The National Academies of Sciences (2017) defines structurally-driven health disparities as those brought about by “the dimensions of social identity and location that organize or structure differential access to opportunities for health including race, ethnicity, gender, employment and socioeconomic status, disability and immigration status, geography, and more.” Fortunately, many of these inequities are remediable. When a society is committed to health equity as a common value, people work together to ensure that everyone, regardless of race, neighborhood, or financial status, has fair and equal access to a healthy community of opportunity (PolicyLink, 2020). Extension is well positioned to serve as a catalyst for community-based efforts to address inequities. Doing so, however, will require a shift in Extension’s strategic direction, but it is one that is long overdue and one that is critical to continue growing Extension’s role in community health prevention and promotion. This new direction will require greater flexibility in the traditional Cooperative Extension model, with greater ability to see and do our work differently than in the past. The 2014 Framework acknowledged the importance of equity in shaping the health and well- being of individuals and communities but did not name it as a focus area for Extension’s health related work. By naming health equity as a core theme, Cooperative Extension moves from treating equity issues as an unfortunate contextual given to actively addressing the conditions that create them.
Definitions of Health Equity
Numerous definitions of health equity exist in the literature. For example, the Robert Wood Johnson Foundation argues that that health equity exists only when “everyone has a fair and just opportunity to be as healthy as possible.” The Centers for Disease Control and Prevention operate from the premise that health equity is a state in which “everyone has the opportunity to attain their full health potential, and no one is disadvantaged in achieving this potential because of social or any other socially-defined circumstances.” The World Health Organization expands upon these definitions characterizing health equity as the “absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification.” Any individual is an amalgamation of a multitude of individual identities that include race, class, ethnicity, ability, gender identity and expression, sex, weight, veteran, marital, and documentation status. Society has enacted a system of laws, policies, norms, and expectations that intentionally or unintentionally allow differing access to resources and opportunities based on these identities. In this context, Extension’s work to advance health in communities through education and behavior change is incomplete when not coupled with a commitment to eliminating barriers to health that these laws, policies, norms, and expectations present. Rurality and its Relationship to Inequities Health trends are showing that non-Hispanic white people living in rural areas are experiencing smaller declines in deaths from cancers and cardiovascular diseases and larger increases in deaths from metabolic, respiratory, alcohol-related, mental and behavioral diseases, and suicides as compared to urban areas. But mortality rates for cancer and cardiovascular disease among Black, Indigenous, and Latinx populations have decreased at an even slower rate than 9
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