Promote Good Public Health by Removing Disparities and Seeking Equity

To promote better personal and community well-being for everyone is a very noble goal that requires effort by all of us to achieve. An essential path toward this goal is to seek to reduce disparities and to increase equity in health status and healthcare access.

Clearly, work on this issue will require the close and careful collaboration between public health and the healthcare disciplines, such as primary care, chronic care, behavioral health, and others. Public health can play an essential role in in improving health status and healthcare access via efforts to change the social and physical determinants of health. The healthcare disciplines can play an essential role via changes in care delivery and payment practices, including insurance coverage.

Now, just a word about disparity and equity. A few years ago, a group of us from the Healthy People 2020 Committee took great pains to define each of these terms using a social-justice framework. A disparity was defined as any difference in health status or healthcare access in which the socially disadvantaged person fared worse. Equity was defined as any effort to reduce this difference between more advantaged and less advantaged people.  You can read more about this in the American Journal of Public Health:

>> READ: Health Disparities and Health Equity: The Issue Is Justice

In practical terms, our public health workers engaged in research, policy and practice will need to collaborate together in order to bring new research and policy on disparities into state and local practice much more quickly. They also will need to work closely with the health disciplines so that the latter are addressing the health issues of persons with these disparities. All will need to work together.

One example of this is disparities in mental illness. We now know that a large proportion of mental illness is due to trauma caused by issues in the social and physical determinants of health, and that these problems disproportionately affect those who are socially disadvantaged. It will be essential to modify these social determinants, and it also will be essential to treat the resulting mental illness.

A second example is low birthweight babies. This is a problem that disproportionately affects mothers who are minority and socially disadvantaged. Addressing this problem will require both public health interventions that address the social and physical health determinants, as well as healthcare interventions that address problems in birthweight.

Another key element of this work is to develop a better understanding of how disparities in health status and healthcare access affect personal and community wellbeing. It is very clear that disparities due to social disadvantage are clustered in communities. Hence, if equity can be improved for multiple persons from these communities, then both personal and community wellbeing can be expected to improve as well.

Today, we are on the cusp of a new generation of wellbeing assessment. It is safe to predict that the US Department of Health and Human Services will begin measuring wellbeing in the short-term future as a result of the work of the Healthy People 2030 Committee. As we go forward to address disparities and promote equity, we should incorporate this new work. Think how wonderful it would be if the U.S. not only had economic accounts such as gross national product, but also national wellbeing accounts as well.

The American Public Health Association is in an excellent position to address these issues of disparity, equity and wellbeing. The sections develop innovative research and policy, the state and regional affiliates develop policy and practice in a local environment. And a full range of public health and healthcare skills is available in the membership. Making this work a core priority of APHA can be a win-win, especially for disadvantaged persons who suffer the effects of disparities in health status and healthcare access.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.