Assessing the Historical and Policy Context when Addressing Health Equity

Health inequities occur because not all people have access to opportunities to lead their healthiest lives. To advance health equity, rural communities may need to understand the underlying systems, structures, and policies that lead to inequities. It may be critical to acknowledge that health inequities are often rooted in historical injustice. For example, the Native American Center for Excellence states that researchers working with tribal communities should be aware of the tribe's history and culture, including any historical trauma that may affect tribal members.

Policies and programs are also part of the community context. The Association of State and Territorial Health Officials' (ASTHO) Foundational Practices for Health Equity discusses the importance of assessing and influencing the policy context. The Commonwealth Fund's A Racial Equity Framework for Assessing Health Policy describes key elements of the policy environment, including:

• Events that may highlight inequities, such as the opioid epidemic or COVID-19
• Actors that are involved in promoting or challenging strategies to advance health equity
• Networks or relationships between decision-makers, community makers, and other key collaborators
• Ideas that include prevailing schools of thought on policy, addressing perceptions of who is deserving and undeserving of services
• Contexts such as state policies that shape the extent to which communities can implement their own policies to advance health equity

Questions for Consideration

• Do we have the necessary skills to understand how policies have contributed to inequities and continue to affect people in the community?
• Are we engaging community members to inform our understanding of the historical context?
• How do local policies provide opportunities for or pose barriers to health and well-being? How have communities that experience inequities been involved in shaping those policies?

Resources to Learn More

Community Context
Website
Discusses considerations for understanding the community context as part of achieving community health.
Organization(s): Healthy Places by Design

Equity Assessment Framework for Public Health Laws and Policies
Document
Offers a guide for assessing equity implications of public health laws and policies.
Organization(s): Network for Public Health Law
Date: 5/2019

Prioritizing Equity: How the Past Informs the Present in Healthcare
Video/Multimedia
Expert panel discussion on historical trauma and its impact on health and quality of care.
Author(s): Gravlee, C. C., Fullilove, R. E.
Organization(s): American Medical Association (AMA)
Date: 5/2021