Assessing the Historical and Policy Context when Addressing Health Equity
Health inequities occur because not all people have access to opportunities to lead their healthiest lives. To
advance health equity, rural communities may need to understand the underlying systems, structures, and policies
that lead to inequities. It may be critical to acknowledge that health inequities are often rooted in historical
injustice. For example, the Native American Center for Excellence states that researchers
working with tribal communities should be aware of the tribe's history and culture, including any
historical trauma that may affect tribal members.
Policies and programs are also part of the community context. The Association of State and Territorial Health
Officials' (ASTHO) Foundational
Practices for Health Equity discusses the importance of assessing and influencing the policy context.
The Commonwealth Fund's A
Racial Equity Framework for Assessing Health Policy describes key elements of the policy environment,
Events that may highlight inequities, such as the opioid epidemic or COVID-19
Actors that are involved in promoting or challenging strategies to advance health equity
Networks or relationships between decision-makers, community makers, and other key collaborators
Ideas that include prevailing schools of thought on policy, addressing perceptions of who is deserving and
undeserving of services
Contexts such as state policies that shape the extent to which communities can implement their own policies
to advance health equity
Questions for Consideration
Do we have the necessary skills to understand how policies have contributed to inequities and continue to
affect people in the community?
Are we engaging community members to inform our understanding of the historical context?
How do local policies provide opportunities for or pose barriers to health and well-being? How have
communities that experience inequities been involved in shaping those policies?
Resources to Learn More
Discusses considerations for understanding the community context as part of achieving community health.
Organization(s): Healthy Places by Design
Assessment Framework for Public Health Laws and Policies
Offers a guide for assessing equity implications of public health laws and policies.
Organization(s): Network for Public Health Law
Importance of Community Context
Describes the importance of community context when implementing strategies to promote health and equity.
Organization(s): County Health Rankings & Roadmaps, University of Wisconsin Population Health Institute
Equity: How the Past Informs the Present in Healthcare
Expert panel discussion on historical trauma and its impact on health and quality of care.
Author(s): Gravlee, C. C., Fullilove, R. E.
Organization(s): American Medical Association (AMA)