As states work to advance health equity, concurrent challenges such as workforce shortages, health care deserts, and disruptions in access to care and Medicaid coverage have hindered efforts to reduce health disparities. NASHP’s 2024 Annual Conference offered an opportunity for state health policymakers to learn about innovative strategies for advancing health equity initiatives, including building on lessons learned during the COVID-19 public health emergency and strengthening community partnerships to better address health-related social needs.
During a fireside chat, “Titans of Innovation and Health Equity,” panelists Kaitlyn Christian, chief engagement officer of the Indiana Management Performance Hub; Brooke Cunningham, commissioner of the Minnesota Department of Health; and Mona Zuffante, chief public health officer of the Winnebago Public Health Department in Nebraska, discussed promising agency and whole-of-government approaches to attain the highest level of health for their residents. The discussion was moderated by Chris DeMars, director of the Oregon Health Authority delivery system innovation office. Panelists highlighted strategies being implemented in their states and Tribal communities to use population health data, integrate cross-agency and social service partners in equity plans, and meaningfully engage communities in developing community-led solutions to health challenges.
Leveraging Data to Advance Health Equity Initiatives
As discussed in NASHP’s Healthy People Healthy States resource guide, many states benefit from access to high-quality population health data. Capturing and integrating data across health, social services, public safety, education, and workforce can be used to identify gaps in access and needs for certain services or interventions. In addition, publicly available data facilitates transparency around state efforts to advance health equity.
Indiana’s Equity Data Portal collects data from multiple agencies, which helps break down agency siloes and enables state leaders to view broad trends in data to inform policymaking. The data portal was developed by Indiana’s Management Performance Hub (MPH) in collaboration with agencies across state government, including the departments of Child Services, Health, Family Social Services Administration, State Police, Correction, Education, Higher Education, and Workforce Development, to track the state’s progress with addressing disparities. Since creating the portal, the MPH has presented findings to both public and private sector agencies to increase transparency around the intended uses of collected data.
Additional Indiana MPH projects showcase how multi-agency data can be used to identify gaps in services and develop targeted interventions. For example, the Fatal Drug Overdose Touchpoints dashboard, developed between the Indiana University School of Medicine, RTI International, multiple state agencies, and the Governor’s Drug Prevention, Treatment, and Enforcement Office, displays real-time interactions with state systems that occur prior to a fatal overdose. The dashboard is intended to provide state agencies and county Overdose Fatality Review Teams with timely population-level data from multiple sources to help identify opportunities to deliver harm-reduction services or engage individuals at risk for overdose in evidence-based treatment.
“Health Policy Is Social Policy, and Social Policy Is Health Policy”: Adopting a Whole-of-Government Approach to Health Equity
Some state approaches to advance health equity include transformative whole-of-government strategies to encourage cross-agency or system-wide collaboration in establishing policies and practices that address health disparities.
Minnesota’s reforms highlight a state approach that uses common vision across the state enterprise to incorporate an equity lens in multiple agencies. In 2022, the Minnesota Department of Health (MDH) created its Health Equity Bureau, which functions as a network hub of information, technical assistance and training, resources, and leadership across MDH and the state. The bureau has supported the development of policies and programs that address health-related social needs led by various agencies. For example, the Minnesota Debt Fairness Act, which was enacted in June 2024, contains provisions that reform medical debt collection.The Act will be implemented by the Minnesota Attorney General’s Office, MDH, and the Minnesota Department of Commerce. The state Department of Education has implemented the Free School Meals program, which provides state reimbursement to schools that participate in the National School Lunch Program and the School Breakfast Program. The state Office of Higher Education facilitates the North Star Promise program, which provides free college tuition for all state and Tribal colleges and universities. In addition, Minnesota has created an Interagency Council on Homelessness, which includes commissioners of 15 agencies, including MDH, who lead the state’s efforts to advance housing, health, and racial justice for people experiencing homelessness. In addition to social programs, Minnesota’s health equity strategy includes expanding access to care and health insurance coverage. For example, beginning in January 2025, MinnesotaCare will expand eligibility to undocumented residents who meet income requirements.
Building Partnerships and Trust with Communities to Inform Health Equity Initiatives
As states work to address disparities, strengthening ongoing partnerships with local communities is key to establishing successful interventions. Ongoing dialogue and partnership with affected communities can provide policymakers with input and feedback on impactful strategies to meet community needs, including where resources can most effectively support culturally informed and community-led interventions.
Culturally inclusive engagement with communities builds trust and facilitates the development of partnerships with local leaders and organizations, which play an important role in addressing disparities. For example, the Minnesota Department of Human Services (DHS) worked with the state’s U.S.-born Black community to develop recommendations included in its 2022 report on Building Racial Equity into the Walls of Minnesota Medicaid. To ensure recommendations highlighted community strengths and community-focused opportunities to build racial equity, DHS hosted public Community Conversations and met with leaders of community-based organizations and community partners working to advance racial equity in health care. Following the report’s publication, Governor Tim Walz’s 2023 budget contained several legislative proposals that aligned with the recommendations. These reforms included extensions of continuous Medicaid coverage for children, increased investment in enrollment navigators, and decreased barriers for doulas paid by Medicaid to practice independently. MDH is committed to continuing to engage with communities to inform its work and will release a 10-year anniversary report on progress made to advance health equity in the state, with the aim to build trust through transparency and accountability.
Panelists also noted that growing and maintaining progress with health equity strategies requires funding support, particularly to ensure that state agencies retain cultural competencies when communicating with diverse communities. For example, in Minnesota, MDH is prioritizing the maintenance of equity-driven offices, programs, grant opportunities, and diverse workforce with support from other funding sources as COVID-19-related funding. MDH is using Public Health Infrastructure Grant funding to support its health equity strategy and maintain the integration of health equity goals in the department’s strategic plan.
Honoring Cultural Traditions to Promote Health and Well-being
The sovereign Winnebago Tribe of Nebraska operates its own Comprehensive Healthcare System and Public Health Department, which centers cultural traditions and beliefs in its work.
The department takes a community-focused approach to health and wellness, in which Tribal community members are engaged to inform the provision of services. For example, the department routinely hosts public forums to allow community members to share their health needs and concerns. These discussions, and the department’s programs overall, are culturally inclusive and feature certain cultural practices, such as opening a meeting with prayer, that are valued by the community. The department has also used the Indigenous Social Determinants of Health and the Kansas Health Institute Health Impact Checklist to inform its outreach and programs. In addition, the department conducts its own Community Health Assessments and Community Health Improvement Plans, Behavioral Risk Factor surveys, and Youth Risk Behavior Surveys. This research has supported outreach to high-need populations that include older adults; the LGBTQ+ and Two-Spirit population; youth; and individuals with diabetes and substance use disorders.
Looking Ahead
As states move forward with their health equity goals, they continue to face ongoing challenges that exacerbate health disparities. State health policymakers want to coordinate — between agencies and with affected communities — to maintain and build on recent progress made to identify unmet needs and opportunities for culturally inclusive outreach and programs. States are also looking to identify sustainable approaches to preserve and grow equity-driven systems, policies, and programs. The strategies discussed here provide examples of agency and whole-of-government approaches.
NASHP will continue to support state officials seeking to learn about and promote emerging strategies and best practices used to advance health equity. Learn more about NASHP’s Equity and Health Disparities policy work on NASHP’s website.
