If you want to narrow health inequities, be bold. The most practical action you can take is not narrow incrementalism, but to spark wide-reaching initiatives to reduce U.S. socioeconomic, racial/ethnic, and gender inequalities while also promoting public health.
The evidence is in: Health inequities are the embodiment of social inequality. The shorter, sicker lives of people burdened by economic deprivation, discrimination, noxious jobs, and environmental pollution result from injurious political priorities, not individual failure.
But as our recent study on the fall and rise of U.S. health inequities demonstrates, these disparities are not inevitable. Between 1966 and 1980, socioeconomic and racial/ethnic inequities in U.S. premature mortality and infant death rates shrank in both relative and absolute terms. Thereafter, the relative gaps widened while the absolute gaps barely changed.
Why the difference? Policies and political courage. Propelled by popular mandates and movements for social justice, our government enacted, in 1963, the first Clean Air Act; in 1964, the Civil Rights Act, the Economic Opportunity Act, and Head Start (for low-income preschool children); in 1965, the Voting Rights Act, Medicare and Medicaid, and desegregation of federally funded health facilities; in 1968, the Fair Housing Amendment; in 1970, legislation establishing the Environmental Protection Agency and the Occupational Safety and Health Administration.
The result: reduced health inequities. In 1980, these policy trends reversed, as conservatives fought to shrink “big government”-at least in domestic programs, since military spending soared. The now-familiar fallout: deregulation of industry, promotion of “free trade,” slashing taxes on the wealthy, repeated freezing of the minimum wage, gutting of environmental and occupational protections, undermining of affirmative action, and de-investment in our nation’s social programs and public health infrastructure. Hence: worsening health inequities.
The lesson: Policies that put social equity and public health first can narrow health inequities. As a nation, we’ve reduced inequities before-and we can do it again.
The policy prescription? Jettison the neo-liberal and neo-conservative policies of the past quarter century. Re-prioritize reducing poverty. Promote insightful diplomacy, not reckless, horrific, wasteful wars (e.g., in Iraq). Spend 20 percent, not 1 percent, of U.S. health dollars on public health and prevention to address societal determinants of health. Support human rights and environmentally sustainable, equitable development. Establish single-payer universal health care. And above all: marshal the political will-and power-to unleash and fund existing and new innovative and impassioned efforts, federal to local, to promote health equity.