Connecting the Dots: Health Inequities, Power, and the Potential for Public Health’s Transformational Role
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By Jonathan Heller
Across the country, public health has been moving its practice further and further upstream to address the root causes of health inequities. Over the last decades, we’ve evolved from a focus on behaviors to a focus on the social determinants of health.
More recently, many have been exploring how various forms of oppression — and specifically racism — impact health and health equity. Now, some health departments are strategizing about the root of the root causes: power.
Health inequities are systemic, avoidable and unjust health outcomes resulting from inequities in the social determinants of health. Inequities in the social determinants of health, in turn, result from power imbalances and forms of structural oppression (racism, sexism, ableism, classism, hetero-sexism) used to maintain them.
Simply defined, power is our ability, as individuals and as communities, to produce an intended effect.
Those who have power in society benefit from the status quo and often use that power to perpetuate social and health inequities (sometimes without explicitly understanding we’re perpetuating these imbalances).
We can and must help build power in communities that have long suffered from disenfranchisement — and consequently health inequities — in order to advance equity.
Below are 4 examples of health inequities and their relationship to power imbalances — including examples where public health could do more transformational work and an example where public health has actively participated in policy change for equity. For each, we describe the health inequity, one social determinant of health that leads to the inequity (though we recognize that there are almost always multiple social determinants of health that lead to each of these), the power imbalance, and what public health’s role is currently and could be.
