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Racial Health Equity Plans in the 30 Largest US Cities

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

Racial inequities in life expectancy vary significantly across US cities, with city-level gaps ranging from zero to more than 10 years. Given that these inequities are rooted in racism and maintained through social structures and policies, population-level solutions are needed. Local health departments (LHD) are well-situated to lead these types of changes.

Methods

We conducted an environmental scan and document review of formal health plans of the LHDs with jurisdictions covering the 30 most populous US cities. We assessed the inclusion of equity priorities and specific and measurable equity goals. Secondary outcomes related to organizational structures, data, formal declarations, and other practices were also assessed. Data were collected between January and August 2022.

Results

The extent of focus on racial equity in the identified strategic health plans varied. Less than half of the cities with a formal public health plan (13 of 29) listed racial health equity as an area of focus. Only seven cities (all of which had a health plan focusing on racial health equity) had specific goals related to racial health equity. Twenty-five LHDs provided local data on racial health inequities. All but seven cities had declared racism a public health crisis. About half of the LHDs had positions or divisions focused on racial equity, or specified equity as an area of focus for Covid-19 efforts.

Conclusions

These findings reveal that few large cities translate growing support for anti-racism into their formal planning. While most LHDs acknowledge (and provide data pointing to) gaps in racial health equity in their jurisdictions, more attention is needed to incorporate specific and measurable racial health equity goals into strategic plans, and provide adequate structure and resources to attain those goals.

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Data Availability

There is no data available for this study beyond what was reported.

References

  1. District of Columbia Department of Health. Washington D.C. Annual Report & Action Plan 2017–2019. [Internet]. 2018. https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/DOH_AnnualReport_011518_INTERACTIVE%20FINAL%20Reduced.pdf.

  2. Roesch PT, Saiyed NS, Laflamme E, De Maio FG, Benjamins MR. Life expectancy gaps among Black and White persons and contributing causes of death in 3 large US cities, 2018–2019. JAMA Netw Open. 2023;6(3):e233146.

    Article  PubMed  Google Scholar 

  3. Benjamins M, Silva A, Saiyed N, De Maio F. Comparison of all-cause mortality rates and Black: White inequities in rates across the 30 most populous U.S. cities. JAMA Network Open. 2021;4(1):e2032086. https://doi.org/10.1001/jamanetworkopen.2020.32086.

  4. Bailey ZD, Krieger N, Agenor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–63.

    Article  PubMed  Google Scholar 

  5. National Association of County and City Health Officials (NACCHO). 2016 national profile of local health departments. [Internet]. 2017. https://www.naccho.org/uploads/downloadable-resources/ProfileReport_Aug2017_final.pdf. Accessed 4 May 2023

  6. National Collaborative for Health Equity. Building public health capacity to advance equity: a national environmental scan of tribal, state, and local governmental public health. [Internet]. 2019. https://www.nationalcollaborative.org/wp-content/uploads/2019/01/nche_environmental_scan_exec_summary.pdf. Accessed 4 May 2023

  7. Inderstrodt J, Perrault E, Hintz E, Hildenbrand G. Addressing health disparities in America: analysis of community health improvement plans. Nurs Res. 2019;68(5):405–12.

    Article  PubMed  Google Scholar 

  8. Sokol R, Moracco B, Nelson S, et al. How local health departments work towards health equity. Eval Program Plann. 2017;65:117–23.

    Article  PubMed  Google Scholar 

  9. Narain KDC, Zimmerman FJ, Richards J, et al. Making strides toward health equity: the experiences of public health departments. J Public Health Manag Pract. 2019;25(4):342–7.

    Article  PubMed  Google Scholar 

  10. Porter JM, Giles-Cantrell B, Schaffer K, Dutta EA, Castrucci BC. Awareness of and confidence to address equity-related concepts across the US governmental public health workforce. J Public Health Manag Pract. 2023;29(Supplement 1):S87–97.

