• Analysis or Summary
  • January 27, 2017

Communities in Action: Pathways to Health Equity

This is CHA’s summary of the following resource.

Report: Communities in Action: Pathways to Health Equity
Source: The National Academy of Medicine, with support from the Robert Wood Johnson Foundation 
Date: January 2017
Format: Report
Length: 440 pages

Summary

With support from the Robert Wood Johnson Foundation, the National Academies of Sciences, Engineering, and Medicine convened an expert committee to consider solutions that could be developed and implemented at the community level to advance health equity. 
 

In this report the committee identifies the major elements of effective or promising solutions and their key levers, policies, stakeholders, and other elements needed to be successful.

What is Health Equity?

Health equity is the state in which everyone has the chance to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or any other defined circumstance. Health equity is inextricably linked with opportunity. 

In the United States, the burden of disease and poor health and the benefits of well-being and good health are inequitably distributed. Although some aspects of a person’s health status depend on individual behaviors and choice, health is also shaped by community-wide factors. 

A community-based solution is an action, policy, program, or law that is driven by the community and its members to affect local factors that can influence health, and has the potential to promote health equity.

Why Health Equity?

Health equity is fundamental to the idea of living a good life and building a vibrant society because of its practical, economic, and civic implications. 

Health inequity is costly. Beyond significant costs in direct medical care expenditures, health inequity has consequences for the U.S. economy, national security, business viability, and public finances, considering the impact of poor health on one’s ability to participate in the workforce, military service, or society. 

Research Needs

While problems including unequal treatment in the health care system, implicit bias, and the need for increased cultural competence have been well-documented, more research is needed to inform the work of communities. Longer-term studies and better, more locally relevant data are needed to fully document and understand health inequities. 

The report recommends that this research should be publicly available to help inform and guide efforts to promote health equity at the community level.

Recommendations

  • Research funders should support research on health disparities and effective strategies to reduce and mitigate the effects of explicit and implicit bias.
  • Research funders should support and academic institutions should convene multidisciplinary research teams that include non-academics. 
  • A public–private consortium should create a publicly available repository of evidence to inform and guide efforts to promote health equity at the community level.
  • All government agencies that support or conduct planning related to land use, housing, transportation, and other areas that affect populations at high risk of health inequity should:
    • Ensure robust and authentic community participation in policy
    • Collaborate with public health agencies 
    • Prioritize affordable housing and implement strategies to mitigate and avoid displacement
  • State departments of education should provide guidance to schools on how to conduct assessments of student health needs.
  • Tax exempt hospitals and health systems and state and local public health agencies should:
    • Make schools aware of existing health needs assessments 
    • Assist schools in identifying and accessing data on key health indicators 
  • Hospitals and health care systems should focus their community benefit dollars to pursue long-term strategies to build healthier neighborhoods.
  • Hospital and health systems should advocate for the expansion of efficient and effective services responding to health-related social needs for vulnerable populations and people living in poverty.
  • Government and non-government payers and providers should expand policies aiming to improve the quality of care, improve population health, and control health care costs to include a specific focus on improving population health for the most vulnerable and under-served.
  • Foundations and other funders should support community interventions to promote health equity by:
    • Supporting community organizing around important social determinants of health
    • Supporting community capacity building
    • Supporting education, compliance, and enforcement related to civil rights laws; and
    • Prioritizing health equity and the social determinants of health 
  • Academic programs should promote the development of and dialogue on theory, methods, and the training of students to create a more useful knowledge base in the next generation of researchers on how to design, implement, and evaluate place-based initiatives to improve community health.
  • Anchor institutions (such as universities, hospitals, and businesses) should make expanding opportunities in their community a strategic priority.
  • Local policy makers should assess policies, programs, initiatives, and funding allocations for their potential to create or increase health inequities in their communities.
  • Public health agencies and other health sector organizations should build internal capacity to effectively engage community development partners and to coordinate activities that address the social and economic determinants of health. 
  • The U.S. Department of Education should support states, localities, and their community partners with evidence and technical assistance on the impact of quality early childhood education programs.
  • Key federal government efforts, such as the Community Solutions Council, should consider integrating health equity as a focus.

Conclusion

System-level changes are needed to reduce poverty, eliminate structural racism, improve income equality, increase educational opportunity, and fix the laws and policies that perpetuate structural inequities. All actors in society— residents and community-based organizations, in partnership with businesses, state and local government, anchor and faith-based institutions—have the power to help promote health equity.