Abstract

Research demonstrates that many preventable disparities in health outcomes result from the structural disadvantage and diminished opportunity faced by racially and ethnically minoritized¹ populations and tribal communities. Extensive research on these health inequities demonstrates that these populations experience higher rates of illness and death for many different conditions, including heart disease, hypertension, and diabetes, and lower life expectancies compared to non-Hispanic White people.

Health equity is the state in which everyone has a fair opportunity to attain full health potential and well-being, and no one is disadvantaged from doing so because of social position or any other socially defined circumstance. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities and historical and contemporary injustices and eliminate health and health care disparities due to past and present causes. It is about fairness and ensuring that no one suffers inequitable outcomes in health and wellbeing, everyone’s voice is heard, and everyone at the table has the power to inform action. When individuals thrive, families, communities, and the entire nation thrive.

There are many levels at which to intervene; however, the committee was asked by the Office of Minority Health to (1) examine federal policies that contribute to preventable and unfair differences in health status and outcomes experienced by all racially and ethnically minoritized populations in the United States and (2) provide conclusions and recommendations that

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¹ See the Key Terms section for a definition of this term.

identify the most effective or promising approaches to policy change, with the goal of furthering racial and ethnic health equity. The committee also took into consideration relevant federal activities already underway.

The committee set out to identify how past and current federal policies (or features/components of federal policies) operate in ways that create, maintain, and amplify racial, ethnic, and tribal health inequities. Moreover, the committee identified key features of past and current policies that have served to reduce inequities to inform its recommendations to not only further reduce and eliminate inequities but also achieve equity, with a focus on policies and programs controlled or influenced by the executive and legislative branches of the federal government. Federal policy makers have worked on health equity issues in the past with significant progress; the goal of this report is to further that progress.

To guide its work, the committee adopted the following key principles:

1. Health is more than physical and mental well-being—it also includes well-being in social, economic, and other factors, all of which are necessary for human flourishing;
2. All federal policies have the potential to affect population health;
3. Evidence is informed by quantitative, qualitative, and community sources;
4. Federal policies should center health equity;² and
5. To advance health equity, structural and systems change are needed.

On the path to eliminating health inequities, both short-term strategies (e.g., mitigation by getting people what they need now to thrive) and long-term structural and systems change strategies that address the root causes (e.g., employment and economic development) will be needed. Based on its review of federal policies, the committee identified four action areas through which the federal government can better support states, localities, tribes, territories, and communities to advance health equity.

1. Implement Sustained Coordination Among Federal Agencies
2. Prioritize, Value, and Incorporate Community Voice in the Work of Government
3. Ensure Collection and Reporting of Data Are Representative and Accurate
4. Improve Federal Accountability, Enforcement, Tools, and Support Toward a Government That Advances Optimal Health for Everyone

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² Centering equity means prioritizing the needs of racially and ethnically minoritized populations and considering the consequences of current and future policies for advancing or impeding health equity.

This report provides 36 conclusions and 13 recommendations for action (see the Summary or full report for a full exposition of each conclusion and recommendation). Several of these recommendations build on actions already underway in the federal government and could be implemented in the short term. Some of the structural-level needs articulated in the recommendations will require broad societal-level change and long-term effort, as these are tied to accumulated inequities over generations that need to be unwound to achieve health equity. Both levels of action are required to make progress on eliminating—versus only mitigating—racial and ethnic health inequities.

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