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Abstract

This review describes the context of health equity and options for integrating equity into public health practice. We first discuss how the conceptualization of health equity and how equity considerations in US public health practice have been shaped by multidisciplinary engagements. We then discuss specific ways to address equity in core public health functions, provide examples of relevant frameworks and promising strategies, and discuss conceptual and measurement issues relevant to assessing progress in moving toward health equity. Challenges and opportunities and their implications for future directions are identified.

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2020-04-01
2024-04-29
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Literature Cited

  1. 1. 
    Alcaraz KI, Sly J, Ashing K, Fleisher L, Gil-Rivas V et al. 2017. The ConNECT Framework: a model for advancing behavioral medicine science and practice to foster health equity. J. Behav. Med. 40:23–38
    [Google Scholar]
  2. 2. 
    Alvidrez J, Castille D, Laude-Sharp M, Rosario A, Tabor D 2019. The National Institute on Minority Health and Health Disparities research framework. Am. J. Public Health 109:S16–20
    [Google Scholar]
  3. 3. 
    Anand S, Diderichsen F, Evans T, Shkolnikov VM, Wirth M 2009. Measuring disparities in health: methods and indicators. Challenging Inequities in Health: From Ethics to Action T Evans, M Whitehead, F Diderichsen, A Bhuiya, M Wirth 48–67 Oxford, UK: Oxford Univ. Press
    [Google Scholar]
  4. 4. 
    Anderson AC, O'Rourke E, Chin MH, Ponce NA, Bernheim SM, Burstin H 2018. Promoting health equity and eliminating disparities through performance measurement and payment. Health Aff 37:371–77
    [Google Scholar]
  5. 5. 
    Asada Y. 2007. Health Inequality: Morality and Measurement Toronto: Univ. Tor. Press
  6. 6. 
    Asada Y, Hurley J, Norheim OF, Johri M 2014. A three-stage approach to measuring health inequalities and inequities. Int. J. Equity Health 13:98
    [Google Scholar]
  7. 7. 
    Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT 2017. Structural racism and health inequities in the USA: evidence and interventions. Lancet 389:1453–63
    [Google Scholar]
  8. 8. 
    Baker P, Friel S, Kay A, Baum F, Strazdins L, Mackean T 2018. What enables and constrains the inclusion of the social determinants of health inequities in government policy agendas? A narrative review. Int. J. Health Policy Manag. 7:101–11
    [Google Scholar]
  9. 9. 
    Begun JW, Kahn LM, Cunningham BA, Malcolm JK, Potthoff S 2018. A measure of the potential impact of hospital community health activities on population health and equity. J. Public Health Manag. Pract. 24:417–23
    [Google Scholar]
  10. 10. 
    Braveman P. 2006. Health disparities and health equity: concepts and measurement. Annu. Rev. Public Health 27:167–94
    [Google Scholar]
  11. 11. 
    Braveman P. 2010. Social conditions, health equity, and human rights. Health Hum. Rights 12:31–48
    [Google Scholar]
  12. 12. 
    Braveman P. 2014. What are health disparities and health equity? We need to be clear. Public Health Rep 129:5–8
    [Google Scholar]
  13. 13. 
    Braveman P, Arkin E, Orleans T, Proctor D, Plough A 2017. What is health equity? And what difference does a definition make? Rep., Robert Wood Johnson Found Princeton, NJ:
    [Google Scholar]
  14. 14. 
    Braveman P, Barclay CJP. 2009. Health disparities beginning in childhood: a life-course perspective. Pediatrics 124:S163–75
    [Google Scholar]
  15. 15. 
    Braveman P, Egerter S, Williams DR 2011. The social determinants of health: coming of age. Annu. Rev. Public Health 32:381–98
    [Google Scholar]
  16. 16. 
    Braveman P, Gruskin S. 2003. Defining equity in health. J. Epidemiol. Community Health 57:254–58
    [Google Scholar]
  17. 17. 
    Braveman PA. 2003. Monitoring equity in health and healthcare: a conceptual framework. J. Health Popul. Nutr. 21:181–92
    [Google Scholar]
  18. 18. 
    Braveman PA, Kumanyika S, Fielding J, LaVeist T, Borrell LN et al. 2011. Health disparities and health equity: The issue is justice. Am. J. Public Health 101:S149–55
    [Google Scholar]
  19. 19. 
    Cacari-Stone L, Wallerstein N, Garcia AP, Minkler M 2014. The promise of community-based participatory research for health equity: a conceptual model for bridging evidence with policy. Am. J. Public Health 104:1615–23
    [Google Scholar]
  20. 20. 
