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Policies And Strategies To Promote Social Equity In Health Pdf

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Why Understanding Equity vs Equality in Schools Can Help You Create an Inclusive Classroom

Not a MyNAP member yet? Register for a free account to start saving and receiving special member only perks. There are many tools available to communities to help them design, implement, and evaluate community-based solutions that advance health equity. The tools described here encompass approaches, methods, measures, and necessary infrastructure.

The committee identified these tools based on the lessons learned from communities that have implemented solutions see Chapter 5 , a review of the literature, input from information-gathering meetings see Appendix C for agendas , and committee expertise. Third, widely available community toolboxes are summarized. Some of the tools shared in this chapter are explicitly designed to address social determinants of health, while others address the consequences of poor health outcomes, and some do both.

The tools also vary in the time frame for implementation; some can be employed within a relatively short time, while others will take more time to plan and implement.

A number of crosscutting tools provide a foundation for developing community-based solutions. Because each community is unique, the tools different communities need will vary.

The tools described below are organized according to the types of actions that communities may need to take to address health equity, such as 1 making the case for health equity; 2 meeting information needs; 3 adopting or developing logic models or theories of change; 4 using civil rights law to promote health equity; 5 medical—legal partnerships; 6 using health impact assessments to understand policy implications; and 7 securing funding to support community action.

The cost of health inequity is usually calculated as a difference in cost, specifically, the excess burden that arises from certain groups. Health-related economic costs are higher among minority racial and ethnic groups than among whites both because they have more chronic conditions and because they have lower average education, which is correlated with poorer health and earlier death.

But the costs are more widespread, affecting not just insurers but also families and employers Dan et al. Factoring in early death raises the estimates even more.

The economic burden for , when the representation of minorities in the population will have increased substantially, is predicted to be more than twice as large as it is now Gaskin et al. Recognizing that health inequities arise from many factors, decision makers face a challenge in weighing different strategies to improve health equity and health outcomes and decrease the cost of inequity. One model that informs health care cost reduction allows the user to simulate outcomes across geographic areas across a host of factors, such as changes to health care delivery, health care payment e.

In that work, a combination of approaches—expanding global payment, enabling healthier behaviors, and expanding socioeconomic opportunities—was estimated to lower health care costs by 14 percent and to improve productivity by 9 percent over 24 years. The most costly intervention component addressed socioeconomic opportunities, and the simulation assumed that the more costly investments occurred after savings from changes in health care delivery and payments.

However, this was also the component that resulted in the greatest estimated improvements in the disadvantaged fraction of the population. Participating in health equity improvement is a voluntary activity on the part of actors in the community. What are the advantages of investments in improved health equity and raising awareness among. While much of the health equity discussion rests on a moral argument, there are several economic arguments to support health equity promotion and improving the social determinants of health.

One example of a social determinant of health for which there are large disparities among communities is education. Starting with education as an illustration, achieving health equity by reaching the poorest and most marginalized groups of people will require strong community ownership of the value and purpose of education, whether it be primary education, job training, or adult literacy. Disparities in education perpetuate disparities in income and health.

What is the incentive—the business case—to improve education and training at individual, employer, and community levels? To individuals, education confers significant wage advantages; therefore, in theory, individuals have a strong incentive to pursue education Blundell et al.

Educational achievement is also shaped by ability; early childhood education; family background, including family income and parent education; and the local environment, including the quality of schools.

The same amount of schooling could lead to very different skills, college experience, and earnings if one person goes to a much better school, with better teachers, instruction, and resources Deming et al. Individuals can also achieve higher job earnings through employer training programs, but those most likely to receive additional training have greater skills and more education to begin with Cappelli, However, the more skilled workers could leave and work for a competing firm.

In the real world, firms do. Firms also engage in particular or firm-specific training rather than general training. In contrast to general training, local employers may be more willing to invest in firm-specific training because the skills do not transfer to competitors as readily. Thus, the immediate business case for individual firms to act on behalf of general education and training in the community is somewhat narrow.

While there is strong motivation at the individual level to pursue improvement, such as education, because of the prospect of higher incomes in the future, there is also a societal component at play. The spillover benefits of a more educated community accrue to everyone. Communities benefit from having an educated and literate population with greater civic engagement, lower crime, greater social cohesion, and economic growth.

Firms can adapt their use of technology and equipment to the skills of a more educated, local work force, and more educated workers may exchange new ideas, furthering innovation. These spillover benefits mean that the community together, not just any one actor, should play an important role in supporting education. The challenge is that education benefits accrue over the long run and are thus investments that politically may be difficult to sustain.

