Advancing Health Equity

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The Community Preventive Services Task Force (CPSTF) has prioritized health equity and social determinants of health (SDOH) in their work since the Task Force was established in 1996.

CPSTF:

    • Examines findings in all Community Guide systematic reviews to assess whether they have health equity relevance.
    • Conducts systematic reviews of intervention approaches that modify SDOH to reduce health inequities. SDOH is one of nine CPSTF priority topics.

CPSTF’s Key Goal Areas for Health Equity

In 2022, CPSTF adopted the following key goal areas to define CPSTF’s role in advancing health equity, identify and prioritize activities to address health equity issues, and develop processes and guidance to implement these activities.

      1. Definitions and Key Concepts: Establish a common language for health equity concepts as they relate to CPSTF’s work.
      2. Prioritization: Ensure that health equity relevance is considered when prioritizing topics and intervention approaches to review.
      3. CPSTF Recommendations and Findings: Incorporate health equity considerations into CPSTF evidence to decision translation processes.
      4. Evidence Expansion in Systematic Reviews: Ensure reviews consider evidence to support determinations about the effectiveness or utility of the intervention in advancing health equity.
      5. Communication and Dissemination: Highlight health equity in communication and dissemination of CPSTF recommendations and findings.
      6. Expand Subject Matter Expertise: Expand health equity subject matter expertise on systematic review teams.
      7. Enhance CPSTF Representation: Promote sustained diversity of CPSTF membership and leadership, and liaisons.

CPSTF Definitions and Key Concepts

CPSTF considered various sources and consulted with subject matter experts1 to develop a set of definitions and key concepts around health equity. CPSTF uses these definitions and concepts to do the following:

      • Provide consistent terminology for use in Community Guide systematic reviews, CPSTF recommendations and findings, and implementation resources
      • Inform decisions about processes used to advance the CPSTF’s health equity work
      • Communicate CPSTF values to the public

Health Equity

Health Equity is when everyone has a fair and just opportunity to attain the highest level of health and well-being. Achieving this requires focused and ongoing societal efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.

Social Determinants of Health

Health inequities are caused by the uneven distribution of social determinants of health (SDOH). SDOH are conditions in the environments where people are born, live, learn, work, play, relate, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Exposure to detrimental SDOH is influenced by structural and systemic factors including racism, income inequality, the organization of work, residential segregation, sexism, nativism, and ableism. These upstream factors result from, and are reinforced by, power inequities, economic processes, as well as policies, practices, and norms that create systematic disadvantage for certain populations.

SDOH can be grouped into six domains that may be intervened upon to improve health and health-related outcomes and achieve health equity.

      1. Economic resources: Access to resources such as income and wealth over the life-course and transmitted across generations. This domain includes exposure to poverty and is linked to having the resources necessary to fulfill basic needs such as food security and decent and stable housing among others.
      2. Education access and quality: Access to high quality educational opportunities. This domain includes access to, and graduation from, well-resourced and equitable learning environments for childhood education (early childhood development, kindergarten through 12th grade, and post-secondary). This domain also includes access to and completion of adult education (basic education, continuing education, and language literacy) programs.
      3. Employment and job characteristics: Access to stable and fulfilling work with equitable pay. This domain includes wages, work schedules, workload, job security, safety, working conditions and environments, workplace accommodations, access to benefits including paid leave and health insurance, work/life balance, unemployment, and underemployment.
      4. Health care access and quality: Access to timely, high quality, and appropriate healthcare. This domain includes access to primary care and specialty care, guideline-concordant care and evidence-based practice, patient-provider interactions, appointment availability and duration, referral completion, health insurance coverage, healthcare costs, and health literacy of patients and communities.
      5. Neighborhood physical environments: Access to physical features of areas where individuals live, work, study, or play. This domain includes area-level measures of: built environment attributes such as walkability, safety, and presence of healthy food outlets; housing availability and quality (e.g., exposure to toxins, air conditioning and ventilation, overcrowding); and other characteristics of physical and natural environments (e.g., air quality, green space, and impacts of climate change).
      6. Social and community context: Exposure to area- or population-level social and community characteristics and relationships. This domain includes exposure to income inequality, violence, social or community cohesion, civic participation, legal and criminal justice systems, and policies addressing racial and social justice.

Populations of Focus to Advance Health Equity

Structural and systemic factors generate health inequities across many different dimensions including race and ethnicity, social class, disability, language, national origin, religion, gender and gender expression, sexual orientation, neighborhoods, and geography. All inequities influence and reinforce each other, and all are important and deserve attention.

Because of the pervasive role of racism and income inequality in shaping health inequities in the United States, the CPSTF currently prioritizes addressing health inequities experienced by historically disadvantaged racial and ethnic populations and populations with lower incomes. However, in all its work the CPSTF will apply an intersectional lens taking into consideration multiple intersecting identities (gender, sexual orientation, and disability among others) and their impact on health inequities whenever possible.

Additional Resources

1CPSTF consulted the following sources when developing their definitions and key concepts:

  • Braveman P, Arkin E, Orleans T, Proctor D, and Plough A. What Is Health Equity? And What Difference Does a Definition Make? Princeton (NJ): Robert Wood Johnson Foundation, 2017.
  • Centers for Disease Control and Prevention. Social Determinants of Health: Know What Affects Health. Published 2021. https://www.cdc.gov/socialdeterminants/about.html Accessed 4/23/22
  • M. Flynn, lead for National Institute for Occupational Safety & Health Occupational Health Equity Program (personal communication, December 10, 2021).
  • National Academies of Sciences, Engineering, and Medicine. Communities in Action: Pathways to Health Equity. Washington (DC): The National Academies Press, 2017. https://doi.org/10.17226/24624.
  • Office of Disease Prevention and Health Promotion. Healthy People 2020: Disparities. U.S. Department of Health and Human Services. Published 2022. https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities Accessed: 4/23/22.
  • Office of Disease Prevention and Health Promotion. Healthy People 2030: Social Determinants of Health. U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-and-data/social-determinants-health Accessed: 4/23/22.