    Carey G, Crammond B, De Leeuw E 2015. Towards health equity: a framework for the application of proportionate universalism. Int. J. Equity Health 14:81
    [Google Scholar]
  21. 21. 
    CDC (Cent. Dis. Control Prev.) 2001. National Public Health Performance Standards Program. Local public health system performance assessment instrument Rep., CDC Atlanta: https://www.cdc.gov/od/ocphp/nphpsp/Documents/Local_v_1_OMB_0920-0555.pdf
  22. 22. 
    CDC (Cent. Dis. Control Prev.) 2016. Health in All Policies. Office of the Associate Director for Policy and Strategy https://www.cdc.gov/policy/hiap/index.html
    [Google Scholar]
  23. 23. 
    CDC (Cent. Dis. Control Prev.), Natl. Cent. Chronic Dis. Prev. Health Promot., Div. Community Health 2013. A practitioner's guide for advancing health equity: community strategies for preventing chronic disease Rep., US Dep. Health Hum. Serv Atlanta: https://www.cdc.gov/nccdphp/dch/pdf/HealthEquityGuide.pdf
  24. 24. 
    Chircop A, Bassett R, Taylor E 2015. Evidence on how to practice intersectoral collaboration for health equity: a scoping review. Crit. Public Health 25:178–91
    [Google Scholar]
  25. 25. 
    Cohen L, Davis R, Realini A 2016. Communities are not all created equal: strategies to prevent violence affecting youth in the United States. J. Public Health Policy 37:S81–94
    [Google Scholar]
  26. 26. 
    Dean HD, Roberts GW, Bouye KE, Green Y, McDonald M 2016. Sustaining a focus on health equity at the Centers for Disease Control and Prevention through organizational structures and functions. J. Public Health Manag. Pract. 22:S60–67
    [Google Scholar]
  27. 27. 
    Dicent Taillepierre JC, Liburd L, O'Connor A, Valentine J, Bouye K et al. 2016. Toward achieving health equity: emerging evidence and program practice. J. Public Health Manag. Pract. 22:S43–S49
    [Google Scholar]
  28. 28. 
    Gamble VN, Stone D. 2006. U.S. policy on health inequities: the interplay of politics and research. J. Health Politics Policy Law 31:93–126
    [Google Scholar]
  29. 29. 
    Graham H. 2009. Health inequalities, social determinants and public health policy. J. Policy Politics 37:463–79
    [Google Scholar]
  30. 30. 
    Hahn RA, Truman BI, Williams DR 2018. Civil rights as determinants of public health and racial and ethnic health equity: health care, education, employment, and housing in the United States. SSM Popul. Health 4:17–24
    [Google Scholar]
  31. 31. 
    Hall M, Graffunder C, Metzler M 2016. Policy approaches to advancing health equity. J. Public Health Manag. Pract. 22:S50–59
    [Google Scholar]
  32. 32. 
    Hogan V, Rowley DL, White SB, Faustin Y 2018. Dimensionality and R4P: a health equity framework for research planning and evaluation in African American populations. Matern. Child Health J. 22:147–53
    [Google Scholar]
  33. 33. 
    Hutchinson RN, Shin SJ. 2014. Systematic review of health disparities for cardiovascular diseases and associated factors among American Indian and Alaska Native populations. PLOS ONE 9:e80973
    [Google Scholar]
  34. 34. 
    IOM (Inst. Med.), Comm. Study Future Public Health 1988. The Future of Public Health Washington, DC: Natl. Acad. Press
  35. 35. 
    Jacobs DE. 2011. Environmental health disparities in housing. Am. J. Public Health 101:S115–22
    [Google Scholar]
  36. 36. 
    Jones CP, Jones CY, Perry GS, Barclay G, Jones CA 2009. Addressing the social determinants of children's health: a cliff analogy. J. Health Care Poor Underserved 20:1–12
    [Google Scholar]
  37. 37. 
    Joseph KT, Rice K, Li C 2016. Integrating equity in a public health funding strategy. J. Public Health Manag. Pract. 22:S68–76
    [Google Scholar]
  38. 38. 
    Kawachi I, Daniels N, Robinson DE 2005. Health disparities by race and class: why both matter. Health Aff 24:343–52
    [Google Scholar]
  39. 39. 
    Knight EK. 2014. Shifting public health practice to advance health equity: recommendations from experts and community leaders. J. Public Health Manag. Pract. 20:188–96
    [Google Scholar]
  40. 40. 
