What does it mean to take a health equity approach to our work?

Addressing inequities in health outcomes requires us to ask different questions.

Health educators, public health practitioners and other health professionals are often keenly aware of the disparities in health outcomes between populations related to race, class and gender. For example, compared to other groups, African Americans have higher rates of chronic disease including diabetes, hypertension and heart disease, and black children have a 500 percent higher death rate from asthma compared with white children. As Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation and David Williams, professor of public health at Harvard University’s School of Public Health share, “Being black is bad for your health.” Part of the issue, according to Williams, is the impact of psychosocial stress that African Americans (and other people of color) experience related to their ongoing experiences with racial prejudice and discrimination.

Issues related to race are interconnected with issues of class, poverty and wealth in part because of past and present patterns of racial segregation. In other words, the neighborhoods and places where we live are also significant predictors of health and life expectancy. In the Detroit area, for example, the life expectancy in the mid-town area of the city which is primarily African American is 69 years compared to a few miles up the road in the Grosse Pointe area. The life expectancy in that primarily white community is 82 years. This type of phenomenon (which is impacted by race and class) has led scholars such as Melody Goodman, professor at Washington University in St. Louis to share, “Your zip code is a better predictor of your health than your genetic code.”

Many health educators and professionals are working to understand underlying and root causes of these issues and strive to address poor health outcomes through a health equity lens. This requires us to go deeper than just examining health disparities or the differences in health outcomes between populations. Health equity is about fairness and justice and requires communities to work together to change policies and practices in order to create access, resources and opportunities that contribute to overall health and wellbeing for all people. Sometimes called the social determinants of health, these include access to safe and affordable housing, quality education, a living wage, healthy and affordable food, transportation, social connection, safe communities and other factors.

According to Doak Bloss, retired health equity and social justice coordinator at the Ingham County Health Department, one way we can work for health equity is to shift the conversation and ask different questions in order to explore root causes of these issues. In a chapter he wrote for the book, Tackling Health Inequities through Public Health Practice, Bloss provides some examples:

Changing the Questions

Instead of asking...

 Perhaps we should ask...

Why do people smoke?

What social conditions and economic policies predispose people to the stress that encourages smoking?

Who lacks health care coverage, and why?

What policy changes would redistribute health care resources more equitably in our community?

How do we connect isolated individuals to a social network?

What institutional policies and practices maintain rather than counteract people’s isolation from social supports?

How can we create more green space, bike paths and farmer’s markets in vulnerable neighborhoods?

What policies and practices by government and commerce discourage access to transportation, recreational resources, and nutritious food in neighborhoods where health is poorest?

Health inequities refer to disparities that are avoidable and unjust. Exploring issues through a health equity lens includes moving away from simple approaches and programs such as only focusing on “stress” or individual behavior change – toward examining historic and current realities impacting groups of people based on race, ethnicity, gender, class and other differences. A health equity lens also invites us to work in partnership within and across communities to change social structures that deny some groups voice, power and political influence. Ultimately the goal is to create more opportunities and greater access to the social, economic and environmental factors that contribute to the overall health of individuals and communities.

Michigan State University Extension provides education and training focused on issues of diversity, cultural competency, equity and social justice. For more information, visit MSUE’s Diversity and Multiculturalism web page.

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