Equity in Action: Operationalizing Processes in State Governance

August 13, 2019

Overview

The recently released Journal of Law, Medicine & Ethics conference supplement issue features articles authored by presenters at the 2018 Public Health Law Conference: Empowering Public Health and Advancing Health Equity, in Phoenix, Arizona. Susan Weisman, senior staff attorney at the Public Health Law Center; Karen Ben-Moshe, senior program associate, Health in All Policies Task Force at the Public Health Initiative; Sarah Hernandez, director of policy for the Office of Health Equity at the Colorado Department of Public Health and Environment; and Vayong Moua, health equity advocacy director at Blue Cross and Blue Shield of Minnesota co-authored the article, “Equity in Action: Operationalizing Processes in State Governance.” In the following Q&A, the authors discuss the article and how it addresses a critical public health issue.

Q: Why is this topic so critical right now?

Although medical advances and a focus on preventative care have contributed to improvements in the health of many Americans, stark inequities persist in access to healthcare and in health outcomes by race, gender, sexual orientation, disability status, immigration status, and more. Increasingly, community representatives as well as public health and public policy leaders have called for comprehensive structural changes in governmental decision-making processes to address structural racism—systems, institutions, and processes that interact with one another (wittingly or not) in ways that reinforce rather than reduce and eliminate inequities. How to accomplish comprehensive structural changes in large institutional systems like state governments is a topic of critical importance. Innovative work toward this end is underway among states, and opportunities to promote efforts and to share approaches, successes, and challenges are needed. States have much to learn from one another’s experiences.

Q:  How does your article address this issue and its challenges?

In this article, my co-authors and I highlight and reflect upon recent efforts to embed an equity lens into legislated and non-legislated policies and practices in the three states from which we draw experience – California, Colorado, and Minnesota – and offer examples of steps taken to make structural changes in state governance within the context of a social determinants of health framework. We emphasize that implementing structural changes to improve health outcomes among communities that have been marginalized requires state government representatives to acknowledge and effectively convey that the unjust community conditions sought to be corrected are rooted in power and policy development processes and, thus, can be changed. The article showcases innovative strategies, pinpoints challenges and lessons learned, and underscores the need for states to prioritize making comprehensive structural changes in order to eliminate persistent inequities.

Q:  How do current policy solutions address this issue?

Every state has unique characteristics, issues, and challenges that call for the development and implementation of tailored policy strategies. The experiences we share from California, Colorado, and Minnesota demonstrate that equity policies and practices can be initiated in multiple ways—for example, through a governor’s issuance of an executive order or through enactment of legislation. The deep work of community and cross-sector engagement to achieve equity goals may flow from first steps such as these but, from there, the work takes on many shapes and forms. Fundamental to progress is a state’s long-term commitment to structural change, a focus on building trust and relationships within communities that have been marginalized, and the prioritization of opportunities to collaborate with communities and external partners on new approaches that are responsive to communities’ needs.

Q:  Is there anything else you would like to note?

This topic will remain critical as long as communities that have been marginalized continue to experience inequities in health outcomes and in access to key indicators of quality of life (e.g., quality childcare, healthcare, housing, schooling, transportation, employment, healthy food, and places to enjoy physical activities). Public health practitioners have valuable training, skills, experience, and access to resources to make substantial contributions, individually and collectively, toward the achievement of state governance equity goals. It is our hope that this article will inspire readers to support and pursue opportunities for engagement.

This guest post was prepared by Susan Weisman, senior staff attorney at the Public Health Law Center; Karen Ben-Moshe, senior program associate, Health in All Policies Task Force at the Public Health Initiative; Sarah Hernandez, director of policy for the Office of Health Equity at the Colorado Department of Public Health and Environment; and Vayong Moua, health equity advocacy director at Blue Cross and Blue Shield of Minnesota.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.