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Though now an illegal practice, government contracts, policies, and practices have generally excluded women, and Black, Indigenous, and people of color. Still, practices and existing structures continue the inequitable distribution of all contracts. Governmental and non-governmental grants and funding should benefit the communities they serve while being proportionate to the communities' demographics. This is where inclusive contracting comes in.

The movement to address racism through policy change in the U.S. is receiving significant political support at every level of government. Government institutions are acknowledging the systemic oppression of people of color that persists in the United States and elevating racism as an urgent public health emergency comparable to other public health crises.

Measuring Health Equity for Planning and Performance Improvement astho, association of state and territorial health officials, environmental scan, health equity, health equity metrics, health equity strategies, social determinants of health, improve health, gender identity, sexual orientation, united states, race ethnicity, health outcomes, public health practice, health disparities, external factors, conducting an environmental scan, highest level of health, health and health, local health, measuring health equity, reduce health disparities, achieve health equity, public health, advancing health equity, health and health care Heidi Westermann, Melissa Lewis Better defining and measuring health equity in ASTHO jurisdictions. With support from CDC’s Center for State, Tribal, Local, and Territorial Support, in 2021, ASTHO initiated a health equity metric assessment to strengthen the evidence base for measuring health equity by identifying and collecting known and emerging metrics that support health equity strategies and monitor advancements toward health equity. To better understand the state of the field, ASTHO conducted an environmental scan that looked at state and territorial planning documents and national frameworks. As the scan revealed wide variation in how jurisdictions use equity-related terms and limited established metrics, ASTHO convened an advisory group to help identify resources and guide the work’s direction. Participating health agencies told ASTHO about their challenges in developing health equity standards and measures, including obstacles related to the underlying culture and the change management required to evolve toward a more equitable public health system. The agencies described both data limitation challenges and workforce capacity and communication challenges. This report summarizes these challenges, proposes incremental recommendations, and acknowledges the need for states and territories to apply both health equity and performance management strategies to develop health equity standards and measures. ASTHO recommends: Addressing data limitations and being transparent about remaining gaps. Building workforce capacity to recognize and address complex concepts and evolving needs through strategic skills and structural, transitional, and transformational change. Employing inclusive planning and performance management promising practices to engage stakeholders to develop meaningful, community-driven metrics. Committing to human-centered communication and community engagement through data visualization, storytelling, and trusted messengers. While this assessment confirmed that states and territories are interested in a list of nationally vetted common health equity metrics, the findings demonstrate a need for true equity engagement between communities and governmental public health leading to a paradigm shift in how we partner to improve health, prevent disease, and eliminate disparities. In addition, given that this assessment began before the COVID-19 pandemic, it does not fully account for the ongoing change associated with dedicated COVID disparities funding, investments in data and infrastructure, and the pandemic’s complex mental, physical, political, social, and economic impacts. As a result, several jurisdictions may need to adapt strategies already underway that are aligned with ASTHO’s recommendations. Health agencies should also consider their level of influence and authority and which partners they would engage to implement these strategies; this may vary by jurisdiction and governance structure. ASTHO will continue to strategize ways to improve and formalize health equity metrics to help public health agencies better serve their communities. Get the Report (PDF) article yes

The novel coronavirus, COVID-19, shows no bias—it has infected people of all ages, genders, races, and ethnicities. However, racial and ethnic disparities in rates of infection and deaths have emerged. Public health officials can and must emphasize the necessity for data on racial disparities as the pandemic unfolds.

