State Policy Options
Given the various determinants of health and interactions among the factors that influence health disparities, no single policy solution exists to address or eliminate them all. Experts recommend pursuing multiple angles, including policies both in and outside of the health care arena, and considering a combination of policies and strategies to address various determinants. Policymakers seeking to address health disparities may wish to consider the following strategies to determine the most appropriate policies for their states.
Address Barriers in Access to Care
Examine factors leading or contributing to disparities in access to care, such as lack of insurance coverage and challenges navigating the health care system. Consider strategies to remove barriers or pilot new models of paying for and delivering care that address disparities. These state strategies may include supporting community health centers or other facilities reaching underserved communities, using telehealth as a way to improve access and extend providers’ reach, and promoting the use of community health workers or navigators to support patients. In addition, patient-centered medical homes, which aim to improve coordination of care, may help address social determinants of health.
Examine Health Care Workforce Needs and Consider Ways to Develop the Workforce
Evaluate backgrounds and languages spoken among the existing health care workforce and how those align with the communities being served. In addition to the health care workforce (whose members typically serve individuals), consider examining public health workers (those who focus on community and population health, such as through health screenings and immunizations). Assess other gaps in the workforce, such as geographic distribution or number of Medicaid providers in the community. Look at ways to address gaps and strategies that may fit the state’s needs, such as cultural and linguistic competency standards, recruitment and retention efforts, and pipeline programs for students from underserved communities. For example, the South Dakota Department of Health offers health care providers multiple trainings, webinars, continuing education and self-assessment materials on health equity and cultural competency.
Support Data Collection Efforts and Use Data to Analyze Needs
Work with state officials in public health, minority health, rural health and Medicaid offices when possible to learn more about existing data collection efforts and data needs within the state. Consider ways the state can support data collection around gaps in health care, health care workforce shortages and disparities experienced by specific populations. Use existing data to focus state efforts and resources. For example, the Maryland General Assembly passed legislation in 2004 to establish the Office of Minority Health and Health Disparities, which is active in sharing minority health trend data with stakeholders and engaging minority populations in state health programs.
Convene Stakeholders and Support Partnerships Across Sectors
Collaborate with other stakeholders to discuss health disparities in the state, current activities and ways to leverage efforts and existing funding mechanisms. Involve nongovernmental groups, community- and faith-based organizations, schools and other sectors outside of health to promote innovative solutions. Reach out to people who are experiencing the greatest health disparities to ask about their barriers and challenges and involve them in discussions about strategies. Connecticut’s Office of Health Equity, for example, established the Connecticut Multicultural Health Partnership in 2008. This partnership between the state department of public health and public and private partners in the community facilitated work to identify and address health disparities. Similarly, Alabama’s Office of Minority Health strives to engage diverse communities to promote minority presence and participation in health planning and policy formation.
Consider Disparities Using a Social Determinants of Health Lens
Analyze the external factors in the social, economic and environmental landscape that may affect health and health disparities in the state. For example, look at health disparities that exist within the context of other factors like education and income. Along these lines, the 2020 Health Improvement Plan published by the Oklahoma Department of Public Health focuses significantly on how social determinants of health shape the state’s health disparities. Consider policies that may address social determinants as a way to improve health for communities experiencing disparities. Colorado’s Office of Health Equity is charged with implementing strategies to address the varying causes of health disparities, including the economic, physical and social environment.
State Policy Actions
In recent years policymakers have recognized the disparities experienced by various populations and related financial costs to the health care system and state. A 2017 report by NCSL highlights different state actions regarding health disparities legislation related to:
- Improving access to health care services.
- Increasing health care workforce diversity and cultural competency.
- Addressing disparities in chronic disease and other health conditions racial and ethnic minorities experience.
- Supporting task forces, committees or research focused on health disparities.
- Addressing social determinants of health.
In the wake of COVID-19, and the evidence highlighting health disparities among historically under-served populations, several states have changed data reporting requirements, increased equitable access to referral systems, required different state executive branch agencies to study, update and implement policies that address health disparities where applicable, and issued executive orders and declared racism a public health crisis.
A compilation of recent health disparities legislation is in the process of being updated.
Please note that NCSL takes no position on state legislation or laws mentioned in linked material, nor does NCSL endorse any third-party publications; resources are cited for informational purposes only.
Health disparities are the culmination of a complex array of factors and determinants. Policy can play a key role in addressing its systemic reach in society. While the health care field has traditionally served as the primary setting for policy solutions, aligning other community stakeholders or community resources to create a framework for addressing social determinants of health is key. Eliminating health disparities will likely require a cohesion of multiple strategies, but successful efforts have the potential to increase life expectancy, quality of life and reduce health care spending by millions of dollars.
