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The Role of Law and Policy in Achieving Health Equity and Attaining Our Healthy People Objectives

Healthy People and the Social Determinants of Health Framework: Carter Blakey, ODPHP

Recognizing that the conditions that create health exist beyond traditional public health and health care silos, Healthy People 2020 included a framework to address the social determinants of health. The framework is structured around 5 domains—Neighborhood and Built Environment, Health and Health Care, Social and Community Context, Education, and Economic Stability—all of which impact health outcomes.

Social Determinants of Health Framework Diagram.The framework also identified 19 underlying factors affecting health, which are the focus of a set of descriptive literature summaries released in 2018 to increase the public’s understanding of the social determinants of health. Many of these factors are inequitably distributed across and within our communities. For example, communities of color and lower socioeconomic status are less likely to have safe housing or access to healthy foods and more likely to experience crime and violence. This means individuals in these communities face more significant barriers to achieving optimal health for themselves and their families. Laws and policies are implicated in creating these unequal distributions, but they can also serve as tools for changing them.

Health Equity in the Development of Healthy People 2030: Carter Blakey, ODPHP

The development of Healthy People 2030 began in 2016 when the Secretary of Health and Human Services convened the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Committee). The Committee was charged with helping the Secretary reduce the number of objectives for Healthy People 2030, while ensuring that selection criteria identified the most critical public health issues as indicated by current national datasets. More information about the development process and the status of Healthy People 2030 is available in a related webinar summary: Applying Law and Policy Solutions to Public Health Challenges in the Coming Decade.

The Committee’s recommendations for Healthy People 2030’s foundational principles and overarching goals emphasize the elimination of health disparities and achievement of health equity. The Committee also encouraged HHS to continue focusing on opportunities to improve the broader social, physical, and economic conditions that generate health and well-being—rather than on individual behaviors and disease outcomes. It also recognized the critical role Healthy People has played, and should continue to play, in monitoring and surveillance of inequalities and inequities between social groups in order to draw attention to the issues and motivate actions to change them.

In developing the framework and recommendations for Healthy People 2030, the Committee organized itself into subcommittees, including one focused on health equity and one focused on law and policy. Several of the subcommittees developed issue briefs to help ensure a common understanding of the concepts the Committee used in its work. The Health Equity Subcommittee emphasized that including social determinants of health and health equity as cross-cutting themes encourages prioritizing these concepts across multiple topic areas and objectives, which may prompt more engagement with partners and other sectors to address them in collaborative and creative ways. The Law and Policy Subcommittee also focused on equity and disparities by exploring law and policy as determinants of health and identifying 5 ways they can impact the distribution of health and well-being1. As considered by the Committee, law and policy can both create and perpetuate unequal and inequitable health-harming conditions and serve as tools to overcome barriers to good health.

To learn more about this work, please see: McGowan AK, Kramer KT, Teitelbaum JB. Healthy People: the role of law and policy in the nation’s public health agenda. The Journal of Law, Medicine & Ethics. 2019;47(2_suppl: 63–67).




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