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Engaging Health Equity

HPHR Fellow Lindsay Rosenfeld

By Lindsay Rosenfeld, ScD, ScM

Health Equity: Asking Questions to Continuously Learn More (#1)

Welcome to Engaging Health Equity. We all can and need to be part of the conversation to imagine and re-imagine what’s possible. I expect you, thoughtful readers, are coming to this blog with varying levels of experience in the work of health equity. I welcome your ideas about the work and encourage open and respectful conversation with each other. To get started, a few thoughts on health equity.

 

Health Equity
So, I don’t know about you, but I can’t keep up with my daily inbox. Yet, I always make sure to open posts from the ever-insightful Fakequity (fakeequity=fake equity). A recent post highlighted a major issue I think about a lot: the lack of precision in our equity discussions. An equity lens is indeed a large, multifactorial perspective that can refer to an overarching way of doing and measuring things. This is useful. But, it isn’t a catchall. We can’t use the term equity when what we really mean is racism.

 

Health
The term health can also be a slippery slope. Health, as defined by the World Health Organization, is “a state of complete physical, mental and social well-being and not merely the absence of disease or `infirmity” (1948). Many argue that this definition of health needs to be updated. People healthily managing disease must be included. In addition, the idea of health being complete is largely inaccurate or impossible or both. Likewise, many largely-ignored voices such as families with undocumented immigrants or children with medical and developmental complexity must be part of creating new definitions and action. Health is part of all programs and policies. Health policy is housing policy. Health policy is educational policy. Health policy is transportation policy.

 

Root Causes of Health
Poor health outcomes are driven by systemic inequities (e.g. entrenched racism, sexism, poverty, homophobia and transphobia, anti-immigrant sentiment, able-ism, sane-ism, white supremacy, and more). But to change the outcomes, we must rigorously examine the process. As Camara Jones notes in her well-known allegory, flowers need certain conditions to grow, and especially to flourish. People are the same. The soil, or our social environment, largely determines the extent of health and development. For people, these environments include our families and neighborhoods and schools. They also include local, state, and federal policy. An equity approach helps us to systematically identify and remove barriers to equitable processes and outcomes in all of these spaces. It allows us to peel back the layers so we can increase facilitators for just and fair health experiences and outcomes. This requires that we take action that reframes our questions, ways of doing things, and desired outcomes.

 

Doing Health Equity
In my work, health equity is about applying an equity frame to health sectors or outcomes to reveal and take action on root causes. But, since health is in everything, we’re constantly making links between health and everything else. Here, equity is a larger umbrella term that focuses every concept and action on justice and fairness. Applying an equity, or health equity lens, means that you’re simultaneously considering multifaceted issues, populations, levels, impacts across time, and more. Yes, it’s a lot to do, but it’s absolutely not negotiable. We must be explicit. We must name the barriers and identify how they operate alone and in combination (intersectionality). We must use the best evidence to link or build new facilitators. Both are necessary. The process is iterative, not linear. Two steps forward. 1 step to the side. A hop back. As we go, we must always acknowledge what we don’t know, and assume we’re missing something important. This leaves us open for new ways of thinking and doing. Countless voices are needed to create the desired process and outcome.

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