Achieving Health Equity through Health in All Policies

The California Pan-Ethnic Health Network (CPEHN) works to ensure that all Californians have access to quality health care and can live healthy lives. We gather the strength of communities of color to build a united and powerful voice in health advocacy.

CPEHN was founded in the early 1990s in the era of national health care reform. Fifteen years later, we find ourselves, once again, engaged in the same debates. Unfortunately, the health of our nation has only gotten worse during these fifteen years, with rates of chronic conditions such as obesity, diabetes, high blood pressure, and asthma ever increasing. This is especially true among our diverse communities. We know now, more than ever, that the way we are approaching health care in the United States is neither strategic nor sustainable, and does not make us a healthier nation. We know now that we have to do things differently.

It is time we put significant investments in primary prevention. Health is fundamental to our happiness and productivity, and our approach needs to involve more than just health care. Our well-being is about the neighborhoods we live in, the opportunities we are afforded, and the actions of our government. national health care reform efforts can begin to achieve health equity by including these three simple approaches:

Incorporate health in all policies. In the past, decisions about issues that have big impacts on community health – for example, transportation, land use, agricultural policy, housing – have been made with little consideration as to whether the end result would be good for our health. The only way that our housing conditions, transportation infrastructure, food options and air quality will promote our health is if we analyze these policies through a health lens. Just as each policy goes through an appropriations process in the legislature, each policy should go through a health analysis. Health, along with education, transportation, environmental, agriculture, labor and housing agencies should be required to work together to identify the health impact of their policies, which will enable them to develop policies that better promote health, or mitigate negative health effects. This is particularly important to ensure that policy decisions do not continue to adversely impact communities that already suffer from poor health. For example, by conducting a Health Impact Assessment, researchers found that providing paid sick days for all workers is not just a labor issue, it would have public health benefits by reducing the spread of flu and protecting the public from diseases carried by sick workers in restaurants.

Revise the federal poverty level guidelines. The current federal poverty levels are outdated and do not take into account modern realities. These levels are used in most of our government’s policies to determine who is eligible to receive important services such as food stamps, cash assistance and health insurance. A 2007 report by the California Budget Project ([PDF] Making Ends Meet: How Much Does It Cost to Raise a Family in California?) found that a single adult in California requires an annual income of $28,336 – more than double the amount of the federal poverty line – to cover basic expenses. The federal poverty level needs to reflect current basic needs and geographic differences.

Collect and analyze data by race, ethnicity, and language. All federal and state agencies, health delivery systems and public health departments need to collect and analyze data by race, ethnicity and language. This information is critical to understanding the population served and the underlying systemic factors impacting health, targeting limited resources most cost-effectively and developing culturally appropriate interventions. Without this data, we will continue to develop one-size-fits-all approaches that contribute to racial and ethnic disparities.

The current health care reform effort is our opportunity to take a comprehensive approach to health – from creating healthier places where we live and work, to equal access to quality care. Let’s make it a reality.


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