Communities in Action Pathways to Health Equity (2017) / Chapter Skim
Currently Skimming:
1 The Need to Promote Health Equity
1 The Need to Promote Health Equity
Pages 31-56
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From page 31... ...
Understanding the social determinants of health requires a shift toward a more "upstream" perspective -- that is, the conditions that constitute the context in which an individual's behaviors are shaped. To put this more simply, Keyes and Galea (2016)
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From page 32... ...
In this report promoting health equity means creating the conditions where individuals and communities have what they need to enjoy full, healthy lives. Health equity requires focused and sustained societal efforts to confront historical and contemporary injustices and eliminate health disparities (Brennan Ramirez et al., 2008; HHS, n.d.)
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This discussion is followed by a brief introduction to the social determinants of health and the impacts of health inequities on society. Next, the changing social and environmental context and the role of communities in addressing health inequity are described.
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U.S. infant mortality rates have decreased since 2005 for the overall population and within each racial and ethnic group; however, sharp racial and ethnic disparities persist.
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. Health Care It is becoming clearer that health insurance coverage alone will not address health disparities associated with race, ethnicity, SES, and geography (Kenney and Huntress, 2012; Ubri and Artiga, 2016)
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. Merely increasing the availability of health care services does not necessarily reduce health care disparities.
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From page 37... ...
As noted above, access to insurance does not directly translate into health equity. The traditional fee-for-service system persists and influences utilization patterns more heavily than patient need or evidence-based practice guidelines (The National Commission on Physician Payment Reform, 2013; Page, 2013; Robinson, 2001)
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From page 38... ...
Addressing the root causes of health inequities, such as the social determinants of health, is important in part to help enable sustainable interventions by engaging multiple sectors and addressing multiple health outcomes simultaneously. The solutions highlighted in this report recognize that national and state leadership are important to effect change in these determinants, but the report specifically addresses these interrelated determinants at the community level (see Chapter 3 for a detailed discussion of the root causes of health disparities, including the social determinants of health)
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Health care spending accounted for 17.5 percent of gross domestic product (GDP) in 2014, and health disparities contribute to a significant amount of financial waste in the health care system.
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From page 40... ...
and inadequate health care coverage may increase the cost of care exponentially due to the exacerbation of complications, the need for more expensive care (e.g., emergency department services) , and the need for more extensive care; furthermore, such treatment can increase longer-term reliance on the health care system for the management of unintended consequences on one hand and preventable chronic diseases on the other (IOM, 2009)
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From page 41... ...
and environmental landscapes affecting health disparities and the determinants of health. The changing economic context is characterized by growing income inequality.
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However, it offers many important lessons on mitigating risk and increasing resiliency in making plans to help the entire population, especially the most vulnerable. Although there is a risk that climate change could worsen health inequities, there is also great opportunity to integrate efforts to promote health into mitigation and adaptation efforts to support more resilient, healthy, and equitable communities (Rudolph et al., 2015)
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. Community-based and -driven efforts are needed to alter environmental, socioeconomic, and cultural conditions in ways that promote health equity.
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Conclusion 1-1: The persistent state of health disparities and health inequity in the United States has profound implications for the coun try's overall health standing, economic vitality, and national security. Thus, addressing health inequities is a critical need that requires this issue to be among our nation's foremost priorities.
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From page 45... ...
• Recommend elements of short- or long-term strategies and solutions that communities may consider to expand opportunities to advance health equity. • Recommend key research needs to help identify and strengthen evidence based solutions and other recommendations as viewed appropriate by the committee to reduce health disparities and promote health equity.
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. The committee was charged with examining community-based solutions, and it developed a simple model to show what it concluded are three important elements of communitybased efforts to promote health equity.
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b Other conditions at the national level might include major sociopolitical shifts, such c The built environment includes transportation, water and sanitation, housing, and other dimensions of urbancollapse. as recession, war, and governmental planning.
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. The model applies the culture of health lens to the committee's understanding of the underlying causes and conditions of health inequity in addition to the community-based solutions that promote health equity.
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From page 49... ...
(See Chapter 3 for a more detailed description of each determinant of health and the ways in which they affect health and well-being.) The committee adapted two of the Culture of Health Action Framework Action Areas for community-level solutions: "Making health equity a shared vision and value" and "Fostering multi-sector collaboration." Based on the committee's information-gathering sessions, relevant literature, and committee deliberations, the committee also identified a third action area of importance for the framework when proposing solutions at the community level: "Increasing community capacity to shape outcomes." This is a process that has emerged as essential for communities to have the power to address inequities and to sustain their efforts.
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From page 50... ...
The first, held in January 2016, focused on obtaining information on health disparities and their root causes, including an overview from the report sponsor. The second, held in March 2016, focused on many of the social determinants of health and BOX 1-2 Definitions Community is any configuration of individuals, families, and groups whose values, characteristics, interests, geography, or social relations unite them in some way (adapted from Dreher, 2016)
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From page 51... ...
Chapter 4 discusses the role and capacity of communities to promote health equity and explains the larger context in which communities are situated, as well as the types of evidence needed to support communities. Chapter 5 provides nine examples of communities that are tackling health inequity and the lessons learned from these efforts.
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From page 52... ...
Until these root causes are addressed nationally, health equity will not be fully realized. However, actors at the community level -- policy makers, businesses, state and local governments, anchor institutions, and community residents -- are agents of local change who have the power to change the narrative and take action that will promote health equity.
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. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acutein patientpps/dsh.html (accessed October 24, 2016)
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https://aspe.hhs.gov/basic-report/affordable-care-act-coverage -implications-and-issues-immigrant-families (accessed October 24, 2016)
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2011. Who are America's children: Examining health disparities among children in the U.S.
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2009. Estimating the cost of racial and ethnic health disparities.
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