A Public Health Approach to Achieving Health Equity

April 03, 2017|2:09 p.m.| Hazel D. Dean

Hazel Dean

As Deputy Director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) one of my goals, as well as that of my center, is achieving health equity—meaning that all people have an equal chance to be healthy, regardless of their race/ethnicity, income, sex, religion, sexual orientation, gender identity, or disability. We can achieve health equity in this country, but to do so we need the commitment of public health leaders and a strong infrastructure to provide the foundation for planning, delivering, and evaluating public health initiatives with health equity in mind. To ensure a strong infrastructure for health equity, we need public health organizations capable of assessing and responding to public health needs, a capable and qualified workforce, and timely data-collection and information-dissemination systems. 

Leadership and Infrastructure

In any organizational structure, leadership is a key factor in shaping the institutional response to any challenges the organization faces. Leaders—whether of private, nonprofit, or local, state, tribal, territorial, or national government institutions—serve as champions and change agents throughout their organizations. Strong and visible leadership that builds awareness of health disparities and inequalities and advocates for health equity can influence an organization’s belief in and commitment to the goals needed to make health equity a reality. Leaders can help ensure that health equity is central to organizational accountability and resource allocation. CDC strives to meet the challenges of building and maintaining a health equity organizational infrastructure, and its efforts can serve as models for practitioners in health departments, community-based organizations, or nongovernmental organizations.

Workforce Development

Equally important is the commitment of an organization’s workforce to implement strategies and activities that will produce health equity. Eliminating health disparities and promoting health equity are principal strategies of the National Prevention Council’s 2012 action plan. Those strategies, which reach across the 17 federal agencies the council comprises, can be adapted by other types of organizations. However, an important aspect of adapting any strategy promoting health equity is having a diverse workforce. A culturally and professionally diverse workforce is crucial for responding to changing U.S. demographics to meet the growing needs of racially and ethnically diverse populations, including diverse populations of women. Often these populations suffer a disproportionate burden of disease, premature death, and injury risk, as described in the CDC Health Disparities and Inequalities Report—United States, 2013. Who is better to keep these concerns front and center than representatives of the groups experiencing a disproportionate burden of ill health? Without diversity, a public health entity’s ability to address the needs of all populations in its jurisdiction can be impaired.

Data and Information Systems

Public health work is built on disease or injury surveillance data, and the elements collected in data systems are what shape that foundation. Demographic data elements should reflect the diversity of our nation’s people. Regrettably though, many data systems in use have not kept pace with the changing U.S. demographics and need to be updated.

Methods for improving data systems within organizations include:

  • Developing a unified approach to defining and measuring health equity, health inequities, and health disparities.
  • Providing training and technical assistance to staff involved with surveillance and other data-collection systems in applying these concepts.
  • Collecting such health equity variables as country of birth, primary language spoken, disability status, and sexual orientation into our surveillance systems at the federal, state, and local levels; and
  • Ensuring that health equity data are collected, analyzed, and disseminated in a timely manner.

Public Health Approach

A public health approach—moving from problem to response—to achieving health equity requires a four-step process.

  1. Foster a public health workforce that mirrors the diversity of the population it serves and the differences across multiple generations.
  2. Collect public health data that include the social determinants of health—income, housing, education, stigma, social context, health care, and the built environment—and compare those data with the census data.
  3. Implement interventions aimed at ensuring the public health workforce reflects the growing population of racial/ethnic minorities and diverse generations within those populations.
  4. Strengthen the public health leadership, conduct robust data collections, and take action to address inequities across the social determinants of health.

Only by addressing the need for a diverse public health workforce and reducing existing health disparities can we begin to achieve our goal of public health equity.

Hazel D. Dean, ScD, DrPH (Hon), FACE, is the deputy director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at CDC. As NCHHSTP Deputy Director, Dean works along with the director to oversee all of CDC's work related to the prevention, control and elimination of HIV/AIDS, viral hepatitis, STDs, and TB in the United States, as well as NCHHSTP's international work.

About this Series

This article is part of a series on advancing health equity being published in 2016-2017 on ASTHO's blog, StatePublicHealth.org.

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