The outer ring of the diagram lists many of the root causes of structural inequity . The list, however, should not be viewed as exhaustive of all of the root causes of inequity. But when decision makers use their power to establish norms, policies, and practices through the lens of racism, for example, people of color may systematically be denied access to the resources and services which support lifelong health and well-being. These resources and services are more commonly referred to as the social determinants of health. This framework incorporates the nine social determinants of health identified by the National Academies of Science, Engineering, and Medicine (NASEM, 2017). Access to healthy food was added as a tenth determinant because of its centrality to the work of Cooperative Extension. The work of Cooperative Extension focuses first on identifying the health inequities which may exist in a given community. Cooperative Extension then works through two major streams of activity in its efforts to improve health. The first stream is through promoting healthy behaviors though communication and education. This work can be focused on either the general population or on groups experiencing inequities in health outcomes. The second stream involves working with and through coalitions to create healthy communities. The work of these coalitions frequently focuses on addressing the social determinants of health which are barriers to achieving optimal health. Together this work focuses on the dual goals of improving population health and achieving equity in health status. The “fin” attached to the left of the ovals lists the five high-level recommendations that Cooperative Extension System must implement if it to be effective in achieving the dual goals.
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