Integrating Health Equity into State and Local Data Sharing Practices Morgan Zialcita, Lana McKinney, Christina Severin, Reema Mistry, Melissa Lewis It is crucial that health agencies incorporate health equity principles into policies and relationships that advance state and local data sharing. Timely and efficient public health data sharing improves public health response and decision-making. It enables local public health agencies (PHAs) to enhance community-level interventions and state PHAs to provide equitable response and allocation of resources within the jurisdiction. However, data sharing between state and local PHAs can be challenging due to resource capacity constraints, factors that limit technical solutions, and sensitivities and complexities associated with public health data collection and dissemination. Adopting policies to advance state and local data sharing and incorporating health equity principles into these relationships can help PHAs better identify and address data disparities, utilize resources effectively, and create an equity-centered public health data infrastructure. Equity Impact Assessment for Policy Changes Adopting data sharing policies using a health equity-focused framework can mitigate unintentional harm to specific populations. An equity assessment requires the systematic examination of available data and expert input to understand how a policy, program, or process will affect various groups, especially those who are either at risk of or experiencing health disparities. The Health Equity Impact Assessment (HEIA), designed to address racial disparities and root causes of inequities that could arise from policy changes, can help agencies explore potential inequities that may result from a policy initiative. Health Equity Considerations for Key State and Local Data Sharing Priorities Informatics Workforce Developing a diverse workforce that is representative of the communities it serves is important for advancing an equitable, inclusive approach to data modernization. However, recruiting and retaining diverse informatics staff—with strong technical, relationship-building, and change management skills—can be challenging for PHAs, especially in resource-limited locations. Health agencies can incorporate health equity principles into their workforce strategies in several ways: Consider soft skills, such as communication and collaboration, alongside technical expertise. These skills are important in establishing and maintaining state and local data sharing relationships. Include data sharing tasks in job descriptions to promote accountability and transparency amongst staff. This approach helps identify the role(s) responsible for data sharing activities and can also support sustainability by minimizing staff turnover. Prioritize inclusive practices and invest in ongoing development of agency staff. For example, provide training on cultural humility and data sovereignty to better equip staff working with tribal nations on data-sharing initiatives, and provide on-the-job training to help employees grow and build capacity. Reassess location, remote work, salary, and tenure policies to attract a diverse and skilled informatics workforce. Agency Alignment and Governance The type of public health governance model in a given state (e.g., centralized, decentralized, shared, or mixed) can influence how state and local PHAs work together both overall and on data-focused initiatives. The following health equity-focused recommendations are applicable across governance types: Establish strong communication channels and processes across partners to ensure all parties explore and understand the health equity considerations associated with data sharing initiatives. Consider options for shared resources to leverage expertise and promote collaboration on data-sharing initiatives (e.g., shared training programs, IT systems, and liaison roles that could perform epidemiology or informatics functions). This shared approach can bridge resource and knowledge gaps between state and local PHAs, especially for communities with limited resources. Consider ways to include local PHA input and ongoing feedback (e.g., through advisory boards) to encourage shared decision-making. Establish processes and policies to identify appropriate levels of data access across both local and state PHAs, so that shared data can inform population health analysis and reporting purposes at community, state, territory, tribal, and federal levels. Data Sharing Agreements and Organizational Policies When pursuing a new or amended data sharing relationship, engaging with legal experts is essential to safeguard sensitive public health data and ensure compliance with all relevant laws. Failure to successfully navigate these relationships and the inherent complexities associated with certain types of data can limit access to valuable information for important public health initiatives that improve equitable outcomes. Health agencies can take the following actions to promote effective collaboration between program, technical, and legal staff: Share the scope of the data relationship, the details of the proposed data exchange, and the overall programmatic purpose of the arrangement with the legal team. This is necessary for effective discussions with legal counsel and will help inform the agency’s approach to documenting the data relationship (e.g., in the form of a data-sharing agreement or DSA). Use decision-support tools, such as the HEIA, alongside the legal team to consider how the new proposed data sharing policy may impact equity across populations. Use clear and accessible language in DSAs and related protocols and policies, with support from legal counsel. Documents written in plain language support transparency, help build trust, and facilitate understanding among interested parties. Foster a culture of knowledge sharing between program, technical, and legal staff. For example, consider inviting legal staff to join advisory committees, listening sessions, or town halls about data sharing considerations to enhance program staffs’ understanding of legal considerations, address perceived barriers, and promote relationships and knowledge exchange between program teams. Conclusion In addition to adopting policies that make data accessible across government levels, it is important to develop mechanisms for communicating with communities about how their data is being used. For example, developing public-facing data dashboards (such as Alaska Department of Health’s Public Health Data Hub) that are easily accessible and understandable can be an effective way to increase transparency and build trust with the public. By committing to these strategies, PHAs can support a more collaborative, coordinated, and equitable approach to state and local data sharing, and strengthen PHAs’ capacity to address public health challenges. website yes

