Communities in Action

Pathways to Health Equity

Civil Rights Strategies

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Our nation’s well-being depends in part on the well-being of its communities.

      Yet many communities are facing the challenges of access to jobs, healthy food options, safe and affordable housing, parks and open space, and clean air and water, free from toxins—the needed conditions to fully thrive. This lack of equitable opportunity gives rise to disparities that exist in health status and health outcomes between different areas of our country.

     Inequities in health stem from structural inequities—the systemic disadvantage of one social group compared to other groups—deeply embedded in the fabric of society, encompassing policy, law, governance, and culture.

     Civil rights strategies are essential tools for supporting community-based solutions to promote health equity. Civil rights laws and principles offer useful tools that stakeholders working with public interest attorneys; public health professionals; community groups; government agencies; and recipients of federal, state, and local funds can deploy to ensure equal opportunity for all in a community.

How can civil rights strategies be used to promote health equity in communities?

What Are Civil Rights Strategies?

Civil rights laws and environmental justice policies can promote equal access to publicly funded resources and prohibit discrimination based on race, color, national origin, income, gender, disability, and other factors. This cross-cutting approach can be applied across different areas—such as park access, education, housing, toxins and pollution, health care access, and other factors that can affect health—and can help ensure compliance with federal laws that are important for health equity.

Litigation does not have to be involved: Civil rights attorneys may partner with allies and broad coalitions to help reduce discriminatory burdens, remove barriers to participation in decision making, and increase access to health and environmental benefits that make communities safe and healthy.

Civil rights laws and approaches:

  • use methods and data in ways that include full and fair participation by diverse communities

  • distribute benefits fairly and mitigate the negative impacts of many forms of social and health inequities and discrimination

Using this approach in community-based health equity work can mean drawing on the work of the civil rights movement, including activating community stakeholders, grassroots organizing, performing research, engaging media, and securing philanthropic support.

The 5-Step Planning Process

Community-based groups can use this planning process to assess current and potential policies and practices, as well as to avoid unjustified discriminatory impacts, intentional discrimination, and implicit bias.

  1. Describe what’s being planned in terms that are understandable to communities.

  2. Analyze the benefits and burdens on all people, including numerical disparities, statistical evidence, demographic data, and other metrics. Who benefits, and who is left behind? Include the range of values at stake to be analyzed, including physical, mental, and social health; economic vitality; and similar considerations.

  3. Analyze alternatives to what is being considered.

  4. Include people of color, low-income people, and other stakeholders in every step in the decisionmaking process.

  5. Develop an implementation plan to distribute benefits and burdens fairly and avoid discrimination.

For examples of the planning process in action, click here.

Examples of Action

Nashville Metropolitan Planning Organization

The Nashville Metropolitan Planning Organization increased the percentage of projects that incorporate safe walking and biking from 2 percent in 2005 to 70 percent in 2010 based on civil rights laws.

L.A. State Historic Park

In response to community action, the U.S. Department of Housing and Urban Development withheld funds for proposed warehouses pending a full civil rights and environmental justice study in 2001, which led to the creation of L.A. State Historic Park.

WE ACT for Environmental Justice

WE ACT for Environmental Justice (WE ACT) supports and empowers residents to advocate for and achieve more environmentally healthy communities. WE ACT’s work is grounded in civil rights analyses and law. When the Metropolitan Transit Authority sent 200 more buses to already overcrowded depots in Harlem and northern Manhattan communities experiencing alarmingly higher asthma rates than other New York neighborhoods, the group filed an administrative complaint with the U.S. Department of Transportation under Title VI of the Civil Rights Act of 1964.

In 2008, WE ACT organized the Environmental Justice Leadership Forum on Climate Change, a national coalition of 42 justice organizations across 20 states. The forum published a Clean Power Plan Tool Kit, which provides guidance for state agencies and stakeholders to conduct civil rights and environmental justice analyses and meaningful engagement with vulnerable communities in planning for and implementing the federal Clean Power Plan rule.

Two of WE ACT’s supporters rallying in 1988 to protest the North River Sewage Treatment Plant.
Two of WE ACT’s supporters rallying in 1988 to protest the North River Sewage Treatment Plant.

Baldwin Hills

The U.S. Environmental Protection Agency partnered in court with community leaders in Los Angeles to sue the city to repair the sewer system in a battle for clean water justice.

The Role of Funders

Philanthropic groups, like foundations, can build on the civil rights movement and advance social justice through advocacy and organizing for structural change. Funders can support community interventions in health equity by supporting education, compliance, and enforcement related to civil rights laws.

To learn more about the role of philanthropy, click here.

How Can Community Groups Use Civil Rights Approaches to #PromoteHealthEquity?

  • Communities and other stakeholders can collaborate on compliance and equity plans for programs or activities that are publicly funded. This can be done using the civil rights planning process by describing what is to be done, analyzing the impact on all communities, analyzing alternatives, including full and fair participation by diverse communities, and promoting health equity.
  • Compliance and equity plans can be used to guard against unjustified and unnecessary discriminatory impacts, as well as against intentional discrimination, in health and wellness programs and activities.
  • Communities can deploy civil rights problem-solving strategies, including building coalitions, planning, collecting and analyzing data, engaging the media, negotiating, conducting advocacy out of court, and with assistance from civil rights attorneys, seeking access to justice through the courts if needed.
  • Communities can work with attorneys and public health experts together to promote a better understanding of the civil rights dimension of health inequities and to show how to address these civil rights concerns for their communities. This can help ensure that civil rights protections against discrimination in health and other publicly funded programs and activities are strengthened and not rolled back.


Civil rights strategies are tools available to all community stakeholders. These approaches have helped mitigate the negative impact of many forms of social and health discrimination. It’s necessary to continue this work to overcome discrimination and the structural barriers that affect health to help make all communities safe, vibrant, and healthy.

To learn more about civil rights strategies for health inequity, please check out chapter 6 and chapter 8 of the Communities in Action report.

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Copyright 2018 by the National Academy of Sciences. All rights reserved