    Article  PubMed  Google Scholar 

  11. Benjamins M, De Maio F, editors. (2021) Unequal cities: structural racism and the death gap in America’s largest cities. Baltimore, MD: Johns Hopkins University Press; https://doi.org/10.1353/book.85763.

  12. Choo CW. Environmental scanning as information seeking and organizational learning. Inf Res. 2021;7(1).

  13. American Public Health Association. Racism is a public health crisis. [Internet]. (2021) https://www.apha.org/topics-and-issues/health-equity/racism-and-health/racism-declarations. Accessed 4 May 2023.

  14. Public Health Accreditation Board (PHAB). Accreditation Activity. 2022. https://phaboard.org/who-is-accredited/. Accessed 4 May 2023.

    Google Scholar 

  15. Public Health Accreditation Board. Standards & measures for initial accreditation. Version 2022. [Internet]. 2022. https://phaboard.org/wp-content/uploads/Standards-Measures-Initial-Accreditation-Version-2022.pdf. Accessed 4 May 2023

  16. County Health Rankings. Length of life. [Internet]. 2021. https://www.countyhealthrankings.org/explore-health-rankings/measures-data-sources/county-health-rankings-model/health-outcomes/length-of-life. Accessed 4 May 2023

  17. Acs 5-Year Data Profiles for 2019, Dp05. United States Census Bureau; (2022)   https://data.census.gov/cedsci/all?q=ACS%202019&d=ACS%205-Year%20Estimates%20Data%20Profiles.Accessed 4 May 2023

  18. Health CoPDoP. Community-clinical linkages for a healthier Philadelphia. 2022.

    Google Scholar 

  19. Baltimore City Health Department. Healthy Baltimore 2020: a blueprint for health. 2017. https://health.baltimorecity.gov/sites/default/files/HB2020%20-%20April%202017.pdf . Accessed 4 May 2023

  20. Boston CHNA-CHIP Collaborative. 2020 community health improvement plan. n.d. http://www.bostonchna.org/wp-content/uploads/2020/12/Boston-CHIP-FINAL-3.5.20.pdf . Accessed 4 May 2023

  21. Dircksen J, Prachand N, al. e. Healthy Chicago 2.0: Partnering to improve health equity. 2016. https://www.chicago.gov/content/dam/city/depts/cdph/CDPH/Healthy%20Chicago/HC2.0Upd4152016.pdf. Accessed 4 May 2023

  22. Marion County Public Health Department. Community health improvement plan. (2019).

  23. Florida Department of Health in Duval County. Duval county community health improvement plan. 2017. hhttps://duval.floridahealth.gov/_files/_documents/2017-2022-duval-chip-revised-march-2020.pdf . Accessed 4 May 2023

  24. Los Angeles County Health Agency. Center for Health Equity Action Plan. 2019. http://publichealth.lacounty.gov/CenterForHealthEquity/PDF/CHEActionPlanFinalDraft_2.15.2019.pdf.

  25. Mettey A, Garcia A, Isaac L, Linos N, Barbot O, Bassett M. Take care New York 2020: every neighborhood, every New Yorker, everyone’s health counts. 2015. https://www1.nyc.gov/assets/doh/downloads/pdf/tcny/tcny-2020.pdf.

  26. Bowman E, Hansotte E, Zuker J. The state of health in Marion county: health equity 2018. https://marionhealth.org/homeslider/2018-health-equity-report/.

  27. Philadelphia Department of Public Health. Coronavirus interim racial equity plan. [Internet]. 2020. https://www.phila.gov/media/20200727145003/Coronavirus-Interim-Racial-Equity-Plan_revise.pdf.

  28. Covid-19 state, tribal, local, and territorial funding. Centers for Disease Control and Prevention; 2022. https://data.cdc.gov/Administrative/COVID-19-State-Tribal-Local-and-Territorial-Fundin/tt3f-rr33/data.

  29. U.S. Department of the Treasury. Coronavirus state and local fiscal recovery funds. 2022. https://home.treasury.gov/policy-issues/coronavirus/assistance-for-state-local-and-tribal-governments/state-and-local-fiscal-recovery-funds.

