State plans bring health equity focus to community level: Social determinants of health key =========================================================================================== * Lindsey Wahowiak States throughout the U.S. are recognizing the importance of health equity, and are creating plans to improve it across their communities. Sometimes called equity reports or assessments, state health equity plans can help health departments and communities ensure that their public health efforts are geared toward improving opportunities for all community members to live a healthy life — regardless of their ZIP code, race, ethnicity, sexual orientation, gender identity, insurance status, level of education or level of income, said Nicole Alexander-Scott, MD, MPH, president-elect of the Association of State and Territorial Health Officials and director of the Rhode Island Department of Health. Equity reports take each of those social determinants of health into account, as they can be barriers to achieving good health, or a free pass to good health for others. ![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/48/7/s1.2/F1.medium.gif) [Figure1](http://www.thenationshealth.org/content/48/7/s1.2/F1) A growing number of states are creating equity plans and reports to help ensure that all residents are given fair and adequate access to the tools they need to be healthy. Photo by Wavebreakmedia, courtesy iStockphoto “Employing a health equity lens in public health also helps ensure that communities consider the needs and health disparities experienced by vulnerable populations,” Alexander-Scott told *The Nation’s Health.* “Without this lens, you run the risk of celebrating improvements in overall public health — for example, an overall reduction in infant mortality — without considering the disparities experienced by certain populations.” While each health equity report is different, and each state has many communities with different needs, all the plans chart where public health efforts are improving health and health equity for all residents. That means each resident is given fair and adequate access to the tools they need to be healthy. Such undertakings are often works in progress, but they can lead to greater movement in improving health outcomes, particularly in vulnerable populations. One example is New York. The New York State Department of Health has made its state and county level data on health disparities available to the public since 2007. But in 2017, the department’s health equity report included data on health outcomes, demographics and other community characteristics for cities and towns with populations that were at least 40 percent non-white. Within the report, there were town- or city-specific reports with data that aligned with the New York State Health Improvement Plan and social determinants of health, such as housing, educational attainment and insurance coverage. The New York State Department of Health noted that local health departments could use such data to understand and identify their own priorities, mobilize communities and promote health equity. While individual communities will have their own needs, state-level data and support is critical, said Tia Taylor Williams, MPH, MS, director of APHA’s Center for Public Health Policy and Center for Schoo,l Health and Education. “If you’re applying an equity lens, there are clear gaps you can see and shore up by partnering across sectors, such as housing and transportation,” Williams told *The Nation’s Health*. “That has a trickle-down effect to the local level by serving as a model and also determining how funding is applied.” Eliminating disparities and achieving equity are some of the Rhode Island Department of Health’s leading priorities, Alexander-Scott said. From the data the department collected on equity, it created its Health Equity Institute, which addresses systemic inequities so that all residents are able to achieve better health. From the institute, the Rhode Island Department of Health has created a Health Equity Zone initiative, which Alexander-Scott described as a “community-led, place-based approach designed to build healthier, more resilient and more just communities across Rhode Island” through action plans for high-risk communities. ![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/48/7/s1.2/F2.medium.gif) [Figure2](http://www.thenationshealth.org/content/48/7/s1.2/F2) In Washington state, health leaders have created and implementated of a community engagement guide on equity. Communities across the country are coming together to address health equity, thanks in part to statewide plans. Photo by Steve Debenport, courtesy iStockphoto In Washington, there is no official statewide plan, but health leaders are using a work group to address health equity in communities. The Washington Department of Health’s Health Equity Workgroup and Center for Public Affairs Community Relations and Equity staff collaborate to set priorities and lead activities to promote health equity. A 2017-2019 work plan on health equity includes nine strategies to implement to enhance opportunity for at-risk communities. Some of the strategies have already been implemented, such as the creation and implementation of a community engagement guide on equity, said Katie Meehan, a health equity consultant at the department’s Center for Public Affairs. State and local health agencies can get help moving toward health equity from ASTHO’s Center for Population Health Strategies, which supports public health agencies in addressing socio-economic and environmental determinants of health and health equity. Assistance through ASTHO includes technical help, leadership development and other educational and professional development opportunities for state and territorial health officials and agency staff. “ASTHO’s organizational vision is to support state and territorial health agencies advancing health equity and optimal health for all,” Alexander-Scott said. APHA also highlights the work state and local leaders are doing to achieve health equity in their communities. The Association’s “Better Health Through Equity: Case Studies in Reframing Public Health Work” report offers examples of successful efforts to address inequities. APHA also works upstream to eliminate the root causes of inequities. The Center for School, Health and Education works with schools and school-based health centers to address the factors that influence health and educational success. “There’s a lot of power and opportunity to really take action on what’s most pressing for all state residents,” Williams added. “It’s important in times when there’s not as much movement at the national level. The federal government can’t dictate what states can do from an equity perspective. It has to be driven by where there’s the most need. There’s a lot of potential and power states have in creating equity.” For more information on health equity and resources from APHA, visit [www.apha.org/health-equity](http://www.apha.org/health-equity). * Copyright The Nation’s Health, American Public Health Association