    Komo KA, Lang DL, Walker ER, Harper PD 2018. Integrating structural determinants into MPH training of health promotion professionals. Am. J. Public Health 108:477–79
    [Google Scholar]
  41. 41. 
    Kumanyika SK. 2016. Health equity is the issue we have been waiting for. J. Public Health Manag. Pract. 22:S8–10
    [Google Scholar]
  42. 42. 
    Last JM. 2001. A Dictionary of Epidemiology Oxford, UK: Oxford Univ. Press
  43. 43. 
    LaVeist TA, Isaac LA. 2013. Race, Ethnicity, and Health: A Public Health Reader San Francisco: Jossey-Bass
  44. 44. 
    Lee J, Schram A, Riley E, Harris P, Baum F et al. 2018. Addressing health equity through action on the social determinants of health: a global review of policy outcome evaluation methods. Int. J. Health Policy Manag. 7:581–92
    [Google Scholar]
  45. 45. 
    Lynch JF, Perera IM. 2017. Framing health equity: US health disparities in comparative perspective. J. Health Politics Policy Law 42:803–39
    [Google Scholar]
  46. 46. 
    Maldonado ME, Fried ED, DuBose TD Jr, Nelson C, Breida M 2014. The role that graduate medical education must play in ensuring health equity and eliminating health care disparities. Ann. Am. Thorac. Soc 11:603–7
    [Google Scholar]
  47. 47. 
    Marmot M. 2010. Fair society, healthy lives. The Marmot review Fin. Rep., Inst. Health Equity London: http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report-pdf.pdf
  48. 48. 
    Michener JD. 2017. People, places, power: Medicaid concentration and local political participation. J. Health Politics Policy Law 42:865–900
    [Google Scholar]
  49. 49. 
    Moffatt H, Fish K, Schwenger S, Sankaran S 2013. Let's talk: universal and targeted approaches to health equity Rep., Natl. Collab. Cent. Determ. Health, St. Francis Xavier Univ Antigonis, NS, Can: http://nccdh.ca/images/uploads/Approaches_EN_Final.pdf
  50. 50. 
    Natl. Acad. Sci. Eng. Med., Health Med. Div 2017. Communities in Action: Pathways to Health Equity A Baciu, Y Negussie, A Geller, JN Weinstein Washington, DC: Natl. Acad. Press
  51. 51. 
    Natl. Res. Counc. (US), Inst. Med 2013. U.S. Health in International Perspective: Shorter Lives, Poorer Health Washington, DC: Natl. Acad. Press
  52. 52. 
    Pauly B, Martin W, Perkin K, Van Roode T, Kwan A et al. 2018. Critical considerations for the practical utility of health equity tools: a concept mapping study. Int. J. Equity Health 17:48
    [Google Scholar]
  53. 53. 
    Pauly BM, Shahram SZ, Dang PTH, Marcellus L, MacDonald M 2017. Health equity talk: understandings of health equity among health leaders. AIMS Public Health 4:490–512
    [Google Scholar]
  54. 54. 
    Pega F, Valentine NB, Rasanathan K, Hosseinpoor AR, Torgersen TP et al. 2017. The need to monitor actions on the social determinants of health. Bull. World Health Organ. 95:784–87
    [Google Scholar]
  55. 55. 
    Penman-Aguilar A, Talih M, Huang D, Moonesinghe R, Bouye K, Beckles G 2016. Measurement of health disparities, health inequities, and social determinants of health to support the advancement of health equity. J. Public Health Manag. Pract. 22:S33–42
    [Google Scholar]
  56. 56. 
    Peter F. 2001. Health equity and social justice. J. Appl. Philos. 18:159–70
    [Google Scholar]
  57. 57. 
    Powell J, Menendian S, Ake W 2019. Targeted universalism: policy and practice Primer, Haas Inst. Fair Incl. Soc., Univ. Calif Berkeley: https://haasinstitute.berkeley.edu/targeteduniversalism
  58. 58. 
    Rosenthal L, Earnshaw VA, Moore JM, Ferguson DN, Lewis TT et al. 2018. Intergenerational consequences: women's experiences of discrimination in pregnancy predict infant social-emotional development at 6 months and 1 year. J. Dev. Behav. Pediatr. 39:228–37
    [Google Scholar]
  59. 59. 
    Rust G, Levine RS, Fry-Johnson Y, Baltrus P, Ye J, Mack D 2012. Paths to success: optimal and equitable health outcomes for all. J. Health Care Poor Underserved 23:7–19
    [Google Scholar]
  60. 60. 
    Shankardass K, Solar O, Murphy K, Greaves L, O'Campo P 2012. A scoping review of intersectoral action for health equity involving governments. Int. J. Public Health 57:25–33
    [Google Scholar]
  61. 61. 
