Address Root Causes of Health Disparities
There are those who encourage health promotion program staff as they plan, implement, and evaluate their programs and advocacy efforts to consider moving upstream and addressing the social determinants of health. A number of strategies are recommended:
Increase high school graduation rates of poor and minority students: Two major consequences for students living in a high-poverty family include an achievement gap limiting students’ success in school and a health disparities gap. These disparities are interrelated in students from families in the lowest quartile of income: they are about seven times more likely to drop out of high school than are their counterparts who come from families within the highest quartile of income. Children from poor families experience more chronic and infectious disease, childhood injury, social/emotional and behavioral problems, and violence compared to children who do not live in poverty. These health disparities increase absenteeism from school and affect learning. More teachers teaching minority students are not credentialed (U.S. Department of Education, 2016). Students of color also experience disproportionately higher suspension/expulsion rates, which increases the absenteeism rate of these students and which in turn contributes to failing classes and ultimately dropping out of school. To address educational inequities, the local health department and the local education agency could establish a community-wide school health council to coordinate the health promotion activities of the community, linking the various health, social service, juvenile justice, and youth development agencies in the community to ensure that inequities in education are eliminated. Students who receive health interventions and other services have been linked with increasing academic success.
Increase health literacy: Health literacy requires that individuals have the capacity to obtain, process, and understand basic health information in order to make healthy choices and secure those interventions needed to prevent or treat disease. Low health literacy has been associated with poor self-reported health status in many diverse populations, including Latinos and Asian Americans, even when education and other well-established predictors of health status are controlled (Healthy People 2030). The problem is twofold. First, navigating the healthcare and health insurance systems with their jargon and terminology creates barriers to know where to go and what actions to take. Secondly, although there are many sources for health promotion information, individuals with low health literacy frequently have trouble taking the right medication and following prescribed health promotion assignments and programs (Koh & Rudd, 2015). In order to help individuals who have particular difficulty with health literacy, use jargon-free written materials, provide simple and understandable step-by-step instructions about health activities, and consider engaging English as a second language programs to address health literacy levels in their classes (Koh & Rudd, 2015; Soto Mas et al., 2015).
Improve air, water, and soil quality: Environmental toxins that adversely affect health need to be reduced. For example, a healthier environment is achieved by reducing exposure to diesel particulates by prohibiting diesel trucks in residential neighborhoods, enforcing the no-idling law near schools, requiring the use of clean technology in new ships and trucks, reducing emissions in existing fleets, and implementing existing state and federal emissions regulations. Monitoring the impact of trucking and shipping activities needs to be expanded among low-income and vulnerable populations. Input from public health professionals on the impact of air pollution needs to also be incorporated in local land use and development decisions, using such tools as health impact assessments during planning phases (Healthy People 2030).
Improve housing options: High-quality, affordable, stable housing located close to resources leads to reduced exposure to toxins and stress, stronger relationships and willingness to act collectively among neighbors, greater economic security for families, and increased access to services (including healthcare) and resources (such as parks and supermarkets) that influence health. Policies need to be implemented that support transit-oriented development, along with incentives for mixed-use and mixed-income development. View one community’s three-pronged plan to end homelessness at Destination: HOME (Destination: HOME, n.d.).
Improve transit options by providing incentives for use of mass transit and nonmotorized vehicle transportation: Designing streets that are safe and accessible for all users (that is, complete streets) will encourage walking and bicycling. Enhancing the safety, accessibility, and affordability of mass transit is also essential. Increased use of these types of transit will decrease air pollution and increase physical activity, which will lead to healthier individuals and communities.
Support healthy behaviors through increased opportunities to engage in physical activity and to access healthy foods: Because physical activity is key to preventing disease and promoting health, policies are needed to encourage physical activity in school and facilitate after-hours use of school grounds and gyms to improve community access to physical activity facilities. Zoning laws and general plans need to be developed to improve the safety of parks, walking paths, and other recreational facilities in high-crime and low-income communities. In addition, provide support to ensure access to healthy foods in all communities through development of grocery stores in low-income communities; incentives for existing stores to offer more healthy food options, especially fresh produce; and incentives for alternative venues, such as farmers’ markets and community or school-based produce stands.
Collaborations Focused on Race and Equity
Incorporating racial equity into California’s state-level agency policies, practices, and culture, Capitol Collaborative on Race & Equity (CCORE) is a community of nearly 30 California State government agencies, including education, health, social services, transportation, corrections and rehabilitation, financial management, natural resources, and others, working together since 2018 to learn about, plan for, and implement practices that embed racial equity approaches in state government. The public/private structure of CCORE helps accelerate broad system-wide changes. CCORE implements a commitment by California’s Health in All Policies Task Force to increase the capacity of State government to advance health and racial equity. In addition to the community of practice, CCORE offers two capacity building components: 1) a training program for State government entities, and 2) a staff team that provides technical assistance and support to the CCORE community (Capitol Collaborative on Race & Equity: https://sgc.ca.gov/programs/hiap/racial-equity).
Actions Using Healthy People 2030 to Advance Health Equity and Social Justice
Healthy People 2030 places a stronger emphasis on well-being and social determinants of health. Deliberately it calls out current and historical racism, injustice and other forms of discrimination as root causes of poor health, and recognizes that until those factors are addressed, health disparities will persist. Healthy People 2030 approaches social determinants through education access and quality, economic stability, social and community context, neighborhood and built environment, and healthcare access and quality.
Leading Health Indicators
Healthy People 2030 objectives are intended to inform action toward improving health and well-being. These objectives—known as Leading Health Indicators (LHIs)—help organizations, communities, and states across the nation focus their resources and efforts to improve the health and well-being of all people (U.S. Department of Health and Human Service, n.d.). The indicators are a select set of objectives on high-priority health issues and challenges. While all of Healthy People 2030’s objectives are important, the LHIs are chosen to draw attention to those that have the highest potential for impact.
LHIs are organized into five distinctive topics, including: 1) health conditions (e.g., cancer, diabetes, infectious disease); 2) health behaviors (e.g., family planning, physical activity, vaccination); 3) populations (e.g., infants, LGBTQ+, people with disability); 4) settings and systems (e.g.,environmental health, health policy, housing); and 5) social determinants (e.g., education access and quality, neighborhood and built environment, social,