Private—public partnerships, such as Made in Durham, which works through a multi-sector collaborative to increase high school graduation rates and employment NASEM, ; Stratton et al. Community momentum for changes in education, employment, or housing, whether through a school reform movement or a housing revitalization effort, may in part be understood as an attempt to mobilize the private sector on behalf of a public effort. The Aspen Institute describes such efforts as integrating social purposes with business methods Sabeti, Such programs are often structured with public funding—for example, vouchers, grants, or tax credits—and private or shared public—private delivery of services and with public accountability structures.

The impetus is often to introduce private-sector competition or innovation and to improve efficiency and performance. Frequently these mobilization efforts draw the attention of foundations, individual philanthropy, or private investors who provide additional resources and bolster further improvements.

If these efforts around the social determinants of health. Other health drivers can be viewed through a similar lens. Often individuals have an incentive to improve their own situations, but this is shaped by local circumstances. Businesses have an interest in reducing the cost of health care; lowering the cost of employer-provided benefits, including workers compensation costs; lowering turnover; improving worker productivity; and reducing the number of sick days.

A healthy workforce is less costly to employers. Yet, firms left to themselves may underinvest in health activities for workers. Thus, communities have a strong case for coming together and devising joint solutions. For example, some such programs have addressed early childhood education, home visiting, prison avoidance, chronic homelessness, and foster care avoidance for children born to homeless mothers. They commonly involve private investors and foundations along with public payers.

When early intervention programs yield desired outcomes—which means savings to the public down the line—the programs pay their investors from public or foundation funds. These solutions are appealing in part as a mechanism for community-building, for reinvigorating local dialogue on the social determinants of health, and for leveraging private institution participation and promoting transparency and efficiency.

At the moment, however, because few such programs have run their course, there is relatively little empirical evidence concerning their effectiveness. Another form of business-driven venture is the employment social enterprise. In this case, various entities, typically nonprofits, invest in disadvantaged groups, including those with low job skills and experience. They provide employment, training, and social services along with wages and experiential learning, working closely with local businesses Maxwell et al.

Social enterprises may also receive technical support and capital funding from entities such as REDF in California, which is itself grant-, foundation-, and donor-supported, as well as funding through tax credits.

Social enterprises represent another form of public—private partnership and arise from a shared sense of purpose and common incentives. The major outcome of interest for community solutions is impact on health. Life expectancy can be a useful measure of impact on health because it is straightforward and easy to interpret, compare, and value.

However, it is less likely that community solutions will have data or measured impact on mortality indicators in the short term, as it takes considerable time to see changes in these long-term outcomes. In addition, the quantity of life is only one metric of health and does not capture quality, satisfaction, well-being, happiness, and opportunity. Instead, the committee sought out community-based solutions that target the social determinants of health with strong links to health outcomes as evidenced by the literature.

However, community-level outcomes cannot be measured without community-level data. The section below outlines what is currently available to communities as well as the gaps in data and data tools.

In the Institute of Medicine IOM Committee on Public Health Strategies to Improve Health highlighted the lack of accurate local data on the social, environmental, and behavioral determinants of health and recommended that the U. Department of Health and Human Services HHS support and implement: 1 a core, standardized set of indicators that can be used to assess the health of communities, including social determinants of health; 2 a core, standardized set of health outcome indicators for national, state, and local use; and 3 a summary measure of population health that can be used to estimate and track health-adjusted life expectancy IOM, However, with a few exceptions e.

To address the issue of measurement heterogeneity, an IOM committee generated a framework, a core measure set, and an initial set of indicators IOM, b. Beyond addressing the challenges of what should be measured and how it should be measured, communities need data and interactive tools to easily access data as well as metrics that are specific to their situations and needs.

Increasingly, there are sources of electronic data that are publicly available and can be used to examine issues related to health and health. Some data sets are specific to health and others are from sectors relevant to health and health equity.

Thousands of data sets are accessible for public use through the U. These include data sets from federal agencies, including U. Department of Health and Human Services agencies such as the U.

Food and Drug Administration, as well as from states e. These include hospital locations, healthy corner stores, farmers markets, community culinary and nutrition programs, crime incident reports, building code violations, and economic indicators City of Boston Data Portal, Such data are sometimes organized into community dashboards that display key indicators. In Fort Collins, Colorado, for example, the dashboard includes quarterly summaries of factors that are related to a culture of health that advances health equity: neighborhood livability and social health, environment, transportation, economic health, environmental health, and safe community.