  30. National Association of County and City Health Officials (NACCHO). 2019 national profile of local health departments. [Internet]. 2020. https://www.naccho.org/uploads/downloadable-resources/Programs/Public-Health-Infrastructure/NACCHO_2019_Profile_final.pdf.

  31. Singh SR, Young GJ, Daniel Lee SY, Song PH, Alexander JA. Analysis of hospital community benefit expenditures’ alignment with community health needs: evidence from a national investigation of tax-exempt hospitals. Am J Public Health. 2015;105(5):914–21.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Fos EB, Thompson ME, Elnitsky CA, Platonova EA. Did performing community health needs assessments increase community health program spending by North Carolina’s tax-exempt hospitals? Popul Health Manag. 2019;22(4):339–46.

    Article  PubMed  Google Scholar 

  33. Wooten WJ, Julien JA, Werth J. How public health accreditation helped one local health department integrate and promote health equity. J Public Health Manag Pract. 2018;24(Suppl 3):S60-s65. https://doi.org/10.1097/PHH.0000000000000777.

    Article  PubMed  Google Scholar 

  34. Ebekozien O, Henry A. Advancing health equity through public health department accreditation in the United States. Perspect Public Health. 2019;139(1):17–8.

    Article  PubMed  Google Scholar 

  35. Lamberti M. Racism as a public health crisis: a qualitative case series of public health responses in the Washington, Dc/Maryland/Virginia area. Georgetown Med Rev. 2022.

  36. Wispelwey B, Morse M. An antiracist agenda for medicine. Boston Rev. 2021;3(17).

  37. Mendez D, Scott J, Adodoadji L, Toval C, McNeil M, Sindhu M. Racism as public health crisis: assessment and review of municipal declarations and resolutions across the United States. Front Public Health. 2021:1142.

  38. Public Health Accreditation Board (PHAB). Standards & measures version 1.5. [Internet]. 2013. https://phaboard.org/wp-content/uploads/PHABSM_WEB_LR1-1.pdf . Accessed 4 May 2023

  39. Gould LH, Farquhar SE, Greer S, et al. Data for equity: creating an antiracist, intersectional approach to data in a local health department. J Public Health Manag Pract. 2023;29(1):11–20.

    Article  PubMed  Google Scholar 

  40. Auer S, Arrazola J, Nichols G, Masters A, Juliano C. Big cities health coalition epidemiology capacity assessment. Bethesda, MD; Atlanta, GA: Big Cities Health Coalition ; Council of State and Territorial Epidemiologists; 2021.

  41. Robert Wood Johnson Foundation. Covid-19 community response: emerging themes across sentinel communities. [Internet]. 2020. https://www.rwjf.org/en/library/interactives/covid-19-community-response--emerging-themes-across-sentinel-communities.html.

  42. Infant Mortality Collaborative Improvement and Innovation Network (CoIIN) Region V Social Determinants of Health Team. Foundational practices for health equity: learning and action tool for public health organizations. [Internet]. 2018.

  43. Liburd L, Hall J, Mpofu J, Williams S, Bouye K, Penman-Aguilar A. Addressing health equity in public health practice: frameworks, promising strategies, and measurement considerations. Annu Rev Public Health. 2020;41(1):417–32.

    Article  PubMed  Google Scholar 

  44. National League of Cities. Cities of opportunity: pathway to equity, a brief based on analysis of participating cities. [Internet]. 2021. https://www.nlc.org/wp-content/uploads/2021/11/NLC-CoO-Brief-110821-Success-Measures-Final.pdf . Accessed 4 May 2023

  45. Health Equity Guide. n.d. https://healthequityguide.org . Accessed 4 May 2023

  46. Health Equity Tools. n.d. https://humanimpact.org/products-resources/issue-area/?filter=iss1-145 . Accessed 4 May 2023

  47. National Academy of Medicine. Community-Driven Health Equity Action Plans. 2021. hhttps://nam.edu/programs/culture-of-health/community-driven-health-equity-action-plans/ . Accessed 4 May 2023

  48. Government Alliance on Race and Equity (Gare). n.d. https://www.racialequityalliance.org/about/who-we-are . Accessed 4 May 2023.

