Everyone Deserves Good Health
April 12, 2016|9:46 a.m.| ASTHO Staff
Health Equity, Health in All Policies
In public health, it is not enough for one part, or a large part, of the population to be healthy. Every person should have the access to and opportunity for optimal health. And the U.S. is far from achieving this. To that end, ASTHO President and Minnesota Commissioner of Health Edward Ehlinger, MD, MSPH, has issued ASTHO's 2016 President's Challenge: Advance Health Equity and Optimal Health for All.
We asked Ehlinger to give us some insights into why he is passionate about this work, and how states can work to achieve strong health outcomes for everyone.
What sparked this challenge? Why did you make this an ASTHO priority for 2016?
My first job after completing my clinical training was directing the maternal and child health program of the Minneapolis Health Department. At that time, Minnesota had one of the best infant mortality rates in the country yet the racial disparities were quite alarming. To address those disparities, I worked to improve access to prenatal care, family planning services, and community-oriented primary care; enroll more people in Medicaid; expand access to the WIC program; establish school-based clinics in all high schools; implement universal home visiting; develop regional perinatal care systems; support breastfeeding; and a host of other programs and services. These were the best practices that I had learned in my clinical and public health training and I implemented them as best I could. I worked on these things for 15 years and was proud of the efforts that my colleagues and I had made.
When I came back to governmental public health 16 years later as health commissioner for the state of Minnesota, one of the first things I did was review the state's infant mortality rate (IMR) to see what kind of progress the state had made. To my shock and disappointment, the data showed that the Black infant mortality rate in Minnesota had not yet reached the White infant mortality rate of 31 years earlier. (I also noted that Minnesota was not unusual. Nationally, the Black IMR in 2011 was still higher than the White IMR in 1980.) It was then that I realized that our traditional approaches to reducing health disparities were not getting us to our goal and that we needed to try a different strategy.
After making health equity the central focus of the Minnesota Department of Health, agency staff and other public health and community groups throughout the state seemed to become energized around the issue. It quickly became obvious that many others had recognized our work in public health had to change if we were going to improve health equity in our state. Similarly, in my work with ASTHO it became clear that the issues of disparities and equity were also challenging other state health officials. In fact, ASTHO had made health equity an integral part of its strategic map. The time was right to focus on advancing health equity and optimal health for all at both the state and national level.
What about health equity personally resonates with you?
Bill Foege, former CDC director, once said that "the philosophy of science is to discover truth, the philosophy of medicine is to use that truth to treat patients, and the philosophy of public health is social justice." I had entered the field of medicine because I was fascinated and excited by the discovery of new truths. As I honed my clinical skills and used those truths to treat patients, I came to realize that as satisfying as it was to care for individuals and help them heal from injuries and diseases, I was not making a dent in the overall health of the communities in which I lived. There were too many other factors impacting the lives of people in my community. And those factors negatively and disproportionately impacted some groups of people more than others—usually racial minorities and low income populations. It became clear that the lack of social justice (everyone getting their basic needs met and no one benefitting at the expense of others) was behind the fact that not everyone had the opportunity to be optimally healthy.
The need for and principles of social justice were instilled in me by my parents and mentors in my childhood community. My search for social justice attracted me to the field of medicine and eventually brought me to the field of public health. Health equity is the public manifestation of social justice.
How does the Triple Aim of Health Equity contribute to the goal of this year's challenge?
My president's challenge is to Advance Health Equity and Optimal Health for All. To move toward that goal, I'm challenging state health officials and the public health workers in their agencies to begin the process of changing how they do their work. I want my president's challenge to help stimulate the transformation of 21st Century public health. My Triple Aim of Health Equity embodies the practices that I believe will help advance health equity and optimal health for all.
The work of "expanding our understanding of what creates health" takes us beyond the dominant public narrative that health is determined solely by personal choices and access to medical care. It will help us realize that it's the policies and systems in our communities that create the social, economic, cultural, and physical environments that have the greatest impact on health.
That broader understanding of what creates health leads to the realization that the policies of other sectors (housing, transportation, economic development, corrections, etc.) also have a profound impact on health. "Implementing a health in all policies approach with health equity as the goal" acknowledges that partnerships between all sectors are necessary to effectively advance health equity and optimal health for all.
To effectively implement a health in all policies approach we will have to "strengthen the capacity of communities to create their own healthy future." Without effective community engagement we will remain in our isolated professional siloes and policy makers will not be held accountable for the investments or policy decisions that they make.
If my president's challenge can stimulate us to implement the Triple Aim of Health Equity in our work, we will have begun the transformation of public health practice that will help move toward the goal of health equity and optimal health for all.
If you were to dream big, what would be the result of this work if it were carried out by states across the U.S. for the next 10 years? What would that look like?
If my president's challenge is optimally successful, public health will be transformed. The work of public health agencies will be guided by the Triple Aim of Health Equity and all policies, programs, and activities will be developed, implemented, and assessed with that perspective. Equity will be the primary focus of the work that is done in every sector. Public health agencies will be looked to by all sectors for consultation and guidance on data analysis and use, community engagement, narrative creation, and policy development that will advance health and overall equity. Agencies in all sectors will see themselves as part of the multidisciplinary/multisector team that is needed for helping our communities to thrive. Health Impact Assessments will be the norm for any project or policy that is being considered and "health notes" in addition to "fiscal notes" will be routine for all proposed legislation. And the question asked of all political candidates will be "what will you do to create health." The results of these efforts will be a reduction in health and other disparities, a growing investment in the "commons," and an evolving sense of social cohesion in our country that recognizes the truth in Senator Paul Wellstone's statement that "we all do better when we all do better."
Edward P. Ehlinger, MD, MSPH is commissioner of the Minnesota Department of Health and president of ASTHO. Learn more about the 2016 President's Challenge: Advance Health Equity and Optimal Health for All at www.astho.org/Health-Equity/2016-Challenge.