Movement for health equity spurs action nationwide: Tackling disparities ======================================================================== * Charlotte Tucker In King County, Wash., there is a community where people routinely live to be 86 years old. Its residents have one of the longest life spans of any community in the world. But just a short bike ride away lies a community where residents routinely live nine fewer years. King County is similar to many places in the United States, where living on one side or another of an invisible line can mean vastly different outcomes in the length and quality of people’s lives. Such health disparities are the result of a complex stew of inequities that plague many American communities. Differences in the quality of jobs, access to health care, transportation, education and environment put many people at a disadvantage right from the start of their lives, and those disadvantages eventually lead to shorter, less healthful lives. But a nationwide movement to correct these disparities and put communities on a path to health equity is making inroads at the national, state and local level. The road will be long and bumpy, advocates caution, but the goals are achievable, said speakers at APHA’s 140th Annual Meeting in San Francisco. “We cannot rest until we have achieved a nation free of health care disparities,” said Howard Koh, MD, MPH, assistant secretary for health in the U.S. Department of Health and Human Services. Speaking at an Annual Meeting session devoted to health equity, Koh said the new model for addressing such issues, which is one of the goals of Healthy People 2020, is a comprehensive approach. Healthy People 2020 is the federal government’s 10-year agenda to help Americans lead healthier lives. Much of the work toward equity is made possible through the Affordable Care Act, the landmark health reform bill passed in 2010. The law created offices of minority health in six HHS agencies and elevated the National Center on Minority Health and Health Disparities to the institute level at the National Institutes of Health. The language surrounding the issue is changing as well. Public health leaders are more apt these days to talk about health equity than health disparities. That is because health disparities — differences in health status between population groups — are thought to arise from health inequities. Substandard education, less access to health care, racism, classism and negative environmental conditions, for example, can contribute to poor health, and addressing those root causes may pave the path to health equity, said Regina Davis Moss, PhD, MPH, MCHES, APHA’s associate executive director for health policy and practice. “The word ‘disparities’ tends to only look at the differences between the incidence and prevalence of health conditions,” Moss said. “‘Inequities’ leads us look at things such as unjust policies and practices and what can be done so everyone has the opportunity to attain their full health potential.” APHA is pursuing health equity issues via several efforts, including its transportation and health program, which seeks more walkable and bikeable neighborhoods. APHA’sCenter for School, Health and Education also works toward dropout prevention by providing school-based health services for educational success. APHA has also published or co-published a number of books on equity-related topics. HHS also created what Koh called an “aggressive action plan” to address inequities by strengthening the nation’s workforce, advancing health through prevention and improving innovation, among other efforts. He highlighted the fact that work against disparities has already made a difference in flu vaccination coverage. In 2011, he said, there were no racial or ethnic disparities among children receiving flu vaccinations, and coverage was highest among Hispanic children. Leaders in the push toward health equity include the Bay Area Regional Health Inequities Initiative. The initiative, which includes 11 cities and counties in the San Francisco area, has formed committees that examine the work being done by member health departments to reduce and eliminate inequities. The group has also created a toolkit for use by other health departments to help assess their work related to health inequities. The toolkit includes surveys, focus groups, interviews and document review guidelines and has proven helpful, according to Suellen Bennett, MSPH, chief of the health equity section at Columbus Public Health in Ohio, who also spoke at the APHA meeting. Columbus Public Health also used a planning survey from Alameda County, Calif., a leader in health equity issues. The toolkit provides a snapshot of what a public health department is doing and helps conduct a capacity and skills assessment and helps identify gaps, Bennett said. ![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/42/10/1.2/F1.medium.gif) [Figure1](http://www.thenationshealth.org/content/42/10/1.2/F1) A poster from King County, Wash., promotes fairness and eliminating inequities. Poster courtesy King County Though the department is still analyzing and figuring out how best to apply the results, the toolkit helped the department tweak its strategic and workforce development plans. It was also useful in the department’s application for accreditation with the Public Health Accreditation Board, Bennett told *The Nation’s Health*. The department is now working to address inequities via increased awareness, strengthening partnerships and actions in programs and initiatives. The big challenge, as with many public health efforts, is funding, she said. “We know that we are not going to get additional money for additional staff,” Bennett said. “But equity has to be incorporated into everything we do. It’s about adding more work to what everybody’s doing and changing the priorities.” King County has embarked on a plan to correct many inequities. County leaders embedded a “fair and just” principle in their strategic plan and adopted an ordinance requiring agencies to consider social justice in all decision-making processes. The county now looks at everything from policy and budget development to community engagement through a lens of social justice and health equity. “It’s definitely been a learning process,” said APHA member Matias Valenzuela, King County’s manager of equity and social justice policy. “There’s not a blueprint for doing this work.” Valenzuela said training for supervisors and managers is critical, but with 13,000 employees, some of whom have little to no familiarity with social justice and health equity issues, it is hard work. Still, he said it is important that the need for the work is codified in the strategic plan and that the ordinance requires consideration of social justice and health equity issues. “High level support that is actually law helps to really push this through,” he told *The Nation’s Health*. Though the effort has only taken shape recently, King County has already made changes. For example, while the workforce is generally representative in terms of demographics, a study found that there were more minorities in nonsupervisory positions. So the county began looking at how it was posting jobs, including what qualifications it required and how it worded ads. Leaders also conducted anti-bias training for hiring panels, having them spend a session with a human resources analyst before the interview process to review possible biases. Despite the planning and the myriad new projects and efforts in place, few people working on social justice and health equity believe that realizing their goals will be a quick process. “We’ve only been at this a few years,” Valenzuela said. “It look a long time to create the conditions we currently have, so we have to be in it for the long haul.” For more information on King County’s programs, visit [www.kingcounty.gov/equity](http://www.kingcounty.gov/equity). For more on HHS’ work, visit [www.minorityhealth.hhs.gov](http://www.minorityhealth.hhs.gov). * Copyright The Nation’s Health, American Public Health Association