Creating Healthier, More Equitable Communities By Improving Governance And Policy

Abstract

How can healthier, more equitable communities be created? This is a key question for public health. Even though progress has been made in understanding the impact of social, physical, and policy factors on population health, there is much room for improvement. With this in mind, the Robert Wood Johnson Foundation made creating healthier, more equitable communities the third of four Action Areas in its Culture of Health Action Framework. This Action Area focuses on the interplay of three drivers-the physical environment, social and economic conditions, and policy and governance-in influencing health equity. In this article we review some of the policy and governance challenges confronting decisionmakers as they seek to create healthy communities on a broad scale. We use these challenges as a framework for understanding where the most critical gaps still exist, where the links could be exploited more effectively, and where there are opportunities for further research and policy development.

The Importance of Policy Change for Addressing Public Health Problems

“…21 Policies that address and dismantle these underlying political, economic, social, and physical determinants of health can advance health equity. 22 For example, when land development changes are proposed, planners and policy makers should consider how these changes may lead to gentrification and displacement of historically marginalized populations, which have implications for their health. 23 By considering health equity, questions such as how a policy will increase or decrease access and opportunity for communities of color, in addition to how a policy may lead to other unintended consequences, can also be raised.…”

The Culture Of Health In Early Care And Education: Workers’ Wages, Health, And Job Characteristics

“…This study contributes to the literatures on the ECE workforce and ECE quality by exploring how worker and job characteristics, work conditions, and child care policies may influence the culture of health in ECE. 16…”

How Do You Build a “Culture of Health”? A Critical Analysis of Challenges and Opportunities from Medical Anthropology

“…And they are thinking deeply about how macro-level social structures endanger the health of communities and perpetuate community-wide poor health. 30 Although some initiatives have taken the important step of ensuring that those affected by structural inequalities help set agendas or even establish the terms of debate (see, eg, Visualizing Health Equity), the team remains concerned that such engagement efforts may only reach those already involved with established institutions and organizations, or with leaders of recognized, established ''communities.'' This could leave those individuals on the furthest margins, including homeless or undocumented individuals, on the sidelines -thereby unintentionally deepening inequities.…”

“…For instance, Gollust, Lantz, and Ubel found strong associations between political party affiliation and willingness to accept public health explanations regarding social determinants of health. 30,35 Findings from the American Health Values Survey revealed disagreement as to whether health equity should be a national goal. 36 And the ongoing ARCHES study is shedding light on why some Americans -advantaged and disadvantaged alike -are unable or unwilling to recognize the impact of structural factors on health, or the interconnections between their own health and the health of people they perceive as different from themselves.…”