This ASTHOBrief offers a menu of strategies and considerations for organizations interested in incorporating a Health in All Policies and equity-centered approach to the development and implementation of requests for proposals and notice of funding opportunities.
The COVID-19 pandemic spotlighted health inequities at national, state, and local levels. This report details the role immunization can play in reducing these disparities, informed directly by conversations ASTHO held with state equity and immunization leaders from March-July 2021. These conversations have been distilled into 20 key actions health agencies can take to make an impact.
Centering the Community’s Voice in State-Led Health Equity Initiatives health equity, public health departments, health outcomes, michigan public health institute, health disparities, underserved populations, marginalized communities, people of color, indigenous people, premature deaths, minority health, cultural competency, public health, life expectancy, improving health, american indians, health service, african american, native american, social determinants of health, sexual orientation, mortality rate, socioeconomic status, covid-19 pandemic, higher rates, alaska natives, group of people, racial groups, social economic, population health, department of health, astho, association of state and territorial health officials Lana McKinney, Jessica Fepelstein Establishing the community voice in health policy discussions. Over the past two years, ASTHO has worked directly with state public health departments and their communities to build capacity for improving health outcomes. These public health departments are building a culture of health equity through policies, practices, and quality improvement measures. This includes the Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative—a 10-state learning community hosted by ASTHO, the CDC Foundation, and the Michigan Public Health Institute. STRETCH supports states in operationalizing health equity and preventing the constant pressures caused by negative health outcomes on their communities. For example, poverty can create constant pressures just as water pushes against a dam, which can build to the point of breaking and push people into poverty. Additionally, ASTHO supports state and territorial recipients of CDC’s COVID-19 Health Disparities grant to improve the health of high-risk and underserved populations disproportionately impacted by the COVID-19 pandemic. Health disparities impact the quality-of-life and financial well-being of communities, with the economic burden of health disparities increasing from $320 billion in 2014 to $451 billion in 2018. This includes associated costs of excess premature deaths, lost labor market productivity, and excess medical care for Americans of color as compared to their white counterparts. Events in recent years, such as the COVID-19 pandemic, revealed the pressures that Black, Indigenous, People of Color (BIPOC) and other marginalized communities experience because of health disparities. Aligned with the technical assistance received by public health departments, several states have taken concrete steps to achieve optimal health for all by supporting training of public health staff and increasing engagement of under-represented and underserved communities in the policy process. Promoting Staff Health Equity Training Ensuring that public health staff and other leaders are equipped with the knowledge, skills, and attitudes necessary to provide culturally competent and equitable care to all patients, regardless of their social background or identity can improve health outcomes. In recent years, states have worked to expand access to cultural competency and humility training for health system workers. Nevada enacted legislation (AB 267) requiring the state Board of Health to establish the frequency for medical facilities and dependent care facilities to conduct cultural competency training for employees who have direct patient contact. It also (1) requires the Office of Minority Health and Equity and Department of Health and Human Services to establish and maintain a public-facing list of approved courses for cultural competency training, and (2) require nurses, psychologists, marriage and family therapists, counselors, social workers, and behavioral analysts to complete a minimum of three hours of cultural competency training to successfully renew their license. At least four other states—Illinois (SB 2427), Massachusetts (S 1413), Virginia (SB 1440), and Vermont (H 512)—considered bills expanding access to cultural competency training for health care professionals. Vermont’s bill would implement the recommendations of the Health Equity Advisory Commission to provide training and continuing education for health care providers to improve cultural competency, cultural humility, and antiracism in Vermont’s health care system. Public health agencies can also promote health equity training by allocating funding and providing training. For example, the Arizona Department of Health Services leveraged funding from CDC’s COVID-19 Health Disparities grant to establish the Advancing Health Equity, Addressing Disparities (AHEAD AZ) program with the University of Arizona Center for Rural Health, which supports the health care and public health workforce, including support for