In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health.

Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways.

Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON COMMUNITY-BASED SOLUTIONS TO PROMOTE HEALTH EQUITY IN THE UNITED STATES
• Reviewers
• Preface
• Acknowledgments
• Acronyms and Abbreviations
• Key Terms
• Summary
  • HEALTH EQUITY IS CRUCIAL
  • MANY FACTORS SHAPE HEALTH AND HEALTH EQUITY
  • COMMUNITY AGENCY TO PROMOTE HEALTH EQUITY
  • DISPARITIES AND THEIR ROOTS
  • POLICY CONTEXT AND PARTNERS
  • TOOLS
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• 1. The Need to Promote Health Equity
  • INTRODUCTION
  • DEFINING HEALTH EQUITY
  • DISPARITIES IN HEALTH OUTCOMES
  • SOCIAL DETERMINANTS OF HEALTH
  • IMPACTS OF HEALTH INEQUITY IN THE UNITED STATES
  • CHANGING SOCIAL AND ENVIRONMENTAL CONTEXT
  • WHY COMMUNITIES?
  • MOMENTUM FOR ACHIEVING HEALTH EQUITY
  • ABOUT THIS REPORT
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• 2. The State of Health Disparities in the United States
  • HEALTH DISPARITIES
  • ADDRESSING HEALTH INEQUITY IN UNIQUE POPULATIONS
  • PLACE MATTERS
  • EVIDENCE GAPS
  • REFERENCES
• 3. The Root Causes of Health Inequity
  • HOW STRUCTURAL INEQUITIES, SOCIAL DETERMINANTS OF HEALTH, AND HEALTH EQUITY CONNECT
  • STRUCTURAL INEQUITIES
  • SOCIAL DETERMINANTS OF HEALTH
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• 4. The Role of Communities in Promoting Health Equity
  • Taking Community Action to Promote Health Equity: The Thunder Valley Community Development Corporation
  • COMMUNITY ACTION: VITALLY NECESSARY
  • THE EVIDENCE ON COMMUNITY-BASED EFFORTS
  • ELEMENTS OF SUCCESSFUL COMMUNITY EFFORTS
  • BUILDING EVIDENCE TO SUPPORT COMMUNITY ACTION
  • REFERENCES
• 5. Examples of Communities Tackling Health Inequity
  • PROCESS OF SELECTION
  • SUMMARY OF CHALLENGES
  • SUMMARY OF KEY ELEMENTS, LEVERS, POLICIES, AND STAKEHOLDERS
  • CONCLUSION
  • Chapter 5 Annex
  • REFERENCES
• 6. Policies to Support Community Solutions
  • TAXATION AND INCOME INEQUALITY
  • HOUSING AND URBAN PLANNING POLICIES
  • EDUCATION POLICIES
  • CIVIL RIGHTS LAW AND POLICY
  • HEALTH POLICY
  • CRIMINAL JUSTICE POLICY
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• 7. Partners in Promoting Health Equity in Communities
  • FINANCE
  • ANCHOR INSTITUTIONS
  • OTHER COMMUNITY-BASED PARTNERS
  • ROLE OF GOVERNMENT
  • CROSS-SECTOR COLLABORATION—HEALTH IN ALL POLCIES
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• 8. Community Tools to Promote Health Equity
  • TOOLS FOR COMMUNITY SUCCESS
  • CROSSCUTTING TOOLS AND PROCESSES
  • MAKING HEALTH EQUITY A SHARED VISION AND VALUE
  • INCREASING COMMUNITY CAPACITY TO SHAPE HEALTH OUTCOMES
  • FOSTERING MULTI-SECTOR COLLABORATION
  • COMMUNITY TOOL KITS
  • CONCLUSION
  • REFERENCES
• 9. Conclusion
  • REFERENCES
• APPENDIXES
  • Appendix A. Native American Health: Historical and Legal Context
  • Appendix B. Community-Level Indicators and Interactive Tools for Health Equity
  • Appendix C. Public Meeting Agendas
  • Appendix D. Committee Biographical Sketches

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2017. Communities in action: Pathways to health equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.