5 opportunities and challenges in efforts to promote health equity

When it comes to promoting the country’s focus on health equity in policymaking, pioneers in health impact assessment (HIA) and health in all policies (HIAP) are making progress to ensure that all People get the opportunity to be healthy. Possible. The term health equity represents the guiding policy principle that disparities in health outcomes caused by factors such as race, income, or geography should be addressed and prevented.

HIA and HiAP, meanwhile, represent two major strategies for doing so. HIA is a process that engages stakeholders to help communities and decision-makers identify the potential health impacts of the decisions they make, and HiAP is a collaborative approach that seeks to improve public health and health outcomes. Seeks to integrate health considerations into policy making across sectors.

At the December meeting convened by the Health Impact Project, organized in collaboration with The Pew Charitable Trusts and the Robert Wood Johnson Foundation, 25 leaders and practitioners shared knowledge, identified goals and next steps, and acknowledged successes and challenges in the field .

The five key takeaways provide a roadmap of where clinicians should focus their efforts:

1. Physicians must support comprehensive efforts to address systemic racism as a driver of health disparities.

The public and policy makers are increasingly aware of the wide disparities in health outcomes based on race and ethnicity. Those working in the HIA and HiAP fields must combine their focus on health equity with broader efforts to reduce racism and other systemic factors that negatively affect the health of people of color. Hundreds of cities, counties and states have declared racism a public health crisis, recognizing how structural disadvantages in areas such as housing, education and employment have driven disparities in disease and mortality based on race and ethnicity. Yet not all regions of the country—including those with deep-rooted racial disparities—acknowledge the impact of systemic racism on health outcomes.

HIA/HiAP practitioners work to gather diverse stakeholder perspectives and to better understand the social, political and cultural context of proposed decisions. They can use these powers to determine how best to act towards systemic changes within the unique decision-making environment of their jurisdiction.

The Institute for Healing Justice and Equity, an initiative working to eliminate systemic inequities through systems change and deep community partnerships, leverages leading practices to support municipal and state governments in sustainably advancing racial equity offers. These include defining racism as a system in laws and policies; providing material, institutional and social support to address generational disparities in wealth; and using racial equality tools in government decision-making processes, among other things. HIA and HiAP practitioners can add value to these efforts through their expertise in assessing and addressing social determinants of health, encouraging community engagement, and evaluating proposed policies from a health equity perspective.

2. The diverse application of HiAP approaches and tools is a major strength of this field.

In Santa Fe, New Mexico, for example, the Chainbreaker Collective, an economic and environmental justice organization, has used the HiAP tool as part of its community organizing efforts to address housing instability. The government of Washington, D.C., meanwhile, is using a new approach called health equity impact reviews to examine how neighborhood and small-area land use plans affect health outcomes tied to factors such as transportation and park access. Can do These efforts highlight that the HiAP approach can be flexibly adapted and implemented to meet the needs and goals of specific communities and jurisdictions.

3. HiAP professionals are facing challenges in expanding and growing their operations.

The sector often faces difficulties in identifying sustainable funding streams, and must contend with limited capacity and funds to address public health issues, especially in light of the toll the pandemic has taken on public health systems. But taken Physicians must focus renewed interest, attention, and resources on community health needs that may have been put on hold due to COVID-19.

The funding opportunities that do exist are often siled, making it more difficult to share or partner with government agencies. And sometimes specific programs restrict physicians from funding significant community engagement efforts. Because factors affecting public health cross many sectors—including the environment, housing, the education system and more—such a patchwork approach can prevent collaboration and be detrimental to achieving improved health outcomes.

4. There is value in incremental change.

HiAP practitioners highlighted the importance of working to meet small, achievable benchmarks. For example, participants described how government agencies can encourage change by examining the implementation of their existing policies from a health equity perspective and by changing the processes and procedures under their control. Similarly, community organizing practitioners stress the critical need for public health and government partners to build trust and demonstrate their commitment to residents, which is the foundation of effective collaboration. Over time, these relationships between agencies and community partners can lead to significant legislative and regulatory changes to protect and promote the health of residents.

5. HiAP practitioners should continue to take advantage of different forms of evidence, including compelling stories about people’s experiences, and use them to inform decision making.

While other agencies and organizations provide quantitative data and statistics, some participants reported difficulties when trying to reach their target audiences with qualitative evidence collected from communities. The Minimum Elements and Practice Standards for HIAs, the guidance produced by the Society of Practitioners of Health Impact Assessment, emphasizes the importance of multiple sources of evidence in these assessments, including local knowledge and expertise and the lived experience of stakeholders. Such information can play an important role in helping policy makers understand potential barriers and solutions to health within communities. It can also provide insights that help interpret quantitative findings and develop recommendations. HiAP practitioners must assess a range of data sources when examining the potential public health and equity impacts of decisions.

Compared to a decade ago, physicians today see a greater interest in health equity and acceptance of social determinants of health due to tools such as the HIA and HIAP. The federal government has demonstrated a commitment to addressing these issues, as evidenced by the bipartisan Infrastructure Investment and Jobs Act and the new National Office of the Environmental Protection Agency focused on environmental justice and civil rights. Such efforts send an important message to those working across the country to improve public health through policy changes; adequate funding to address the social, economic and environmental factors that shape health; and community buy-in and engagement.

Ruth Lindbergh directs the Health Impact Project in collaboration with the Robert Wood Johnson Foundation and The Pew Charitable Trusts.

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