Arizona’s 17 Critical Access Hospitals health equity strategic plans, and implementing a COVID-19 testing program that provided testing to communities most in need regardless of socioeconomic or immigration status, including those living in correctional facilities and unhoused people. Health Equity Commissions Health equity commissions play a critical role in advancing optimal health for all by bringing together experts, stakeholders, and policymakers to draw on evidence-based approaches that address the root causes of health disparities and to develop strategies to prevent them. At least two states proposed legislation related to health equity commissions in 2023. Colorado passed a law (SB 23-151) extending its Health Equity Commission through 2029. New Jersey is considering S 3136, which would establish and require a Commission on Health Equity to, among other things, recommend implicit bias training requirements for health care providers. Empowering Community Members to Engage in the Policy Process Hearing directly from community members, particularly those with lived experience, provides health agencies with unique insights into the community’s needs and daily life, and helps gain support from those most affected by the policy. There can be several barriers to holistic community engagement, particularly for community members who have fewer resources. Policymakers can take steps to lower these barriers by providing access to childcare, supporting transportation costs to a meeting, and/or compensating community members for their time and effort supporting the policy development process. In 2022, Washington enacted SB 5793 to compensate community members with lived experience for their time and expertise when serving on boards, commissions, councils, committees and other similar policymaking groups. The law directed the state’s Office of Equity to develop equity-driven compensation guidelines for all state agencies, which Washington’s Department of Health used to create and implement its Community Compensation Guidelines. These compensation guidelines outline how and when community members can be paid for their time and expenses when engaging in the policy process. Such methods are particularly valuable because the communities facing the most inequity are also the ones most systemically marginalized. Similarly, in 2023 Oregon’s legislature considered SB 694 to create a Task Force and Work Group Stipend Fund. The fund would provide for providing members who do not otherwise receive compensation for their participation to be compensated for their time and travel for task force or workgroup related work. ASTHO will continue to monitor policy developments supporting health equity programs and initiatives, providing relevant updates. Special thanks to Maggie Davis, JD, ASTHO’s director of state health policy, for her contributions to this blog. Additional Resources to Help Public Health Leaders Increase Community Engagement ASTHO’s Programmatic Health Initiatives and Strategies Georgia Health Policy Center’s Guide to Funding Navigation to help communities design and sustain equity-advancing investment. <!-- Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative framework. --> website yes
The first cohort of the STRETCH Initiative held two hybrid convenings, where ten state teams engaged with content experts and each other.
We can prepare for the future of health equity and data by ensuring the equitable collection of data and building systems that are flexible enough to account for forward progress.
This blog explains ASTHO’s Islands Health Equity Framework, which outlines a culturally resonant approach to health equity in the island areas.
Establishing an Office of Health Equity or Minority Health Learn how to establish, structure, and fund a health equity or minority health office. A dedicated office of health equity or minority health can provide a focus on cross-cutting efforts and strategies that help to improve services, outreach, and engagement with marginalized communities. This report delves into the typical scope for setting up a health equity or minority health office, including how to establish, structure, and fund it—providing a blueprint to island areas working to build one or considering establishing one in the future. In addition, it explores lessons learned from state offices of health equity or minority health, including California, Michigan, Nebraska, Nevada, New Jersey, New York, Ohio, Vermont, and Washington. Get the Report (PDF) website yes
The disparities experienced during the COVID pandemic have brought a national focus to health equity in our nation. The attention and resources currently being provided to help address health inequities provide an opportunity that I have never experienced in my public health career. There are still challenges, but we have an opportunity to build momentum for the first time in decades if we can focus on implementing evidence-based strategies, demonstrating change and documenting our progress.
People with chronic diseases have suffered the most during the pandemic both in rates of COVID-19 mortality and morbidity, and the health disparities that exist in those with chronic disease and poor social determinants of health are stark. On today’s episode, we speak to chronic disease and health equity experts on how to address this growing divide.
