State Approaches to Health Equity

Several states are working to supporting health equity by addressing the root causes of persistent health inequities through public health policies, plans, initiatives, reporting, and partnerships. The Association of State and Territorial Health Officials recently summarized some examples of states working to advance health equity:

  • States are partnering with stakeholders and community residents to develop tools and resources that are community driven and developed to address health equity. The Colorado Department of Public Health and Environment, Office of Health Equity recently released the Colorado Equity Action Guide, which examines the root causes of health inequities experienced by Coloradans and provides historical context for present-day adverse health outcomes by describing the impact of structural racism and inequitable policies throughout the state’s history. The guide provides action steps, integrates community voices, and serves as a practical tool for community members, government officials, and philanthropy to work together to advance equity. 
  • States are taking the opportunity to update internal policies and plans to ensure health equity is prioritized and integrated into their operating procedures, practices, and programs, as they prepare for public health department accreditation or re-accreditation now that the revised accreditation standards and domain requirements place greater emphasis on health equity. ASTHO staff analyzed 44 state health improvement plans (SHIPs), a required document for public health accreditation. Forty-three out of forty-four state plans indicated health disparities as a general focus, with ten states explicitly identifying health equity as a priority. In Washington, D.C.’s SHIP plan, DC Healthy People 2020, an agency goal was to “achieve health equity by addressing the social determinants of health and structural/system-level inequities” impacting D.C. residents. The district developed 2020 target rates for various social and environmental conditions, such as economic food insecurity, as well as recommended strategies.
  • States are embracing a broader view on what creates health and leading efforts to include health in all policy (HiAP) considerations across all sectors. The Triple Aim for Health Equity Framework, coined by former ASTHO President Ed Ehlinger (alumnus-MN), encourages policymakers to take a HiAP approach as a means to advance health equity. ASTHO defined HiAP as a collaborative approach that integrates and articulates health considerations into policy making across all sectors and levels to improve the health of all communities and people. ASTHO’s 2018 State of Health-in-All Policies report featured nine state case studies which profiled their HiAP and health equity activities. California was the first state to formally create a HiAP Task Force in 2010. The task force has representatives from 22 diverse state agencies and has been successful in integrating health and equity in state policies. The task force recently partnered with the Government Alliance on Race and Equity to create a racial equity capacity-building pilot program for California state employees.