Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity (2023) / Chapter Skim
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Summary
Pages 5-24
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From page 5... ...
When individuals thrive, communities and the entire nation thrive. Racial,2,3 ethnic, and tribal health inequities and their root causes have been substantially documented, and the evidence is clear -- advancing health equity needs to be approached using a holistic view of health, one that considers all that impacts it: economic stability, access to quality education and health care, and vibrant and livable communities (such as access to housing, 1 This Summary does not include references.
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focus on federal policies that contribute to preventable and unfair differences in health status and outcomes experienced by all racially and ethnically minoritized4 populations in the United States and (2) provide 4 Rather than referring to "racial and ethnic minorities," "members of minority groups," or "underrepresented minorities," this report uses the term "minoritized," which refers to people from groups that have been historically and systematically socially and economically marginalized or underserved based on their race or ethnicity as a result of racism (such as American Indian and Alaska Native, Asian, Black, Latino/a, and Native Hawaiian and Pacific Islander communities)
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Healthy People 2030 defines SDOH as "the conditions in the environments where people are born, live, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks." Healthy People 2030 acknowledges that targeting individual health behaviors cannot eliminate health inequity and so has an "increased and overarching focus on SDOH." HHS has organized the SDOH in five areas: • Economic stability • Education access and quality • Health care access and quality • Neighborhood and built environment • Social and community context The committee used this categorization for its report. conclusions and recommendations that identify the most effective or promising approaches to policy change with the goal of furthering racial and ethnic health equity (the committee was asked to review both promising and evidence-based solutions)
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A policy could influence health inequities in many ways. For example, the report considered policies that are neutral in terms of racial, ethnic, or tribal inequity but have indirect equity implications (i.e., policies that aim to improve health or the factors that shape it without considering health equity may unintentionally improve equity or improve population health overall but fail to decrease, or even widen, gaps)
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Given these limited and inaccurate data, the committee relied on a range of information to form a fuller understanding of the mechanisms that result in health inequities for these populations. Role of Communities Community voice and expertise have been critical for creating and implementing strategies to advance health equity, allowing many communities to flourish despite barriers.
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The committee had to make difficult decisions regarding which policies to highlight in this report; omitting one does not mean it is any less important. Furthermore, the committee builds on the abundance of high-quality, evidence-based, and peer-reviewed reports from the National Academies and other organizations that have laid out the evidence for the root causes and mechanisms of health inequities or provided recommendations for specific federal actions to advance health equity.
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The committee built on these and other efforts and analyses in its report. ACTION STEPS TO ADVANCE HEALTH EQUITY Based on its review, the committee provides 36 conclusions in the five SDOH categories on their connection to health and conclusions for many of the reviewed policy areas (see Summary Annex for a listing of all
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Many federal policies affect health even if that is not their main focus. Coordination among federal agencies is critical to advance health equity.
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Therefore, achieving racial, ethnic, and tribal health equity requires centering equity in federal policy creation, decision making, implementation, and regulation, such as through accountability standards, across the board. The ELTRR plan includes 10 crosscutting recommendations to address agency coordination and infrastructure in service of eliminating inequities.
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Recommendation 3: The federal government should assess if federal policies address or exacerbate health inequities by implementing an equity audit and developing an equity scorecard. Specifically, a.
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Racial, ethnic, and tribal communities have been consistently left out of the federal policy-making process, and the effects have sometimes been egregiously inequitable. Community voices are needed to redress past harms; earn trust; secure partnership, buy-in, and collaboration; and ensure policies are fully responsive to their needs and advance health equity.
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experience as essential for designing, implementing, and evaluating those programs and services. Recommendation 4: The federal government should prioritize commu nity input and expertise when changing or developing federal policies to advance health equity.
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should require the Census Bureau to facilitate and support the design of sampling frames, methods, measurement, collection, and dissemination of equitable data resources on minimum OMB categories -- including for American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino/a, and Native Hawaiian or Pacific Is lander populations -- across federal statistical agencies. The highest
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, in cluding populations who self-identify as American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Pacific Islander, and Hispanic or Latino/a. In January 2023, OMB released a Federal Register notice with proposed changes to the collection of data on race and ethnicity.
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Furthermore, context on social factors when interpreting racial and ethnic health inequities is crucial to understand the multiple levels of influence that impact health outcomes. Recommendation 8: Congress should increase funding for federal agen cies responsible for data collection on social determinants of health
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To benefit from the guidance of scientific and community experts, the federal government should make interagency coordination on data equity a permanent feature of its work across statistical agencies. By situating the Office of Data Equity under OMB, the federal government will be able to ensure cross-agency coordination and collaboration on data improvements that advance health equity in all federal agencies and policies.
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can lead to differential access based on geography. Equitable implementation supports government efficiency and effectiveness and can decrease inequities and improve outcomes for all.
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The pros and cons, including cost and health equity implications, should be weighed for each excluded category in federally funded programs. Advance American Indian and Alaska Native Health Equity Although the committee was expansive in its attempt to incorporate all minoritized racial, ethnic, and tribal communities impacted by federal policies, it paid special attention to AIAN communities, who are often overlooked in large national reports.
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Although these actions will not address all barriers to health equity for the AIAN population, together, they will give more voice and prominence to AIAN people, which will help advance health equity for a population that is ignored and inadequately resourced. Health Care Access One major barrier to health equity is health care access, which includes health insurance coverage and the availability of and access to culturally appropriate, high-quality care, including preventive care, primary care, specialist care, chronic disease management, dental and vision care, mental health treatment, and emergency services.
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Staying vigilant for such unintended consequences of implemented policies is essential and needs to be built into feedback monitoring loops and measured in equity audits. Furthermore, as the federal government works to advance health equity, it should keep front and center the guiding principles in this report.
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