Advancing Health Equity Through Public Health Policies

The Role of Public Health Policy

Determination of disparities in health status

Access to health care

Identify problems in the decision-making equation responsible for health policy

Dispel the notion that decision making in public service at the managerial level is largely a neutral and valueless exercise, while in fact it is requires policy choices that improve the health of populations

Public health practitioners’ role in policy formulation is instrumental in affecting the distribution of resources that can diminish health inequities

Health Equity

Heckler Report / The first U.S. government’s report that comprehensively addressed the issue of racial and ethnic disparities, 1985

60,000 excess deaths due to health disparities (mostly African Americans)

Helped to establish the Office of Minority Health

Health Equity

In 1998, President Clinton, through U.S. Surgeon General, Dr. David Satcher, announced an initiative establishing a national goal of eliminating racial and ethnic disparities in health status by 2010

In 1999, the Agency for Healthcare Research and Quality was directed by Congress to annually provide a report that monitors “prevailing disparities” associated with race, ethnicity and economy in “priority populations”

CDC Health Disparities & Inequalities Report, 2011: Executive Summary Report

Read the above Executive Summary Report

Social Policies (Evaluated on their effect on health equity)

Should address the root causes of racial, ethnic and geographic disparities

Decision makers’ orientation and ideology are important in forming policies

Principles that guide public health practice must be based on:

Social justice

Evidence-based public health

Knowledge of the social determinants of health inequity

Recognize the socioecological framework of health equity

Adhere to the public health code of ethics

Health Disparities

Health disparities – population-specific differences in the presence of disease, health outcomes, or access to health care (HRSA definition)

Key is that there are differences between populations in measures of health (e.g. access to care, health outcomes, rates of chronic disease)

How to eliminate health disparities?

Commonwealth Fund (www.cmwf.org) recommends the following steps in developing policies to eliminate racial and ethnic disparities:

Consistent racial and ethnic data collection by health care providers.

Effective evaluation of disparities-reduction programs.

Minimum standards for culturally and linguistically competent health services.

Greater minority representation within the health care workforce.

Establishment or enhancement of government offices of minority health.

Expanded access to services for all ethnic and racial groups

Involvement of all health system representatives in minority health improvement efforts.

Health Inequalities

Equivalent to health disparities

Again, the issue is that there is a difference between the health status of one population compared to another population

Health Equity

Health equity = absence of systematic disparities in health (or in the major social determinants of health) between groups with different social advantage/disadvantage (e.g. wealth, power, prestige). -Braveman, Gruskin (2003)

Thus, health inequalities are the presences of such differences

Example – inequality or inequity?

Example: the disproportionate numbers of poor and minority citizens in the U.S. that do not have adequate access to health care

Is it a health inequality? Yes, since there is a difference in rates of access to health care amongst segments of the population

Is it a health inequity? Depends on whether you idea of justice involves “the right to health care”; if so, then yes, it is unfair and unjust that there are differences in this fundamental right, the right to health care.

The important difference is that we must make a value judgement in the case of health inquities

A Suggested Framework

Until the recent past, difference in health and disease were not important enough for governments and researchers to study.

This suggests a troubling value judgement that was made for these last centuries – health inequalities are not important enough to study…these inequalities were not considered inequities, and thus, did not deserve attention (for if differences are not unfair differences or unjust differences, then they can be minimized and shrugged off)

A Suggested Framework (Cont.)

Therefore, our default should be to consider every health inequality/disparity as a health inequity, until we can prove that it is not so.

In other words, we should ground our thinking in the human right to health (a value judgement) and the human right to health care and therefore treat each and every health inequality/disparity as unfair and unjust until we can prove otherwise.