Acknowledging Grief as a Determinant of Health: Public Health Needs to Listen and Learn
June 6, 2025
Overview
Grief is a near-universal human experience, yet it remains markedly absent from public health discourse and infrastructure. Instead, public health systems tend to treat bereavement as a private, individual matter rather than a legitimate population health concern. As we reconsider the broader mental health landscape, we must ask: What would it look like for public health systems to fully acknowledge grief in its cultural complexity?
Grief is a near-universal human experience, yet it remains markedly absent from public health discourse and infrastructure. In recognition of Mental Health Awareness Month, we released a special podcast discussion, Grief, Loss, and the Gaps in Support Across Public Health, in which two Network attorneys reflect on the deeply personal experience of losing a family member to drug overdose, and explore how institutional silence, stigma, and fragmented systems can deepen suffering by leaving grief unacknowledged and unsupported—even as a growing body of evidence shows its profound impact on mental, physical, and social well-being.
Public health systems tend to treat bereavement as a private, individual matter rather than a legitimate population health concern. Policy frameworks, surveillance mechanisms, and service delivery models routinely overlook the cumulative burden of grief, particularly as it intersects with structural inequities, cultural norms, and barriers to care. This lack of formal acknowledgment is especially concerning given the well-documented health risks associated with grief. Bereavement, for example, is linked to increased risks of mental health disorders, cardiovascular disease, and premature death. Parents who lose a child face higher hospitalization rates for mental illness; surviving spouses often experience heightened depression and social isolation.
Moreover, grief and trauma trigger complex physiological responses that affect multiple body systems. Research shows that intense grief activates the body’s stress response, leading to elevated levels of cortisol and other stress hormones. Prolonged activation can impair immune function, increase inflammation, and contribute to chronic conditions such as cardiovascular disease, hypertension, and delayed wound healing. Studies also link grief-related trauma to dysregulation of the autonomic nervous system, increasing vulnerability to anxiety, depression, and post-traumatic stress disorder. These biological impacts underscore grief’s far-reaching consequences beyond emotional suffering.
Despite these documented effects, grief is largely absent from public health data collection, policy frameworks, and programmatic initiatives. Few public health departments collect grief-related data or provide structured support for bereaved individuals. Without this information, designing effective interventions, allocating resources, and addressing community needs remain significant challenges.
Legal protections for bereavement also remain limited and inconsistent. The Family and Medical Leave Act (FMLA) does not explicitly provide bereavement leave, though some states including California, Oregon, Illinois, Maryland, and Washington, have enacted policies to address this gap. Still, even where bereavement leave is available, it is often brief and inadequate for meeting the complex emotional and practical demands that accompany loss. Without institutional support, many bereaved individuals must manage their grief alongside work obligations and financial pressures, placing an overwhelming burden on those already facing hardship.
Public health must play a more proactive role in building more compassionate and culturally responsive systems that recognize grief as a natural and significant determinant of health. One organization, Evermore, is challenging the status quo and advancing grief as a public health priority through thoughtful, equity-driven policy and practice. Their work includes expanding access to paid bereavement leave through model federal and state legislation; improving national data collection and research to better understand grief’s health impacts and disparities, including culturally specific needs; and developing a coordinated national strategy on grief, including resources for public health agencies that emphasize culturally responsive approaches. These efforts represent a critical shift in reframing grief as a collective public health challenge deserving of sustained policy attention.
Policy reform is only the starting point for aligning institutions with values of equity, dignity, and humanity. In the future, public health could also try to account for grief from loss that is ambiguous, ongoing, and complex, especially if it is not easily named or resolved. This includes not only the death of a loved one, but also the rupture of community through displacement, or the erasure of identity through marginalization. For many communities, grief is shaped by collective and systemic experiences such as structural racism, forced migration, systemic violence, and historical erasure.
Our prevailing health frameworks and grief support systems largely reflect Western biomedical models that prioritize individualized psychological processing and clinical intervention. This narrow lens overlooks the lived realities of individuals and communities whose grief is deeply embedded in cultural, spiritual, and communal practices—such as collective rituals, storytelling, intergenerational caregiving, and spiritual ceremonies—that serve as foundational elements of mourning and resilience. When public health systems fail to acknowledge or integrate these diverse expressions of grief, they perpetuate cultural insensitivity and barriers to care, running counter to national standards for Culturally and Linguistically Appropriate Services (CLAS), which emphasize respect for diverse cultural health beliefs, practices, languages, and health literacy.
As we reconsider the broader mental health landscape, we must ask: What would it look like for public health systems to fully acknowledge grief in its cultural complexity? How might laws, institutions, and workplaces change if designed to support those living through loss in ways that honor diverse traditions rather than impose one-size-fits-all models? For public health professionals, advocates, and policymakers, this is an urgent invitation to learn from cultural wisdom and build systems that respond with care.
This article was written by Quang (“Q”) H. Dang, J.D., Co-Executive Director, Network for Public Health Law.
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