At the national and state levels, there is much lively debate on health reform, with a goal of improving the health care system as well as the overall health of individuals and communities. Many efforts are also underway in communities across Hawaii to create healthier environments and enable healthier individuals.

Yet even with all these efforts, there is an undercurrent of inequity that leaves people with lower income and less education at a significant disadvantage. Health inequities are unfair, avoidable, systematic differences in health status, morbidity and mortality rates, distribution of disease and illness rates across population groups.¹

Health Does Not Equal Health Care

It is easy to assume that health and longevity are greatly affected by health care, and in some cases this is true. However, the reality is that health care’s influence overall is relatively small. Much more powerful are social and economic conditions that are largely determined by government in its social and economic policies. Thus most social policies are directly and indirectly health policies, including policies and funding strategies for education, transportation, employment, housing, air and water quality and land use. Within communities, environmental factors such as safe and affordable housing and transportation, good air quality, fresh and nutritious food, and safe and accessible green space/recreational areas are increasingly being recognized as vital to good health.

Yet, people with lower socioeconomic status are disproportionately represented in neighborhoods with unsafe and unaffordable housing and transit, fast food outlets and liquor stores, pollution, and limited parks and green space. Research studies have documented the adverse health effects of these community conditions and the resulting stress from living in these environments.² Further, advocates are increasingly using these research findings to influence policymakers to address the root causes of inequities. In this context, consideration of access becomes not just a discussion of available health care resources but also one of community support.

To truly improve health outcomes, it is necessary to improve both access to health care and access to the neighborhood conditions and life opportunities that support healthy choices and good health.

Policy Principles

As we enter the 2011 Legislative Session, the following policy principles provide guidance and context for how policymakers can best address the root causes of health inequities.³

1. Embrace the concept of health in all policy. Because agriculture, transportation, education, housing, land use and economic policies all potentially influence population health, it is imperative to use health impact assessments to provide policymakers with the information they need to consider health in all policies.

2. Funding opportunities should focus on encouraging and supporting collaborative work across multiple sectors and disciplines.

3. Measure and monitor the impact of social policies on health, including monitoring health status by subgroups (race/ethnicity, income, education) and geographic location.

4. Give voice to groups that are the most impacted by social and health inequities through meaningful participation in identifying policies that will be effective.

5. Develop policies that will reduce stress on individuals and families and interventions to help individuals cope better with stress, as chronic stress increases vulnerability to a range of diseases.

6. Strengthen the social fabric of neighborhoods by connecting and supporting residents so that all have a sense of belonging, dignity and hope.