Health Equity Health equity means everyone has a fair and just opportunity to be as healthy as possible. To achieve this, we must remove barriers to health — such as poverty, discrimination, and deep power imbalances. We must also remove their consequences, including lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care. The Massachusetts Community Health & Healthy Aging Funds are explicitly focused on addressing the root causes of inequity. Structural and institutional racism and other forms of oppression need to be disrupted to eliminate inequities in population health outcomes. These forms of oppression need to be understood and disrupted to eliminate health inequities and address the social determinants of health. The Massachusetts Community Health & Healthy Aging Funds use an approach known as “leading with race and racism.” This approach recognizes that people of color in Massachusetts have historically and consistently had less opportunity to lead a healthy life. The Massachusetts Community Health & Healthy Aging Funds also recognize that the root causes of health can create barriers to health for all types of populations. As a result, the Funds want communities to lead with race and racism, explicitly but not exclusively. Leading with Race and Racism The Massachusetts Community Health & Healthy Aging Funds use an approach known as “leading with race and racism.” This approach recognizes that people of color in Massachusetts have historically and consistently had less opportunity to lead a healthy life. The Massachusetts Community Health & Healthy Aging Funds also recognize that the root causes of health can create barriers to health for all types of populations. As a result, the Funds want communities to lead with race and racism, explicitly but not exclusively. The Health Tree: Connecting Health Outcomes to Root Causes The tree below shows the relationship between health outcomes and the root causes of health. LEAVES – The leaves of the tree represent health outcomes. These include the physical and mental health of individuals and populations. Historically, the Funds have focused on four health outcomes: Chronic disease with a focus on cancer, heart disease and diabetes Housing stability/homelessness Mental illness and mental health Substance use disorders BRANCHES – Health behaviors such as diet and exercise influence one’s risk of poor health outcomes. While individuals can make lifestyle changes to improve their health, it’s important to consider the factors that influence their ability to engage in healthy behaviors. TREE TRUNK – Certain conditions influence people’s ability to engage in health behaviors.Social determinants of health (SDOH) such as education, employment, and housingare the environmental conditions in which people live, learn, work, play, worship, and age. These conditions affect a wide range of health, functioning, and quality-of-life outcomes and risks. Historically, the Funds have focus on six common social determinants of health: Built environment – encompasses the physical parts of where we live, work, travel and play, including transportation, buildings, streets, and open spaces. Social environment – consists of a community’s social conditions and cultural dynamics. Housing – includes the development and maintenance of safe, quality, affordable living accommodations for all people. Violence and trauma – the use of force or power, threatened or actual, against oneself, another person, or against a group or community, with the behavior likely to cause harm. Employment – the availability of safe, stable, quality, well-compensated work for all people. Education – refers to a person’s educational attainment – the years or level of overall schooling a person has. For more information on these social determinants of health, click here. For the full version of the document, click here. TREE ROOTS – When we think about making lasting changes in the social determinants of health, we need to think about what created these conditions in the first place. What are the policies and systems involved? The tree graphic highlights some of these root causes of health, including racism, poverty, ageism, and structural and institutional barriers. SOIL – The underlying systems of dominant culture and narratives are represented by the soil in which the tree stands. Healthy soil means healthy roots, trunk, branches, and leaves. Dominant culture is “the culture that has been able, through economic, social, or political power, to impose its values, language, and ways of behaving on other cultures” (Integrative Inquiry). Like the soil surrounding the root system, white supremacy culture can often be nearly invisible given its position as “normal.” Health and Racial Equity Resources The Health Tree Metaphor and the Importance of Shared Language: A blog post shows how we use the EquiTree to demonstrate the relationships among health outcomes and systems. The Groundwater Approach: A document from the Racial Equity Institute highlighting a metaphor to help individuals understand that we live in a racially structured society, and that that is what causes racial inequity. Health Equity in Cross-Sector Partnerships: Webinar recording by the Community Health Training Institute that outlines cross-sector partnerships and how health equity work is strengthened when we work together. Moving from the Social Determinants of Health to Health Equity: Webinar recording by the Community Health Training Institute that describes strategies for addressing social determinants of health and explores upstream strategies for moving toward addressing equity. Community Building Through a Health Equity Framework: Webinar recording by the Community Health Training Institute that describes health equity in a community context and identifies strategies for collaborative work when working across differences.
