Examination of Health Equity Interventions in Governmental Public Health

Posted on June 14, 2024 by Skky Martin

This entry is part 2 of 6 in the series Jul 2024

This scoping review enhances the field of health equity science by detailing the approaches and interventions implemented by governmental health departments to reduce racial and ethnic disparities in health and healthcare.

Although there have been targeted investments in research, practice, and policy, racial and ethnic health inequalities “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations” continue to endure in the United States. Governmental public health agencies are tasked with tackling these enduring racial and ethnic health disparities. However, there hasn’t been a thorough examination of interventions carried out by these agencies aimed at fostering health equity and reducing health disparities. In our study, “A Scoping Review of Health Equity Interventions in Governmental Public Health,” we describe a comprehensive review of health equity interventions performed in collaboration with public health agencies. This review focused primarily on four dimensions of racial health equity interventions including: intervention components, intervention settings, intervention delivery agents, and intervention outcomes. PRISMA-ScR were followed to conduct this review and analysis, and the scoping review protocol was registered with Open Science Framework. This scoping review includes intervention studies from Ovid MEDLINE, PsycINFO, and Academic Search Premier, published between 2017 and 2023. The search strategy used terminology focused on four concepts: race/ethnicity, equity, health departments, and epidemiologic studies. Covidence was used to screen articles and conduct data extraction.

Summary of Findings

The database searches yielded a total of 10,046 references and after removing duplicates this resulted in 8,661 abstracts screened for inclusion. After title and abstract screening, 293 were classified as potentially relevant by at least one reviewer and advanced to the full article review phase. A total of 39 studies were selected for final inclusion and none of these were excluded during data extraction. The most common reasons for article exclusion included interventions without a relevant link to public health departments, lack of intervention, and/or non-health equity article focus. Included article publication dates ranged from 2017 to 2023. For the majority of these studies (34), the unit of analysis was participants, whereas the other five were focused more on specific hospitals, clinics, health departments, and organizations. The sample sizes of the included studies ranged from 18 to 25,886 participants.

This review indicated that health equity interventions involving public health agencies focused on the following categories:

preventing transmission (n=12), including COVID-19 (n=3), HIV (n=8), and TB (n=1)
access to care (n=9)
health behavior (n=8)
infectious disease testing (n=7), including COVID-19 (n=3) and HIV (n=4)
cancer screening (n=3)

Critical strategies included in interventions for reaching racialized populations included 1) using community settings, 2) mobile clinics, 3) social media/social networks, 4) phone-based interventions, 5) community-based workers, 6) health education, 7) active public health department involvement, and 8) structural/policy change.

The health equity interventions in public health agencies focused on:

individual-tailored strategies (testing and prevention)
provider-tailored interventions (training providers), and
structural or policy changes (often focused on city-level policies)

Most of the research included multiple racial/ethnic groups (i.e., most studies enrolled participants from more than one racial/ethnic minoritized group or enrolled racial minoritized people and other groups). The second largest group of interventions had a study population that was focused on African Americans/Black people (n=12). In most examinations of long-term health and healthcare disparities, African Americans/Black people fare worse than all other groups in health outcomes, which explains the high interest in interventions for this group.

This scoping review enhances the field of health equity science by detailing the approaches and interventions implemented by governmental health departments to reduce racial and ethnic disparities in health and healthcare. Health equity science delves into the patterns and factors influencing health inequalities, aiming to produce evidence to inform programs, policies, surveillance, communication strategies, and future scientific research endeavors directed at eliminating inequities.

Implications for Policy & Practice

The literature on health equity interventions in public health departments highlights the need for research that specifically assesses the broader impact of interventions in truly reducing disparities. Such research would need to report equity of service outcomes that directly measure disparity reduction between racial/ethnic minoritized people and other groups.
Certain important outcomes need more attention from a health equity lens, including maternal and child health, mental health, cardiovascular disease, and asthma.
Public health interventions need stronger evaluation designs with a focus on the applicability and sustainability of health interventions.
While terms used in interventions need better standardization and operationalization in general, a comprehensive examination of varied intervention components and categories to improve the ability of public health departments to understand what works and what does not is crucial.
Focused research is needed on less often included racial/ethnic minoritized groups, including Asians and American Indians/Alaska Natives.
Cultural adaptation and community involvement in healthcare system interventions need more attention.

For more information, read “A Scoping Review of Health Equity Interventions in Governmental Public Health.”

This project was funded by the National Association for County and City Health Officials (NACCHO), Association for State and Territorial Health Officials (ASTHO), and the Centers for Disease Control and Prevention (CDC). The content and conclusions of this project are those of the authors and should not be construed as the official position or policy of the CDC, NACCHO, or ASTHO, nor should any endorsements be inferred.

Co-author Acknowledgement

I would like to express my appreciation to all of the co-authors who supported this manuscript. Thank you, Janette Dill, Denisha Demeritte, Hannah Geressu, Roshani Dahal, Chelsey Kirkland, Shanda Hunt, and Romil Parikh.

About the Author

Skky Martin: Dr. Skky Martin is a researcher at the Center for Public Health Systems. Her research interests include health disparities, social determinants of health, and the interrelationship between public health and medical education. Dr. Martin is a mixed methodologist and her research interests include health disparities, health equity, maternal health, and medical education. She holds a PhD and MA in sociology and a Certificate in Public Health from Loyola University Chicago. Dr. Martin’s dissertation specialized in medical sociology and health education, focusing on the ways in which patients, providers, and medical schools experience and conceptualize racial and ethnic disparities in maternal health.