Healthy People 2030: Let’s Talk About Health Equity

Healthy People 2030 provides data, resources, and tools to help achieve health equity.

It is often not one factor or one driver that impacts health disparities, but an intersection of factors.

For more than 40 years, Healthy People has tracked the health of the nation and set 10-year, data-driven, national objectives to improve health and well-being. Central to the Healthy People initiative is eliminating health disparities, achieving health equity, and attaining health literacy to improve health and well-being for all. And realizing these goals requires creating equitable opportunities, through investments, efforts and resources, for health. With each decade the initiative has gained deeper insight into the drivers of health inequities, the significance of the social determinants of health, and the importance of reporting health disparities – all of which has contributed to this decade’s commitment to providing more actionable health equity content.

As an initial step in Healthy People’s most recent effort to assess equity within this new paradigm, we conducted a review of peer-reviewed and gray literature to examine how health equity is currently defined, conceptualized, and measured by public health professionals. Through this environmental scan, we found that while there are differences in specific definitions, similarities exist in conceptualizations of equity. For example, looking at various definitions of health equity, many publications referenced similar words or phrases. The aim of achieving the “highest level of health” for all people, providing the “opportunity” to do so, and ensuring the “absence of disparities” are a few examples. The existence of so many definitions signals the need to establish a common definition and much work remains, but the evolution of a common definition of health equity is moving in the right direction.

As heartening as we found such shared conceptualization, determining the most effective methodology for measuring health equity isn’t showing the same forward progress. As a public health community, we continue to grapple with establishing the most universally appropriate metrics for equity.

Health researchers have long included standard demographic identifiers in data collection, and bivariate analysis is commonly undertaken to refine, sharpen and polish the takeaways we are able to mine from that data. But we still aren’t seeing everyone clearly enough, nor in the entirety of their multivariate complexity. As we continue to explore health disparities and health equity measurement and their linkages, we must apply more nuance to how we understand them and the factors that determine individual’s health.

As public health professionals pursuing health equity, we must commit to defining, identifying, and communicating the factors that influence health. Having a shared understanding on common concepts and language used to define health equity can help advance efforts and collaborative action to improve health and well-being for all. After all, without a clearly defined vision as to what health equity is, how will we know what is to be measured? What’s more, without such clarity, how will we ever know if we are successful?

While the answers to these two questions are still being formed, one thing is certain: we cannot do it alone. We know that the factors which contribute to health outcomes extend far beyond the scope of public health itself, and as such, the conceptualization, measurement, and advancement of health equity is a shared responsibility for all professions. Healthy People 2030, including its Social Determinants of Health Framework, can be a tool for understanding the influences that shape individual’s lives, choices, and, ultimately, health.

In the context of the pandemic, we saw that age, pre-existing conditions and vaccination status were contributing factors as to how serious a COVID-19 infection would be for an individual. But what about the occupation of the individual? Have we fully considered the prevalence of local social/familial connections, or access to trails and sidewalks for free outdoor recreation, or whether those who suffered the worst outcomes from COVID-19 lived in a free-standing home or multi-story apartment? What’s the interplay amongst these social determinants? These are factors we must continue to explore.

Our hope is that the tools and frameworks outlined in Addressing Health Equity and Social Determinants of Health Through Healthy People 2030 will help public health professionals – and others working on issues regarding equity – continue to explore this critical data topic. Additionally, Healthy People will continue to provide disparities data to further inform these efforts and bring together a diverse network of national, state, and community level organizations with a common goal to improve the health and well-being of all people.

But that starts with a shared understanding of what we’re talking about in terms of health equity and agreeing on what we will measure, how we will measure it, and the benchmarks that will demonstrate our progress in achieving it. Only then can we move forward toward the Healthy People 2030 vision – a society in which all people can achieve their full potential for health and well-being across the lifespan.

Read the article in the Journal of Public Health Management and Practice:

Deborah Hoyer, MPH, is a public health advisor at the US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. In her role, she promotes and supports Healthy People 2030, a set of national health objectives for this decade. Deborah is part of a coordinated team working to advance the health and well-being of the nation through the adoption of Healthy People and its resources. She earned her Master of Public Health from the University of Washington.

Elizabeth Dee, MPH, is a Public Health Analyst in the Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary at the U.S. Department of Health and Human Services (HHS). In this role, she supports the implementation of Healthy People 2030, including the Healthy People 2030 Social Determinants of Health Workgroup, and serves as the Healthy People State and Territorial Coordinator Lead. Elizabeth holds an MPH from the Johns Hopkins Bloomberg School of Public Health.