  49. National Equity Atlas. 2021. https://nationalequityatlas.org/.

  50. Yearby R, Watson S, Gibson C, et al. Governmental use of racial equity tools to address systemic racism and the social determinants of health. The Inst Healing Justice Equity; 2021.

  51. National Equity Project. 2021. https://www.nationalequityproject.org/.

  52. Race for Equity. [Internet]. 2021. https://www.raceforequity.net/.

  53. National League of Cities. Addressing health disparities in cities: lessons from the field. [Internet]. 2015. https://www.nlc.org/wp-content/uploads/2017/03/nlc-health-disparities-lessons-learned_finalprintversion.pdf.

  54. National League of Cities. Advancing racial equity in your city. [Internet]. 2017. https://www.nlc.org/wp-content/uploads/2017/10/NLC20MAG20on20Racial20Equity.pdf.

  55. Public Health and Equity Resource Navigator. n.d. https://phern.communitycommons.org/ . Accessed 4 May 2023.

  56. Charlton P, Kean T, Liu R, et al. Use of environmental scans in health services delivery research: a scoping review. BMJ Open. 2021;11(11):e050284–e050284.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Graham P, Evitts T, Thomas-MacLean R. Environmental scans: how useful are they for primary care research? Can Fam Physician. 2008;54(7):1022–3.

    PubMed  PubMed Central  Google Scholar 

  58. DeSalvo K, Wang Y, Harris A, Auerbach J, Koo D, O’Carroll P. Public health 3.0: a call to action for public health to meet the challenges of the 21st century. Prev Chronic Dis. 2017;14:E78. https://doi.org/10.5888/pcd14.170017.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Prentice B. Expanding the boundaries: health equity and public health practice. Washington, Dc: National Association for City and County Health Officials. 2014.

  60. Castaneda Y, Jacobs J, Margellos-Anast H, et al. Developing and implementing racial health equity plans in four large US cities: a qualitative study. J Public Health Manage Pract. 2023.

  61. Ansell D, James B, De Maio F. A call for antiracist action. New England J Med. 2022;387(1).

  62. San Francisco Department of Public Health. Budget hearing presentation. [Internet]. 2021. https://www.sfdph.org/dph/files/budget/files/FY_21-23_HC_First_Budget_Hearing_Presention-1-19-21_Final.pdf . Accessed 4 May 2023

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Acknowledgements

The authors would like to acknowledge the valuable assistance of our interns during different stages of the project: Andrew Kim, Rebecca Krasny, and May Li.

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Authors and Affiliations

  1. Sinai Urban Health Institute, 1500 S. Fairfield Ave, Chicago, IL, 60608, USA

    Maureen R. Benjamins & Jennifer Poonsapaya

  2. American Medical Association, Chicago, IL, USA

    Emily Laflamme & Fernando G. De Maio

  3. DePaul University, Chicago, IL, USA

    Fernando G. De Maio

Authors
  1. Maureen R. Benjamins
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  2. Jennifer Poonsapaya
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  3. Emily Laflamme
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  4. Fernando G. De Maio
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Contributions

MB: conceptualization, writing—original draft, reviewing, and editing, methodology, data collection. FDM: conceptualization, writing—reviewing and editing. JP: data collection, methodology and analysis, writing—original draft. EL: conceptualization.

Corresponding author

Correspondence to Maureen R. Benjamins.

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This study (MSH #18–40) was ruled exempt by Mount Sinai Hospital’s Institutional Review Board (FWA# 00005088).

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Benjamins, M.R., Poonsapaya, J., Laflamme, E. et al. Racial Health Equity Plans in the 30 Largest US Cities. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01662-x

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