About the Practices in the Resource Library for Advancing Health Equity in Public Health
The six practices below reflect areas of work a local health department can engage in to advance health equity. The different practices blend into, cross-over, and support one another. For example, while community engagement is the focus of the practice to "work in true partnerships," it also is an element of other practices, such as "work at the policy level."
The practices presented in this framework are grounded in the Ten Essential Services and the Public Health Accreditation Board (PHAB) Standards.
Jump to a Public Health Practice
To advance health equity, local health departments must engage in intentional practices to expand the understanding of what creates health, and call attention to existing health inequities. These efforts must occur within the local health department, within the larger city and/or county organization, with partners, and with the broader community. Local health departments already engage in many activities that have the potential to increase understanding and build commitment to health equity, including community health assessment and planning, health education and promotion, and engagement with elected officials.
See PHAB standards 1.1, 3.1, 5.1, 5.2, 6.1, and 12.3 (PDF) for more details.
Why focus here?
- Public health cannot advance health equity alone; understanding in the community is essential to build commitment to health for all.
- The extent of health disparities and inequities are often underestimated and/or misunderstood. If community leaders and decision makers are unaware or misinformed about what creates health, they cannot use their influence to create healthy conditions for all.
- Approaches to improve health and health inequities are limited when the general understanding is that health is created by health care and personal choices. A broader understanding of what creates health will build commitment to tackle the root causes of health inequities.
While public health professionals may recognize the role social, economic and geographic forces play to shape health outcomes, many are not equipped with the knowledge and skills needed to take action on the root causes of health inequities, such as economic practices that limit job opportunities, school discipline policies that disproportionately impact certain groups, and housing/home ownership patterns based on race or socioeconomic status.
The Bay Area Regional Health Inequities Initiative has identified multiple competencies essential for advancing health equity, including: personal attributes such as passion, self-reflection, listening skills, and a commitment to health and equity for all; understanding the social, environmental, and structural determinants of health; knowledge of affected communities; collaborative and community organizing skills; and cultural competency and humility.
Why focus here?
- The field of public health is broadening its scope of practice as described in the National Association of County and City Health Officials' Expanding the Boundaries: Health Equity and Public Health Practice. The skills of the public health workforce must develop to be able to engage in these practices.
- Advancing health equity requires staff to work differently; for this, they need training and support.
- Capacity building in this area cannot be accomplished through training alone; time and space for personal growth, and authentic engagement and courageous conversations both with leaders and affected populations also are necessary.
Local health departments must focus efforts internally as well as externally. Health equity must be incorporated into organizational policies, processes, programs, and budgets if local activities are to achieve optimal health outcomes for all. Local health departments can work to integrate health equity into a variety of areas including urgent and non-urgent communications policies; health education and promotion policies; and staff recruitment, retention and training policies.
See PHAB standards 2.4, 3.1, 3.2, 7.2, 8.2 and 11.1 (PDF) for more details.
Why focus here?
- Advancing health equity is not, and cannot be seen as "extra work" or a new "program." It must become standard practice; i.e., "the way we do business."
- Increasing expectations for local health departments without aligning or shifting resources to support a commitment to health equity limits the possibilities of real change.
- The local health department may not be taken seriously by the communities and organizations they seek to engage if they have not first taken a hard look at their own workforce, and at their policies and structures to determine whether these advance health equity or perpetuate inequities.
To advance health equity, local health departments must explicitly include and engage with communities of color, American Indians, those in poverty, immigrant communities, and others experiencing health inequities. This engagement must be authentic; the local health department must go beyond forming intermittent relationships for the purposes of gaining feedback, and seek to build and sustain lasting relationships. In these relationships the local health department must be willing to listen and allow the community to lead the work. Engagement should not be used as a way to confirm or advance a preexisting idea or agenda. Local health departments can strengthen community relationships through their current engagement efforts in community health assessment and planning, health education and promotion, understanding and addressing barriers to health care access, and efforts to change policy.
Ssee PHAB standards 1.1, 1.2, 3.1, 4.1, 4.2, 5.1, 5.2, 6.1, and 7.1 (PDF) for more details.
Why focus here?
- Efforts to advance health equity will be more successful if they are designed with (not simply for) communities experiencing health disparities.
- The local health department cannot advance health equity on its own; health is shaped at the community level, and the whole community is needed to address community conditions for health.
- Community history, wisdom, and knowledge is a critical source of information and experience that should be considered together with public health practice and evidence.
- Public health practice, like any profession, can unintentionally develop and sustain structural inequities. Genuine engagement with the community is one way to assure that the local health department recognizes needed changes and is taking appropriate action.
A health equity approach to data requires a process that both identifies health differences between population groups and examines and identifies the causes of these population differences in health. This means expanding data collected to include information about smaller ethnic and cultural communities, using data that focuses on the conditions that create health, and incorporating qualitative data to shed light on the root causes of health inequities and lead to solutions. It means looking beyond averages, engaging the community to understand what the data says, and using visuals, stories, and community voices to make data compelling and actionable. Local health departments can build on their current use of data to call attention to issues and create urgency for action.
See PHAB standards 1.1, 1.2, 3.1, 3.2, and 7.1 (PDF) for more details.
Why focus here?
- Using data to identify health inequities is key to identifying where changes are needed in programs, practices, and policies.
- Harnessing the power of data to document health inequities can help build commitment to change, acquire necessary resources, lead to specific actions to advance health equity, and monitor progress.
Creating the conditions in which people can be healthy requires policy solutions. Local health departments must learn to engage beyond health care and the education of individuals, and work with people outside of health on policies that shape the social and economic conditions in which people go about their daily lives (e.g., planning, zoning, recreation, transportation, and more). The work of local health departments in the area of policy includes maintaining an awareness of a broad range of policies under consideration; identifying policy solutions; and engaging, informing, and influencing those who set policies.
See PHAB standards 5.1, 5.2, and 6.1 (PDF) for more details.
Why focus here?
- Health inequities are shaped and sustained by policy decisions, and cannot be undone by increasing services to individuals. Policy solutions are essential to advance health equity.
- Other sectors are also working to address inequities in their areas (although they might be unaware of the impact of their efforts on health), and can potentially be powerful partners in local efforts to advance health equity.