Why do some workers get paid sick leave, while 85% of food preparers have to choose between coming to work sick or losing a day’s wages? Why do fewer than 1 in 10 African Americans live in a census tract that has a supermarket, compared to almost one-third of whites? Why do we send drug offenders to jail when it’s cheaper and more effective to send them to treatment? How do these inequities affect health for all of us?
As HIP and others conduct innovative research that highlights the health issues inherent in all policy decisions, we are seeing an emergence of new public health professionals who are interested in Health Impact Assessment (HIA) and Health in All Policies (HiAP) research as tools to advance health and equity. In the first two years of HIP’s Health and Equity Fellowship, we have had 90 applicants from across the country, and with a diverse range of personal and professional backgrounds.
We asked Fabiola Santiago, who recently completed our first Health & Equity Fellowship: What advice do you have for emerging public health and HIA practitioners who are interested in health & equity research?
HIP’s Health and Equity Fellow is responsible for initiating and leading a new and innovative HIA or HiAP project that aims to advance the consideration of health and equity in decision-making. For my primary project, I led an HIA focused on proposed legislation to address wage theft, the nonpayment or underpayment of wages rightfully owed to employees.
In working on the wage theft HIA, I found that health and equity are still relatively new concepts for many organizations. Throughout this experience, I was simultaneously learning and teaching these concepts and the HIA steps. Patience is key. As someone with a strong background in social justice issues and an ardent inclination towards public health, the link between social determinants of health and health outcomes is evident to me, but it’s not necessarily explicit in research. Extra research is often needed to form predictions in areas where a health lens is not available. Budget additional time for each HIA step, and still expect delays.
During my fellowship, I also worked on a Health in All Policies project – the Local Control Funding Formula. This project involved a broad set of partnerships. I learned that each organization and individual may have a different agenda, some will be more equity focused, others more on health, and still others on other issues. Being mindful of these differences, yet staying focused on the overall goal can reduce confusion, but innovative ideas can emerge from the conversations. Communicating findings will generate more partnerships and garner more support in issue areas. Not everyone may use the same language, but the goals may be similar. Paying attention to these nuances has the potential to create new relationships.
For all the projects I worked on, I found it important to be flexible yet firm. As you embark on your project and especially while working with people and organizations you’re close to, it’s important to be flexible to their needs. But it’s also important to make sure that the project does not fall too far behind. Respect their feedback, incorporate their suggestions, but remember to value your professional expertise as well. As an emerging professional, it can be hard to make executive decisions, but it’s important to your development as a leader.
The purpose of the HIA is to first and foremost increase the consideration of health and equity in decision-making. However, if the HIA does not succeed in influencing decision makers, it does not mean it failed. Hearing, “Thanks so much for your work. I can’t believe we haven’t looked at how wage theft impacts health” is a sign that the overall purpose of the HIA is heading in the right direction. Additionally, when I conducted focus groups, seeing how candid participants were, and creating a space for them to vent was also a sign of success because it illustrated how much their working conditions impacted their daily lives.
Social determinants of health and community are key. Addressing health problems from their root causes will inevitably take longer, but in the long run will have a much greater effect. Changing the social determinants that influence people’s health has the potential to prevent and alleviate the most pressing health problems. Additionally, the field of public health must lead in elevating community voices—especially from those whom are most affected.