization, and how to begin changing department practices.
Interestingly, although many report “building community alliances,” relatively few “share power and decision making” or “engage in movements or campaigns.” Embedded in our theory of change are that health departments should move towards sharing power, collaborating with community organizers and working towards transformational change as individuals and organizations. As we expand the Health Equity Guide case studies and resources, we hope to lift up more concrete examples to support this transformational work.
Imagining a different set of ways to advance public health
Part of changing our practices involves imagining and visioning a different way of doing things.
Consider, how would your work in health change if public health workers:
- Operated from a place of true health promotion, not just treating the sick
- Reflected the demographics of the communities we are serving at every level
- Attended meetings, influenced policies, and/or worked closely with community organizers to advocate for better conditions for health
- Understood their work to regularly include building relationships with residents most impacted by inequities
- Were paid to deepen their own understanding of structural health inequities, including processing their own experiences of privilege and oppression
- Were encouraged to innovate, take risks, and be emergent to address changing health needs
What “radical” or “transformational” idea do you have about how health departments can truly identify, tackle and eliminate the root causes of health inequities? What is your vision for a world without inequities? We would love to hear your ideas and thoughts in comments!
Megan Gaydos is a Project Director at Human Impact Partners. She manages the Health Equity Guide, co-facilitates equity trainings, and works on research on how organizing and power building support the conditions needed for health.
📌 Did you know? Human Impact Partners provides health equity capacity building to public health organizations. Contact us to learn more about our offerings at info[at]humanimpact.org.