Communities in Action: Pathways to Health Equity

Americans today live shorter, sicker lives than people in other developed countries, and, across the nation, health varies by income, education, race and ethnicity, and geography. Warning that the United States will pay the high price in lost lives, wasted potential and squandered potential resources until these gaps are closed, a comprehensive report from the National Academies of Sciences, Engineering, and Medicine (NASEM) calls for leaders across sectors to make health equity a priority for the nation.

Why Does Health Equity Matter?

When health equity is achieved, “everyone has the opportunity to attain full health potential, and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance,” the report says. And ensuring that opportunity is crucial not just for individuals, but also for the nation’s economic and growth prospects, for its national security and for its communities’ well-being and vibrancy. 

Data show the costs of current health inequities: The report estimates that racial health disparities alone are projected to cost health insurers $337 billion between 2009 and 2018. The impact on national security is also high, with some 26 million young adults unqualified to serve in the U.S. military because of persistent health problems, or because they are poorly educated or have been convicted of a felony.

The report calls on leaders from education, transportation, housing, planning, public health, business and others to prioritize health equity. It offers specific recommendations—ranging from research priorities to guidance for public and private policies and multisector partnerships—along with tools for communities to use.

Health equity means we all have the basics to be as healthy as possible. However, across the nation, many communities have experienced generations of isolation from opportunity. Some neighborhoods have more liquor stores than grocery stores, lack safe and affordable housing, or have poor-quality schools.

Acknowledging that the root causes of health inequities are “diverse, complex, evolving and interdependent,” the Panel calls for greater investment and collaboration across sectors to address the multiple factors that influence health, and to change the types of policies, practices and systems that have kept inequity in place.

The report also highlights nine communities across the United States that are taking steps to address health inequities.

The Panel’s Conclusions

1. Health equity is crucial for the well-being and vibrancy of communities.
2. Health is a product of multiple determinants, and disparities in health are shaped more by social, economic, environmental, and structural factors—and their unequal distribution—than by health care.
3. Health inequities are in large part a result of poverty, structural racism, and discrimination. Interventions with the greatest promise target factors arising from roots causes in two clusters:
   
   • Intrapersonal, interpersonal, institutional and systemic mechanisms that organize the distribution of power and resources differentially across lines of race gender, class, sexual orientation, gender expression, and other dimensions of individual and group identity.
   • The unequal allocation of power and resources—including goods, services, and societal attention—which manifests itself in unequal social, economic and environmental conditions, also called the determinants of health.
4. Communities have agency to promote health equity. Community-driven solutions should address at least one of the nine social determinants—education, employment, health systems and services, housing, income and wealth, physical environment, public safety, social environment, and transportation—and be:
   
   • Community-driven;
   • Multi-sectoral; and
   • Evidence-informed.
5. Supportive public and private policies at all levels and programs facilitate community action.
6. The collaboration and engagement of new and diverse (multi-sector) partners is essential to promoting health equity.
7. Tools and other resources exist to translate knowledge into action to promote health equity.
8. Systemic root causes of health inequities in the Unites States can seem overwhelming; it will take considerable time and effort from all the actors in the community—business, state and local government, anchor institutions, and other community residents—to change the narrative and promote health equity.
   

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