How Public Policy Advances Health Equity

January 22, 2014

Elizabeth-Krause-1142“How fundamental is public policy to the success of the equity agenda that the foundation endeavors to achieve?” asks Elizabeth Krause, vice president of policy and communications at the Connecticut Health Foundation (CT Health), and Chris Armijo, program officer at the Colorado Trust, in a Views from the Field piece from Grantmakers in Health.

Chris ArmijoElizabeth and Chris explain the utility of the marriage of policy and health equity, and provide examples of how their respective organizations are taking this approach.Elizabeth describes how CT Health has seeded the creation of a new organization that can answer the question, “Whose job is it in Connecticut  to advocate for policies to reduce health disparities?”Chris describes how the Colorado Trust began to turn the previously vaguely connected health advocacy and equity fields into an ecosystem of advocates who work together. What connections do you see between policy, advocacy, and health equity?

Views from the Field: Public Policy and the Equity Agenda

5 Responses to How Public Policy Advances Health Equity

  1. In response to the above (some excerpted items from my policy research) –
    While health equity and public policy matters are intertwined and one lens of analysis is in using john a. powell’s “targeted universalism” concept (#1) – there remains a much more needed justification in how such policies are formulated and implemented. John Rawls advocated the ‘Theory of Justice’ as “a public framework of thought – public reasoning” (#2). The policies mentioned in john powell’s paper that followed ‘universalism’, e.g., the ‘Social Security Act (1935)’ & ‘Interstate Highway Act (1956)’ were before ‘Social Justice Theory’ came to the forefront as a policy-making thought. Rawls’ theory was expanded further by Nobel Economist Amartya Sen‘s Development & Capability theory (#3). Prior to Rawls – policy making was governed more by ‘welfare’ and ‘utilitarian’ theories which were prone to ‘universalism’, as the example of “rising tide lifts all boats”’ shows that it doesn’t work well for those who have ‘leaky boats’ (#1).
    Health equity is a matter of social justice (#4 – a must-read) and *“targeted universalism” (TU*) needs more diligence in thought and implementation. TU* for policies has been used in global settings – United Nations (#5) and for development & poverty corrections (#6). TU* entails high administrative, transaction and political costs (#5, #6). Amartya Sen’s Capability Approach (#7) shows a way to attain development from adversities (disparities) with open transparency and trust in a social economy. In the health-related economy, two policy tools that use selective “targeting” to address health equity & disparity matters are Community-based participatory research (CBPR) and Culturally and Linguistically Appropriate Services (CLAS) Standards (see #8 & #9). In a given policy-making procedure, two questions may help answer its effectiveness & viability (#5) – in “substantive justice” (are the goals of a particular social policy just?) and in “procedural justice” (can the policy be carried out fair manner?). Without transparency & accountability, policy procedures fall short in answering those two questions and in turn, fall short in delivering social justice (#7).

    #1. powell, john a., Post-Racialism or Targeted Universalism

    #2. John Rawls – A Theory of Justice (a classic text on social & distributive justice)

    #3. Amartya Sen – Equality of What? (expands on Utilitarian, Welfarian & Rawlsian theories with development & capability approach)

    #4. Amartya Sen – Why Health Equity? in ‘Public Health, Ethics, and Equity’ (a must-read)
    Book review here –

    #5. Targeting and Universalism in Poverty Reduction (in United Nations’ policy making)

    #6. Amartya Sen – The Political Economy of Targeting (social justice in using targeting in policy-making)

    #7. Amartya Sen – ‘Development as Freedom’ (1999) – also emphasis on the need of open transparency & trust in a social economy.

    #8. In need of CLAS – my comments on the ‘Health Justice CT’ blog post underlying the importance of ‘TRUST’ & Open Transparency in public health policy and health equity. Also see #7.

    #9. Health Access vs. Health Equity: The Tale of the Tape – my comments on the ‘Health Justice CT’ blog post stating the critical participation of Community (in CBPR) in addressing issues of health equity & disparities and the moral hazards.

  2. Elizabeth says:

    Thanks for your comments SB. Mr. Armijo and I simply advocate for the increased use of policy tools and frameworks that can help advance health equity. We think targeted universalism is an important one, which is why we selected it for illustrative purposes with limited space, but it’s certainly not the only one and we appreciate that you’ve shared several others for readers interested in this topic.

  3. Amartya Sen (& the UN) policy implementations are more applicable for adversities (famine, poverty, etc) but underwent tremendous political costs (#5 & #6 above). @CTHealth and @ColoradoTrust are (non-govt) philanthropies with little, if any, political costs which gives it a better chance to implement policy-making successfully. My interests are also in how “procedural justice” can be better implemented by social enterprises and in certain cases, would include “substantive justice” as well. Currently, there are no unifying theories or frameworks which explains social enterprises in the context of public health (or healthcare). Thanks.

  4. UPDATE: ‘Social Entrepreneurship and Healthcare’ fits well with the framework of ‘Shared Health Governance’ (SHG). It was first introduced by Jennifer Prah Ruger in her book – ‘Health and Social Justice’ (see links below). In addressing the matters of Health Equity and Policy – one needs the foundation of ‘Social Justice Theory’ to put it in perspective for policy making & implementation (see #3 & #4 in my comments above).

    Health and Social Justice (a good textbook)

    ‘Shared Health Governance’ – more on the SHG framework

    Health and Social Justice (The Lancet overview)

    She was a student of Amartya Sen at Harvard and is currently a professor at Univ. of Pennsylvania’s Dept of Medical Ethics & Health Policy (link to her other works)

  5. Elizabeth says:

    Thank you for sharing some additional references and resources.

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