Promoting Health Equity: A New Challenge for Frontiers in Public Health

Abstract

Public Health Education and Promotion, a new section of the journal Frontiers in Public Health, provides a refreshing forum for those readers who have traversed the familiar landscape of near-intractable health inequities on a national and global level and desire new knowledge on how best to ameliorate health inequities and the social factors that perpetuate them. The new “frontier” in public health hopefully heralds an era of increased and appropriate resource allocation for interventions that improve public health education and consequently begins to shift the needle toward health equity. This article highlights a series of approaches that, asserting an ecological model, can promote and sustain health equity by: • Providing an easily accessible repository of public health data and health information that promotes health literacy at a population level. • Elevating public health research on health equity, aligning it with the best clinical and clinical translational research at leading institutions. • Identifying strategies to ameliorate health inequity, primarily by promoting evidence-based, public health pedagogy in all institutions of higher education while advocating for the development of a diverse public health workforce. Poor health literacy has been strongly linked to health disparities (1– 4). Health literacy is defined in the Institute of Medicine (IOM) report Health Literacy: A Prescription to End Confusion as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (5). Health literacy goes beyond a narrow concept of health education and individual behavior-oriented communication and addresses the environmental, political, and social determinants of health. The body of health literacy research and practice has expanded remarkably in the past decade; however we are still in the nascent stages of understanding the interface between health literacy and public health. Kristen Sorenson and colleagues offered a conceptual framework that integrates the “medical” conceptualization of health literacy with the broader “public health” perspective (6). Their model illustrates the necessary interface between disease promotion and social determinants to address public health literacy, with the individual health promotion found in traditional health literacy. It is now incumbent upon leading scientific journals to provide concrete examples of how health literacy approaches can be used to improve community and population health and reduce health disparities. Readers will have the opportunity to review the current field of public health literacy and health disparities in more detail in a forthcoming edition of this journal. Public health education research needs to be funded at a level commensurate with the urgency to reduce the burden of chronic diseases and health inequity worldwide, and Public Health Education and Promotion has to be at the forefront of disseminating that research to a broad audience. Public health education research has to specifically address the socioeconomic, environmental, and behavioral determinants of disease (7), which has to occur in a collaborative manner among the leading academic medical centers, schools of public health, and institutions such as the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC). The Affordable Care Act (8) recently ushered in a new level of research collaboration through the establishment of the Prevention and Public Health Fund, which has invested substantially in evidence-based activities including research. According to the Department of Health and Human Services, the CDC has continued support for its Prevention Research Centers program (9). This effort directs a national network of 37 academic research centers, at either a school of public health or a medical school with a preventive medicine residency program. The centers are committed to conducting prevention research and are leaders in translating research results into public health practice. These centers have rich capacity for the community-based, participatory prevention research needed to understand the major community changes that can prevent and control chronic diseases. The Agency for Healthcare Research and Quality (AHRQ) has also established Centers for Excellence in Clinical Preventive Services in Illinois, North Carolina, and Colorado which support the HHS National Prevention Strategy by developing evidence around the most efficient and effective ways primary care health systems can deliver clinical preventive services (10). These and other examples of community-based participatory prevention research should be extensively highlighted to promote more widespread adoption. As outlined by the CDC and the NIH Institute for Minority Health, the future health of the nation will be determined to a large extent by how effectively we work with communities to eliminate health disparities among those populations experiencing a disproportionate burden of disease, disability, and death (11). Nonetheless, health professional schools have produced a practitioner workforce more educated in specific disciplines and lacking in formal public health training. In September 2010 the Association of American Medical Colleges (AAMC) and the CDC sponsored a workshop (12), “Patients and Populations: Public Health in Medical Education” which provided a framework for integrating public health content into medical school curricula. It is timely that schools of medicine and allied health provide members of the future physician workforce the knowledge, skills, and attitudes to address health disparities in partnership with community health and public health workers. Unquestionably, a reduction in health disparities will require more interdisciplinary approaches, with a more active interface between public health programs and health professional schools, coupled with a systematic approach that aligns governmental and non-governmental agencies to specifically address health equity. Indeed, the resolution of this country’s persistent health inequities is intrinsically linked to enhanced instruction in public health in our schools of medicine, public health, and allied health (13, 14). Such comprehensive health disparities curricula have been infrequent in contemporary health professional schools and organizations (15). The Liaison Committee for Graduate Medical Education (LCGME) adopted standards for cross-cultural education as early as 2002 (16), and both the AAMC and IOM (17, 18) have provided recommendations for health disparities education. However, health disparities curriculum in health professional schools may fail to evaluate knowledge, skills, and attitudes over time and are less likely to be linked to improved patient heath status and greater community benefit. While there is continued interest in courses on healthcare delivery and healthcare systems, there may be less in other appropriate areas like occupational health and medicine. Health policy development is required in J Gen Intern Med (2004) 19:1228–39. doi:10.1111/j.1525-1497.2004.40153.x Pubmed Abstract | Pubmed Full Text | CrossRef Full Text 2. Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetic outcomes. JAMA (2002) 288:475–82. doi:10.1001/jama.288.4.475 Pubmed Abstract | Pubmed Full Text | CrossRef Full Text 3. Williams MV, Baker DW, Honig EG, Lee ML, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. 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Culture, illness and cure: clinical lesions from anthropologic and cross-cultural research. Ann Intern Med (1978) 88:251–8. doi:10.7326/0003-4819-88-2-251 CrossRef Full Text 27. Flexner A. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching, Bulletin No. 4. Boston, MA: Updyke (1910). Keywords: health equity, medical education, public health workforce, health literacy, diversity Citation: Ross WR (2013) Promoting health equity: a new challenge for Frontiers in Public Health. Front. Public Health 1:27. doi: 10.3389/fpubh.2013.00027 Received: 22 July 2013; Accepted: 02 August 2013; Published online: 23 August 2013. Edited by: Reviewed by: Copyright: © 2013 Ross. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. *Correspondence: rossw@wusm.wustl.edu