By Lori Freeman
Chief Executive Officer
This issue of Pulse is focused on health equity. Over the years, many organizations have sought to define health equity through improved definitions, graphics, and stories. Despite these efforts, health equity remains complex by nature and is still not often understood in its fullest context.
To help demonstrate this point, I've gathered a few (certainly not all) efforts to describe health equity.
"Health equity means that everyone has a fair and just opportunity to be healthier. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care." – Robert Wood Johnson Foundation
The foundation says the following should be added when the definition is used to guide measurement; without measurement, there is no accountability: "For the purposes of measurement, health equity means reducing and ultimately eliminating disparities in health and its determinants that adversely affect excluded or marginalized groups."
"Everyone has the opportunity to attain their highest level of health." – American Public Health Association
"The attainment of the highest level of health for all people." – Healthy People 2020
"Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically." – World Health Organization
"… equity in health can be defined as the absence of systematic disparities in health (or in the major social determinants of health) between social groups who have different levels of underlying social advantage/disadvantage — that is, different positions in a social hierarchy. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to well-being and to overcoming other effects of social disadvantage." – Defining equity in health, P. Braveman, S. Gruskin.
Regardless of your choice of definition, we all can agree that addressing health equity by removing health disparities is the key premise of most common definitions.
As a state governmental public health professional working in maternal and child health, your ability to understand, influence, and address health equity through programs and policy could be a challenging notion to get your arms around. Yet, as you read these articles, you'll see many examples of exactly how the work of Title V and its maternal and child health partners at the state level actually can, and does, address critical issues surrounding health equity. This work has never been more important than it is right now in our country. Know that you are a potential part of the solution.
I'll leave you also with a potential resource for both you and your agency. While working at the National Association of City and County Health Officials (NACCHO) prior to my arrival to AMCHP, I was introduced to an excellent training tool, The Roots of Health Inequity. NACCHO has invested significant resources and spent years developing this free, web-based training tool targeted to the public health workforce. I encourage you to consider reviewing this resource and potentially using it to educate your own workforce about health equity. In 2018, I also plan to introduce this training to AMCHP staff and incorporate it as an onboarding requirement for new staff members.