Leadership Defines A Legacy: State Approaches to Health Equity

August 16, 2018|10:36 a.m.| ASTHO Staff

On Aug. 6, the world mourned the death of Margaret Heckler, the former HHS secretary under President Ronald Reagan who worked to prioritize health disparities and social determinants of health. In 1985, Heckler commissioned the landmark Report of the Secretary’s Task Force on Black and Minority Health. Now commonly known as the Heckler report, this assessment highlighted the disproportionate burden of death and illness impacting racial and ethnic minorities and initiated a taskforce to improve the health of minorities and eliminate health disparities, the first of its kind by the federal government.

The most significant outcomes of the Heckler report were the creation of the HHS Office of Minority Health in 1986, and in 1990, the development of a regional minority health consultant network, along with the creation of state and territorial offices of minority health, which focus state efforts on the health and well-being of racial and ethnic minority communities. The report was also a catalyst that led to focused disparity reduction efforts and was widely cited in national reviews and articles that promoted changes to state laws.

Thirty-three years later, state and territorial health officials are continuing work to not only reduce persistent health disparities but also advance health equity and address factors outside healthcare settings by improving the social determinants of health. State and territorial health officials have the unique opportunity to step into the role of chief health strategists to drive solutions that address the nation’s most formidable health challenges to improve the population’s health.

States continue to support health equity by addressing the root causes of persistent health inequities through public health policies, plans, initiatives, reporting, and partnerships. Below are a few 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.

Former HHS Secretary Heckler led the charge for government officials “to exert leadership, influence, and initiative to close the existing [health] gap.” State health agencies can continue to play a significant role in eliminating health disparities as well as advancing health equity by leading the conversation about how health is created, encouraging multi-sector collaborations, and developing policies to address the social determinants of health to improve population health.

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