Equity Will Come Standard at ASTHO

March 23, 2022 | Michael Fraser, Kimberlee Wyche Etheridge, Joya Coffman

There has been tremendous investment in state efforts to engage communities in the work of public health, to address the inequities we see in health, and to promote wellbeing of everybody—our recent experience with the COVID pandemic underscores just how much work remains to be done. Ultimately, the job of public health is to assure the conditions in which everybody can be healthy—everybody. Public health takes that charge very, very seriously.

An issue that public health wrestles with is how to combat racism as we would any other public health emergency. ASTHO’s board of directors has declared structural racism a public health emergency. And health equity is the number one priority in ASTHO’s strategic plan, which means our staff will prioritize equity work as we support all aspects of our members’ technical assistance and capacity building needs.

ASTHO is committed to empowering our staff to approach their work through an equity lens. That’s why we created a health equity team that is working organization wide to address three target audiences: ASTHO staff, state and territorial health officials, and other public health leaders. To begin with, ASTHO has established the following definition, which lays the foundation for our external work:

“Health equity is when everyone has a fair and just opportunity to be as healthy as possible in a society that values each member equally through focused and ongoing efforts to address avoidable inequities, historical and contemporary injustices, and the elimination of disparities in health and healthcare.”

From establishing training modules for new and seasoned employees, to embedding equity in program work plans and logic models, ASTHO is weaving health equity into the organization’s very fabric.

By creating a Policy Academy to support state and territorial health leaders implement our structural racism policy statement, state teams will carry equity through the policy development process so it specifically addresses organizational structural racism. Through its Diverse Executives Leading in Public Health (DELPH) program, ASTHO is training the next generation of health officials, poised to lead when the opportunity arises.

“Health Equity” is not the same as “Equity”

It is critical to understand and distinguish health equity work from Diversity, Equity, and Inclusion (DEI) initiatives. And, as organizations grapple with social and civil discourse, they must also address systematic racism and institutional biases. Organizations that purposely work towards creating a diverse, inclusive, and equitable work environment are better creators, innovators, communicators, and problem solvers.

In alignment with the health equity work that ASTHO is leading to leverage policies and practices that create healthy communities where everyone has access to optimal health, ASTHO recognizes that as an established organization with influence, funding, and workforce, we are not immune to systemic racism and racial hierarchy. ASTHO is examining our internal structure and deploying strategies to transform our culture and address policies and practices that correct inequities.

Through the lens of the Truth, Racial Healing, and Transformation (TRHT) framework, ASTHO leadership and staff have committed to a process that examines five key pillars that must be addressed to dissent from conscious and unconscious bias and beliefs that place hierarchy in human value: narrative change and racial healing/relationship-building, separation, the law, and economy. To achieve sustained organizational culture change, staff and leaders are assessing how these areas present themselves within our professional environment, and collectively envisioning how we can address and undo the detrimental consequences of racism.

A year of productive discussions, authentic reflection, collective visioning, and prioritization has primed ASTHO for change. This transformation will encompass our human resources and workforce practices and opportunities, administrative policies, communication strategies, and organizational culture of sharing. Our goal? A strengthened organization and professional community that reflects ASTHO’s values of leadership, respect, diversity and inclusion, responsiveness, integrity, and collaboration. And it is critical we project those values in both the national public health work we lead and in the internal community we cultivate.

While ASTHO has significantly raised the bar to addressing health equity, in no way have we solved long-standing injustices. Much work remains to be done and all journeys must start with one step and focus on the long game. ASTHO is working in this space so we can hand the next generation a healthier, more equitable world to inhabit.