How the Civil Rights March on Washington Embodied Key Public Health Tenets astho, association of state and territorial health officials, civil rights march on Washington, public health, national day of service, martin luther king jr, collective action, health equity, social determinants, united states, african Americans, dream speech, lincoln memorial, jobs and freedom, august 28 1963, improving health, washington for jobs, john lewis, student nonviolent coordinating committee, social determinants of health, coretta scott king, national days, health inequalities, civil rights leader, civil rights activists, dr martin luther king, nonviolent coordinating committee sncc, people are born grown, nobel peace prize Melissa Lewis What we can learn about public health best practices from the March on Washington. Every year on the third Monday of January, we celebrate Dr. Martin Luther King, Jr’s birthday as a federal holiday and recognize his life, legacy, and contributions as one of the most prominent civil rights leaders and activists of our generation and nation’s history. It is the only federal holiday that has also been designated as a National Day of Service to encourage Americans to take action and continue to uplift Dr. King’s legacy of social justice and equity by volunteering to improve their communities. I remember learning about tolerance, equality, and citizenship in school when discussing the March on Washington and hearing snippets of Dr. King’s fiery “I have a Dream Speech.” The message galvanized the civil rights movement and the nation. And it wasn’t just the largest civil rights demonstration on record at the time; it was a powerful example of civil disobedience and sent a message of hope for a dream deferred for Black Americans and a bold stand against injustices. On Aug. 28, 1963, more than 250,000 Americans attended the March on Washington for Jobs and Freedom (“the March"). And while it is one of the most celebrated speeches in our history, there are key elements of that day that were overshadowed but are still relevant today and serve as a call to action for public health professionals to reflect on as we continue to honor Dr. King’s legacy and serve our communities. Learn from the Past to Inform the Future The success of the March highlights the value of learning from the past and acknowledging history as an essential step to addressing equity. The original concept of the March on Washington came from A. Phillip Randolph, a labor leader and civil rights activist who planned previous marches on the nation’s capital in the 1940s to pressure the White House to address discrimination in the military. To avoid these large-scale marches, President Roosevelt passed an executive order prohibiting discrimination in the defense industry, and President Truman desegregated the U.S. Armed Forces. Although these marches were cancelled, the threat of well-organized demonstrations highlights their importance as a tool for change that informed planning for the March. Similarly, the critical timing of the 1963 march was strategically determined to help advocate for the passage of the Civil Rights Act. During the speech, Dr. King reminded Americans about “the fierce urgency of now.“ It was the 100th anniversary of the abolishment of slavery and Black Americans were still unable to realize the American dream; they were still being oppressed, terrorized and experiencing structural discrimination. As we work to embed equity into our daily operating practices, this reminds us that moving beyond rhetoric and taking action are critical to transformational change. Take Collective Action and Form Collaborations/Coalitions for Changemaking The March is an example of the impact of successful collective action. The leaders of the major civil rights organizations worked together to organize the march. Dr. King and Mr. Randolph aligned their interests to plan the March. Other influential multi-racial coalitions and organizations participated, which underscores the importance of engaging communities; they organized, supported, and advocated for the March and the stalled Civil Rights legislation. Health professionals from the Medical Committee for Civil Rights—a group sponsored by major national membership associations for doctors, nurses, dentists, and social workers—protested for change and justice to address the conditions that impact poor health outcomes. The March on Washington mirrors the marches that took place across the country to protest the murder of George Floyd in 2020. It’s a reminder to the public health field of our social justice roots and that we are also members of the communities that we seek to improve. Value Inclusion and Center Intersectionality Bayard Rustin, a brilliant strategist and organizer, was the chief architect of the March and an openly gay man. He faced criminalization and public attacks from opponents and members within the major civil rights organizations. This did not deter Dr. King's appreciation for Rustin’s work, nor his ability to be successful. Due to his sexual orientation, Rustin’s principal role in the march has been nearly erased from history. The role of women in the planning and execution of the March was also paramount to its success. However, women were not given leadership roles, or the opportunity to have prominent speaking roles by meeting organizers. Some of the prominent women who contributed to the planning of the March on Washington were Dorothy Height, a civil rights activist known as the “Godmother of the Movement” and President of the National Council of Negro Women, and Anna Arnold Hedgeman, a civil rights activist and politician who was the only woman on the planning committee. Both Mr. Rustin and the women faced double oppression, but their significant impact on the March and the movement emphasizes the importance of diversity and inclusion. As public health professionals, we must recognize that communities and individuals have multiple intersecting and overlapping identities and apply those considerations when developing and implementing interventions. Address the Social Determinants to Advance Health Equity Most importantly, the March on Washington underscores the importance of expanding our understanding of what creates health and addressing the community conditions—the social determinants of health (SDOH) that impact health outcomes. The March’s focus was not limited to racial equality but extended to economic justice and other social issues. More than 60 years ago, Dr. King and other leaders sounded the alarm on addressing the differences in the SDOH to achieve optimal health for all and create thriving communities. Speakers presented a list of 10 demands addressing the need for a living wage, desegregation, voting rights, employment protections, adequate housing and education, and workforce job placement and training. Public health leaders continue to carry the torch the speakers from the March on Washington lit over 60 years ago. Their persistence to uphold health equity as a primary public health initiative may be considered an act of civil disobedience, but if the consequence is improving health for all Americans, isn’t it worth the risk? website yes

Vivian Lasley-Bibbs, Board President of NASOMH, discusses helping minority/health equity offices with capacity building, policy, and workforce development.