Best Practices for Sustained Community Engagement Learned from the STRETCH 2.0 Midpoint Best Practices for Sustained Community Engagement from STRETCH Jessica Fepelstein The brief reflects on critical takeaways and key insights from a community health and health equity program. Creating systemic change within state public health agencies while simultaneously curating authentic, sustainable relationships with community partners can be challenging. Whether it’s issues with sustainable funding, conflicting priorities, or the toll of undertaking transformative work, making progress in these areas are often slow-moving. To assist state agencies with this work, the Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative was born. Funded by the Robert Wood Johnson Foundation, STRETCH is a co-creation between ASTHO, the CDC Foundation, and the Michigan Public Health Institute focused on building lasting, systemic change to advance equity in all sectors of public health. The first iteration of STRETCH was from October 2021 through May 2023, with STRETCH 2.0 launching in January 2024 and going through May 2025. During STRETCH 1.0, its creators learned that community partners not only needed to be more involved in assisting state public health agencies in setting their equity priorities, but also needed to be leading this work in step with agency staff and leadership at the onset of decision-making conversations. Therefore, in STRETCH 2.0, community-based organizations became the project's primary applicants and fiduciary recipients, creating a state collaborative with public health agency staff. Collaboratives from seven states comprise the STRETCH 2.0 cohort, who receive technical assistance and support via personalized core response teams and engage in peer-to-peer learning through monthly practical application workshops. Creating this level of learning and sharing among states was another key lesson learned by the STRETCH partners; those working in health equity and systems change are hungry for connection with their peers. These connections not only allow staff to share best practices and common pain points, but also allow them to lean on each other emotionally and create a space of psychological safety in this sometimes-taxing work. This lesson has been operationalized with the creation of the STRETCH Network of Health Equity Practitioners virtual community. This community is open to anyone in the health equity and/or systems change public health ecosystem who would like to connect with fellow practitioners, participate in monthly “Speak and Share” discussions, and receive additional materials and best practices from across the country. Also open to the public are the STRETCH 2.0 national convenings, quarterly virtual events aimed to disseminate STRETCH lessons and create a connected network of systems change practitioners. These national touchpoints aim to expand the reach of the STRETCH initiative beyond the cohort and allow all state public health agencies to better operationalize health equity and move towards lasting, systemic change. Midway through the second iteration of STRETCH, there are already key themes and critical takeaways the partners have observed while working with the cohort of state collaboratives. Among them is ensuring community voice is always front and center in all state public health initiatives, even internal operations. Secondly, valuing the lived experiences of community members and their organizations—particularly with financial incentives—is a critical component in ensuring capacity for this valuable work. Finally, while having a plan is beneficial, the ability to be flexible and meet the needs of the collaboratives as they shift is a critical aspect of success when working on multi-sector initiatives. Key Takeaways: Lessons Learned Midway through the STRETCH 2.0 Cohort With Us, Not for Us Centering community voice is not a novel concept in community engagement and health equity efforts. One of the best practices the STRETCH initiative has found in centering community voice is allowing each state collaborative to set the purpose and agenda for their core response team’s site visit. One participant from South Carolina expressed that this model of having “on the ground” partners in charge of planning the visit was a key success of the experience and recommended continuing the use of this model moving forward. On a micro-level, this is an example of the importance of centering the community’s voice and allowing those with lived experience to lead the work. Along with systemic change, this focus on community leading the work is a central tenant of the STRETCH Initiative. Time is Money Another common theme in health equity work is the lack of sustainable funding to achieve systemic change, specifically when working directly with community partners and nonprofit organizations. To reduce the financial burden of participating in STRETCH, the second iteration of the project offered funding directly to the applying community-based organization to assist in strengthening the organization’s capacity to fully engage with this work right at the beginning. Providing a financial investment for the project not only allowed organizations to dedicate time, staff, and resources to the work of STRETCH, but it also “walked the walk” in terms of valuing community members' lived experience and