Some nongovernmental organizations also offer public access to various data sources relevant to community-based solutions that advance health equity. In other instances, data are available as files e. Such resources see Box are currently more valuable for national-, state- or city-level assessments, as most of the data sets lack data at the neighborhood or community level. Moreover, many of these data sources are more suitable for use by researchers than by communities.

For the purpose of this report, the committee uses the definition of indicator from the IOM report: a statistic or measure that is widely acknowledged to be useful for measuring something of concern to policy makers or the public IOM, In the following section, indicators are summarized according to the components of the conceptual model for the report: 1 social determinants of health, 2 making health equity a shared vision and value, 3 increasing community capacity to shape outcomes, and 4 healthier, more equitable communities in which individuals and families live, learn, work, and play.

The indicators selected for inclusion were based on a recent environmental scan on social-determinants-of-health indicators Koo et al. The intent was to provide examples pertinent to community-based solutions rather than to provide an exhaustive summary. Further details of selected indicators by data set or index are provided in Appendix B. Social determinants of health There are many data sources that contain indicators related to various social determinants of health.

Indicators are most frequently available at the state or county level. The Metro Atlanta Equity Analysis examines eight dimensions of community well-being demographics, economic development, education, environment, health, housing, public safety, and transportation through online tools.

The Dahlgren-Whitehead rainbow

Health equity arises from access to the social determinants of health , specifically from wealth, power and prestige. In order to achieve health equity, resources must be allocated based on an individual need-based principle. According to the World Health Organization, "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Thus, health must be discussed along with all other basic human rights. Health equity, sometimes also referred to as health disparity, is defined as differences in the quality of health and healthcare across different populations. It is not possible to work towards complete equality in health, as there are some factors of health that are beyond human influence. On the other hand, if a population has a lower life expectancy due to lack of access to medications, the situation would be classified as a health inequity.

Policies and Strategies to Promote Social Equity in Health

The first covers concepts and principes of equity in relation to health, and should be read in conjunction with this paper Whitehead The present paper sets out to develop the discussion further by outlining a strategic approach to promote greater equity in health between different social and occupational groups. This draws on the work of WHO advisory groups and associated litterature listed at the back, together with practical examples from industrialized countries where strategies have been put into action.

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Not a MyNAP member yet? Register for a free account to start saving and receiving special member only perks. There are many tools available to communities to help them design, implement, and evaluate community-based solutions that advance health equity. The tools described here encompass approaches, methods, measures, and necessary infrastructure. The committee identified these tools based on the lessons learned from communities that have implemented solutions see Chapter 5 , a review of the literature, input from information-gathering meetings see Appendix C for agendas , and committee expertise.

Policies and Strategies to Promote Social Equity in Health

Like health equity, the social determinants of health SDH are becoming a key focus for policy-makers in many low and middle income countries. Yet despite accumulating evidence on the causes and manifestations of SDH, there is relatively little understanding about how public policy can address such complex and intractable issues. This paper aims to raise awareness of the ways in which the policy processes addressing SDH may be better described, understood and explained. It does so in three main sections. First, it summarizes the typical account of the policy-making process and then adapts this to the specific character of SDH. Third, methodological considerations of the preceding two sections are assessed with a view to informing future research strategies. The paper concludes that conceptual models can help policy-makers understand and intervene better, despite significant obstacles.

If you would like to be involved in its development let us know. Health inequalities in society - where your level of health is connected to your socioeconomic level - has led to a growing awareness that many health issues can be determined by social factors. Economic, environmental and social inequalities can determine people's risk of getting ill, their ability to prevent sickness, or their access to effective treatments.

Sabel, C. Reijneveld, Peters, D. Gasper, D. Nicola Christie, Tracing the institutionalisation of health impact assessment in the Republic of Ireland across health and environmental sectors ," Health Policy , Elsevier, vol. You can help correct errors and omissions.


Policies and strategies to promote social equity in health. Background document to WHO - Strategy paper for Europe. Author & abstract; Download; 16 Citations.


Policies and Strategies to Promote Social Equity in Health

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4 Comments

Celsa L. 16.12.2020 at 00:52

Dahlgren, Göran & Margaret Whitehead. Policies and strategies. to promote social. equity in health. Background document to WHO – Strategy paper. for Europe.

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