Extension's National Framework for Health Equity

Racism as Driver of Inequity

More recently, racism is increasingly being elevated as a dimension of social identity that deserves increased attention at this current point in time. At the time of writing, more than 30 states have declared racism as a public health crisis or emergency. However, it is important to frame racism not as a social determinant of health that is randomly distributed, but rather, as a fundamental cause that drives establishment of norms,

policies, and practices that influence the social determinants of health. That is, many social

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determinants of health would be less influential if racism were eliminated. According to Hardeman and Karbeah (2020) “structural racism encompasses (a) history, which lies underneath the surface, providing the foundation for white supremacy in this country; (b) culture, which exists all around our everyday lives, providing the normalization and replication of racism; and (c) interconnected institutions and policies which key relationships and rules across society providing the legitimacy and reinforcements to maintain and perpetuate racism.” Cornell Health (2020) suggests that “framing racism as a public health issue compels organizations and governmental units across the country to address the crisis in the broad, systemic ways that other threats to public health have been addressed over time. These can include strategic initiatives in policies, practices, enforcement, education, and support services.”  Racism and Health

Recognizing Inequities

Unfortunately, many community health assessments are done at the county level and lack the granularity needed to identify those communities experiencing the poorest health outcomes. In a sense, these assessments actually mask health inequities that may exist within a county. To ensure that interventions are tailored to unique needs of communities bearing the greatest health burdens, is necessary to examine health by census tract or zip code. CDC’s Places: Local Data for Public Health allows local Extension faculty and staff to access health outcome data at the census tract level and actually visualize disparities. Using such information to drive resources to specific such communities are called precision approaches.

Targeted Universalism

Addressing inequities will require that Cooperative Extension help communities identify measurable health goals that everyone should be able to achieve. A community can then work with a disciplined focus on identifying obstacles to achieving those goals, calling attention to the inequities, and committing resources toward closing the gaps which exist. This approach is more commonly referred to as targeted universalism (Powell, et al, 2019). The goal of this approach is to ensure that no one is disadvantaged in achieving their full health potential. Learn More  Targeted Universalism


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