expertise. While strengthening community compensation guidelines and initiatives is not novel to the STRETCH project, it is a key component of the success of the second iteration. Flexibility is Critical While the STRETCH partners did plenty of planning when developing the program’s activities, a critical theme of the initiative has been learning to meet each state collaborative’s unique and ever-changing needs throughout their participation. Whether it was leadership changes, hurricane responses, or shifts in staffing capacity, each state was faced with its own unique needs and challenges over the first half of STRETCH 2.0. A key lesson learned from the project is understanding how to alter plans and meet the states where they are with what they need, rather than focus on creating a uniform experience. In practice, this has taken shape by turning check-in meetings into working sessions, providing virtual and in-person options for relationship-building activities, and staggering site visits throughout the project year based on the priorities of each state. By remaining flexible and working in step with state collaboratives to best meet their needs, the STRETCH project has continued to be valuable to all cohort members. Want to learn more about the STRETCH project and other work of ASTHO’s Programmatic Health Initiatives and Strategies team? Check out the STRETCH framework microlearning course, our website, or email the team. article yes
This ASTHO report, which was co-authored with the World Institute on Disabilities, answers top questions around disability preparedness initiatives, and prioritizes inclusive planning while providing overarching guidance that can be applied to a variety of health and public health systems and structures. The report highlights key planning considerations to ensure public health emergency plans include people with disabilities, and is intended to be used in conjunction with other department and agency plans, as well as disability agencies in the local jurisdiction.
A guide to setting up and facilitating Health Equity Circles in the workplace.
This how-to guide provides steps, tips, and templates for developing and maintaining effective partnerships within island health agencies.
Guidance and Perspectives From Leaders to Their Peers
Leveraging Healthy People 2030 to Build Non-Traditional Multisector Partnerships multisector partnerships, healthy people 2030, health equity, health outcomes, social services, health disparities, preventable disease, premature death, health literacy, economic stability, social determinants of health, department of health, improving the health, united states, long term, life expectancies, population health, chronic diseases, prevention and health promotion, health care system, disease prevention and health, health systems, healthy people 2030 objective, subject matter experts, office of disease prevention, personal health literacy, achieving health equity, health problem, population groups, astho, association of state and territorial health officials Corinne Gillenwater, Megan DeNubila-Griffin ASTHO | This toolkit helps public health build and maintain relationships with non-traditional partners across a multitude of sectors. The goal of this toolkit is to help state and territorial health agencies (S/THAs) build non-traditional, non-public health sector partnerships to improve health outcomes and advance health equity. The Healthy People 2030 objectives, aligned closely with the Social Determinants of Health (SDOH) framework and Health in All Policies (HiAP) lens, can serve as the cornerstone of these collaborations. This toolkit is implementation-focused, providing partnership-building and -sustaining skills that are rooted in Healthy People 2030 tools and success stories and can be operationalized for community needs. Overall, this toolkit encourages S/THAs to implement these described strategies in their own public health practice to: Establish and maintain partnerships within and across sectors at the state and territorial level to create a shared vision of health. Respond to public health priorities collaboratively and strategically. On This Page Using Healthy People 2030 in Non-Traditional Partnerships to Improve Public Health Types of Non-Public Health Sector and Non-Traditional Partnerships for Consideration Foundations of Strong Partnerships Sustainability of Partnerships 10 Steps for Strong Public Health Multisector Partnerships Conclusion Additional Resources website yes
This blog describes the island areas COVID-19 successes and their cultural and historical context.
Community design strategies that increase the availability of safe and accessible outdoor spaces create more physical activity opportunities for people of all abilities.
In 2020 and early 2021, state policymakers took action to raise awareness of the impacts of racism on health outcomes, to reverse the damage of racist polices, and to implement policy changes to ensure that future policies are enacted with a racial equity lens. In the past two years, many states introduced and adopted resolutions declaring racism a public health crisis. In the early weeks of 2022, there is notably less legislation that has been introduced as compared to the same time last year.
How states are building sustainable health equity programs.
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