Health Promotion Programs. (SOPHE) Society for Public Health Education

However, since LHIs focus on upstream measures, many factors that contribute to health inequity and social injustice cut across these five priority topics and specifically address social determinants of health, health disparities, and health equity. For instance, Healthy People 2030 includes objectives on housing affordability, food security and hunger, safe and active transportation, education access and quality, better employment conditions and economic stability; as well as creating neighborhoods and environments that promote health and safety. Such objectives are achieved through community engagement and coalition building across sectors (e.g., housing, business, transportation, healthcare, etc.).

      Framework to Address Health Equity and Social Justice

Many communities use the Healthy People framework to address health equity and social justice. Washington DC Department of Health initiative to address health equity in the community (Figure 2.6) is drawn from Healthy People. The DC Department of Health monitors nine drivers: education, employment, income, housing, transportation, food environment, medical care, outdoor environment, and community safety. Because of their individual impact, but especially given their interconnectedness, the nine key drivers provide the main framework that collectively engineer how health is created outside of traditional healthcare and public health. Together, they illustrate the importance of social and structural determinants, which, intentionally or otherwise, produce persistently inequitable health outcomes (District of Columbia Health Department, 2020).

      Figure 2.6 DC Healthy People 2020 Framework and Action Plan to Achieve Health Equity

Source: DC.Gov

      LGBTQ+ Individuals Have Special Health Concerns

      A goal of Healthy People 2030 is to improve the health, safety, and well-being of LGBTQ+ individuals. LGBTQ+ encompasses all races and ethnicities, religions, and social classes (Office of Disease Prevention and Health Promotion, 2020). Eliminating LGBTQ+ health disparities and enhancing efforts to improve LGBTQ+ health are necessary to ensure that LGBTQ+ individuals can lead long, healthy lives. The many benefits of addressing health concerns and reducing disparities include reductions in disease transmission and progression; increased mental and physical well-being; reduced healthcare costs; and increased longevity. Gay, lesbian, bisexual, transgender, and queer individuals have special health concerns besides the usual ones that affect most men and women. Efforts to improve LGBTQ+ health include:

       Collecting Sexual Orientation and Gender Identity (SOGI) data in health-related surveys and health records in order to identify LGBTQ+ health disparities.

       Appropriately inquiring about and being supportive of a patient’s sexual orientation and gender identity to enhance the patient-provider interaction and regular use of care.

       Providing medical students with training to increase provision of culturally competent care.

       Implementing antibullying policies in schools.

       Providing supportive social services to reduce suicide and homelessness among youth/

       Curbing human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) with interventions that work.

       Many LGBTQ+ youth thrive during adolescence, but stigma, discrimination, and other factors put them at increased risk for negative health and life outcomes. LGBTQ+ health requires specific attention from healthcare and public health professionals to properly address their health needs.

      The Health in All Policies Guide

Health in All Policies: A Guide for State and Local Governments was created by the Public Health Institute, the California Department of Public Health, and the American Public Health Association in response to growing interest in using collaborative approaches to improve population health by embedding health considerations into decision-making processes across a broad array of sectors. The guide draws heavily on the experiences of the California Health in All Policies Task Force and incorporates information from the published and gray literature and interviews with people across the country. Health in All Policies is based on the recognition that our greatest health challenges—for example, chronic illness, health inequities, climate change, and spiraling healthcare costs—are highly complex and often linked. Promoting healthy communities requires that we address the social determinants of health, such as transportation, education, access to healthy food, economic opportunities, and more. This requires innovative solutions, a new policy paradigm, and structures that break down the siloed nature of government to advance collaboration. Opportunities for health are created primarily outside of the healthcare and traditional public health systems. Differential opportunities for health are the result of a much broader spectrum of societal structural and institutional norms, laws, policies, and practices. None is permanent, nor set in stone. With political will, all are amenable to change. (District of Columbia Department of Health Office of Health Equity, 2019).

      Five Key Elements of the Health in All Policies Guide

      Promote health, equity, and sustainability. Health in All Policies promotes health, equity, and sustainability through two avenues: (1) incorporating health, equity, and sustainability into specific policies, programs, and processes, and (2) embedding health, equity, and sustainability considerations into government decision-making processes so that healthy public policy becomes the normal way of doing business.

      Support intersectoral collaboration. Health in All Policies brings together partners from the many sectors (i.e. intersectoral collaborations) that play a major role in shaping the economic, physical, and social environments in which people live, and therefore have an important role to play in promoting health, equity, and sustainability. A Health in All Policies approach focuses on deep and ongoing collaboration.

      Benefit multiple partners. Health in All Policies values co-benefits and win-wins. Health in All Polices initiatives endeavor to simultaneously address the policy and programmatic goals of both public health and other agencies by finding and implementing strategies that benefit multiple partners.

      Engage stakeholders. Health in All Policies engages many stakeholders, including community members, policy experts, advocates, the private sector, and funders, to ensure that work is responsive to community needs and to identify policy and systems changes necessary to create meaningful and impactful health improvements.

Create structural or process change. Over time, Health in All Policies work leads to institutionalizing a Health in All Policies approach throughout the whole of government. This involves permanent changes in how agencies relate to each other and how government decisions are made, structures for intersectoral collaboration, and mechanisms to ensure a health lens in decision-making processes.

      Finally, public health must share a common vision for progress, a vision based in social justice as a way to achieve health equity. Himmelstein and Woolhandler (2017) proposed what such a vision would be in their 21^st Century Vision for Progress in the United States:

       Moving forward to create universal healthcare

       Reparations for slavery and Native American genocide

       A $15 minimum wage and guaranteed minimum income

       Enforcing pay equality and extending reproductive and lesbian, gay, bisexual, and transgender rights

       More and better public housing, public education, and public transit

       The reversal of mass incarceration and restoration of ex-offenders’ civil rights

       Legalization of the undocumented

       Expanding