    Skocpol TJ. 1991. Targeting within universalism: politically viable policies to combat poverty in the United States. The Urban Underclass C Jencks, PE Peterson 411–36 Washington, DC: Brookings Inst.
    [Google Scholar]
  62. 62. 
    Solar O, Irwin A. 2010. A conceptual framework for action on the social determinants of health Discuss. Pap. 2, World Health Organ Geneva: https://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf
  63. 63. 
    Stacy CP, Schilling J, Barlow S, Gourevitch R, Meixell B et al. 2018. Strategic housing code enforcement and public health Res. Rep., Urban Inst Washington, DC: https://www.urban.org/sites/default/files/publication/99190/strategic_housing_code_enforcement_and_public_health.pdf
  64. 64. 
    Trinh-Shevrin C, Islam NS, Nadkarni S, Park R, Kwon SC 2015. Defining an integrative approach for health promotion and disease prevention: a population health equity framework. J. Health Care Poor Underserved 26:146–63
    [Google Scholar]
  65. 65. 
    Tulchinsky T, Varavikova E. 2014. The New Public Health London: Elsevier
  66. 66. 
    Tyler ET, Conroy KN, Fu C-M, Sandel M 2011. Housing: the intersection of affordability, safety and health. Poverty, Health and Law: Readings and Cases for Medical-Legal Partnership ET Tyler, E Lawton, KN Conroy, M Sandel, B Zuckerman 225–73 Durham, NC: Carolina Acad.
    [Google Scholar]
  67. 67. 
    US DHHS (Dep. Health Hum. Serv.), Task Force Black Minority Health, Heckler M 1985. Report of the Secretary's Task Force on Black and Minority Health Rep., US Dep. Health Hum. Serv Washington, DC:
  68. 68. 
    Viruell-Fuentes EA, Miranda PY, Abdulrahim SJ 2012. More than culture: structural racism, intersectionality theory, and immigrant health. Soc. Sci. Med. 75:2099–106
    [Google Scholar]
  69. 69. 
    Vona-Davis L, Rose DP. 2009. The influence of socioeconomic disparities on breast cancer tumor biology and prognosis: a review. J. Women's Health 18:883–93
    [Google Scholar]
  70. 70. 
    Walker RJ, Strom Williams J, Egede LE 2016. Influence of race, ethnicity and social determinants of health on diabetes outcomes. Am. J. Med. Sci. 351:366–73
    [Google Scholar]
  71. 71. 
    Wallack L, Thornburg K. 2016. Developmental origins, epigenetics, and equity: moving upstream. Matern. Child Health J. 20:935–40
    [Google Scholar]
  72. 72. 
    Wanless D. 2004. Securing good health for the whole population Final Rep., Dep. Health London:.
  73. 73. 
    Ward MM. 2012. Personalized therapeutics: a potential threat to health equity. J. Gen. Intern. Med. 27:868–70
    [Google Scholar]
  74. 74. 
    Whitehead M. 1992. The concepts and principles of equity and health. Int. J. Health Serv. 22:429–45
    [Google Scholar]
  75. 75. 
    WHO (World Health Organ.) 2014. Health in All Policies (HiAP) framework for country action. Health Promot. Int. 29:i19–28
    [Google Scholar]
  76. 76. 
    WHO (World Health Organ.), Comm. Soc. Determ. Health 2008. Closing the gap in a generation: health equity through action on the social determinants of health Fin. Rep., Comm. Soc. Determ. Health, WHO Geneva: https://www.who.int/social_determinants/thecommission/finalreport/en/
  77. 77. 
    Williams DR, Jackson PB. 2005. Social sources of racial disparities in health. Health Aff 24:325–34
    [Google Scholar]
  78. 78. 
    Williams DR, Mohammed SA. 2009. Discrimination and racial disparities in health: evidence and needed research. J. Behav. Med. 32:20–47
    [Google Scholar]
  79. 79. 
    Williams DR, Priest N, Anderson NB 2016. Understanding associations among race, socioeconomic status, and health: patterns and prospects. Health Psychol 35:407–11
    [Google Scholar]
  80. 80. 
    Woods LL 2nd, Shaw-Ridley M, Woods CA 2014. Can health equity coexist with housing inequalities? A contemporary issue in historical context. Health Promot. Pract. 15:476–82
    [Google Scholar]
  81. 81. 
    Woolf SH. 2017. Commentary: progress in achieving health equity requires attention to root causes. Health Aff 36:984–91
    [Google Scholar]
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