Examining the Impact of Law and Policy on Health Equity

June 28, 2018|3:36 a.m.| ASTHO Staff

ASTHO’s guiding principles on Achieving Optimal Health for All remind us that state and territorial health agencies play a critical role in creating and supporting strategies to achieve health equity. While not solely the responsibility of state and territorial agencies, these agencies often work closely with healthcare systems, non-health agencies, and organizations in other sectors (e.g., education, housing, labor, justice, transportation, agriculture, economic development, and environmental protection) and develop shared goals to promote health equity and reduce disparities. Together, public health agencies and their partners can ensure better access to care, improve healthcare quality, and develop approaches to best meet the needs identified across all populations, regardless of race, ethnicity, gender, socioeconomic status, or religion. Public health agencies are also encouraged to provide recommendations to policymakers, the public, partners, and business communities on legislative solutions to overcome the economic and human impacts of health inequity.

Through its legislative tracking and research efforts, ASTHO assists its members in identifying emerging and promising policies and laws. Below are several bills addressing health equity and disparities that were considered during the 2018 state legislative sessions. While none of these bills have yet made it to law, they provide examples of the ways state policymakers seek to achieve health equity and reduce disparities—from the familiar (e.g., collecting and using health data to assessing and reporting on disparities) to the innovative (e.g., assessing the disparate impact of legislative proposals on racial and ethnic minorities and funding programs affecting the social determinants of health with hospital budget surpluses).

Knowing and understanding the extent of disparities within a state can serve as a prerequisite for how to address them and improve health equity. In Connecticut, the legislature considered a bill (HB 5415) directing the state’s health information technology plan to develop the ability to collect and use health equity data to improve health outcomes. Companion bills in Massachusetts, S 641 and H 622, would establish an office of health equity that would collaborate with other state agencies to reduce disparities, evaluate the effectiveness of programs to eliminate health disparities, and prepare an annual report evaluating the commonwealth’s progress toward eliminating racial and ethnic health disparities.

A bill in Mississippi, HB 146, would aim to “decrease the disparities in all gender and racial groups in many diseases and preventable conditions by 2022.” To achieve this goal, the legislation instructs the state health officer to establish a program to reduce disparities in a set of priority areas including, infant mortality, breast and cervical cancer screening, HIV/AIDS and sexually transmitted diseases, adult and child immunizations, cardiovascular disease, diabetes, accidental injuries, and violence. The state health officer would also be responsible for working with community-based organizations to develop a comprehensive, coordinated plan to reduce health disparities in the priority areas and submit biannual reports on the program. Another bill in Mississippi, HB 470, would create a Health Disparities Council to make recommendations for the reduction and elimination of racial and ethnic disparities found in accessing quality healthcare and health outcomes within the state. 

Law and policy can themselves be determinants of health and lead to disparities. In May, a bill (HB 5877) was introduced in the Illinois legislature to allow the estimation of a proposed law’s impact on racial and ethnic minorities. These assessments could be used to illustrate the way a proposed piece of legislation would negatively or positively impact the health of a minority population.

Finally, funding for programs and initiatives to promote health equity and address the social determinants of health is frequently needed and difficult to obtain. In Vermont, a pair of bills (S 290 and H 553) were introduced to require hospitals to remit a portion of their budget surpluses into a social determinants of health fund. The fund would be used to award grants to local communities for programs affecting social determinants of health. 

Promoting health equity, reducing disparities, and remedying social determinants of health relies on partnerships and the ability to inform partners of the ways these issues can be addressed. ASTHO will continue to monitor both familiar and innovative state legislative proposals that can impact health equity.