Many states are transforming their health care delivery systems to improve health and control costs. Reducing health disparities – and addressing their social and economic causes – is at the heart of many of these efforts.
Health equity means everyone has an equal opportunity to live a long and healthy life regardless of race, ethnicity, gender, income, neighborhood, education, or any other social condition.
Despite its high price tag, the majority of health care spending ignores critical determinants of health, including social and economic factors, the environment, and health behaviors. By increasing health equity, states can achieve improved, long-term health outcomes.
The following resources showcase effective state efforts to achieve health equity, improve care, and prioritize the social determinants of health. To suggest a resource or share your state’s efforts, contact Elinor Higgins.
Tools
Racial and Ethnic Disparities
- States Address Racial and Ethnic Disparities in their COVID-19 Responses and Beyond, March 2021.
As communities of color have been disproportionately affected by COVID-19, states are working to prioritize equity in their response and recovery efforts. This blog features equitable approaches states are using to address the effects of the COVID-19 pandemic today and in the future. - How States Collect Data, Report, and Act on COVID-19 Racial and Ethnic Disparities, 2020-2021. The racial inequities exposed by COVID-19 case and death rates can guide states as they target testing initiatives and vaccination clinics to address health inequities in communities of color. This map details which states are using race and ethnicity data when reporting infections, deaths, and vaccinations.
- Guest Blog: Massachusetts Attorney General Issues Recommendations to Address Health Inequities, December 2020. To showcase what states are doing to address health disparities that the COVID-19 pandemic has laid bare, NASHP highlights state initiatives through reports and guest blogs, such as this one by Massachusetts Attorney General Office Health Care Analyst Noam Yossefy and Assistant Attorney General Sandra Wolitzky. The blog highlights the state’s recommendations to achieve racial justice and equity in health.
- States Build Infrastructure to Advance Equity in their COVID-19 Responses and Beyond, December 2020. New state approaches to health equity are critical first steps toward identifying and addressing systemic issues of discrimination, structural racism, and health care under-service that have led to COVID-19 disparities and developing informed policies that advance equitable solutions. This blog describes state actions during the COVID-19 pandemic.
- New Tool Helps States Assess Hospital Community Benefit Spending on Health Equity, November 2020. As state budgets tighten due to the COVID-19 pandemic, it is more critical than ever for states to ensure that the tax exemptions hospitals receive for their community benefit contributions are yielding genuine value to communities. This new NASHP tool helps states gather detailed information from hospitals in order to assess their community benefit expenditures and programs.
- States Work to Advance Racial Equity in COVID-19 Outcomes and Beyond, October 2020. The COVID-19 pandemic drives home the need for states to re-assess work on advancing racial equity and to redirect efforts to be more effective. States are focusing on the equitable distribution of resources and funding to promote health and safety for all during the pandemic. Some states are also beginning the long-term work of addressing systemic racism and other root causes of the disparities illuminated by the pandemic.
- NASHP Slide Deck Helps Policymakers Understand the Health Care Cost Conundrum, October 2020. This slide deck shares facts about the cause and impact of rising health care costs. It provides a straightforward, easy-to-understand overview to help inform policymakers and make the case for action. It is designed to prompt discussion around several questions, including: What if states could dedicate some of the resources now going towards direct health care costs to other priorities, such as investing in social determinants of health or working to achieve health equity?
- State Strategies to Address the Black Maternal Health Crisis, October 2020. States have developed several strategic approaches to address severe racial disparities in maternal health outcomes – currently Black women are four-times more likely to die from pregnancy-related causes than White women. This blog explores those states’ strategies, including workforce development, data collection, and quality improvement initiatives, to improve the overall health and well-being of women and newborns.
- How Supported Employment Can Address Mental Health Inequities in Minority Populations: Five States’ Experiences, December 2018. This issue brief examines state supported employment programs and implications for addressing health disparities in mental illness.
- State Immunization Services and Policies, December 2018. The National Academy for State Health Policy (NASHP) has compiled resources that address disparities in access to immunizations for pregnant women and children.
- NASHP Identifies State Strategies to Address Mental Health and Education Inequities, November 2017. This blog describes interviews with state health officials on the impact of various interventions and their effort to reduce mental health disparities.
- Addressing Inequities through Innovations in Oral Health Policy, January 2017. This blog addresses disparities in oral health and various state initiatives to increase effective, equitable systems of care.
- In the Zone: State Strategies to Advance Health Equity by Investing in Community Health, June 2016. This chart compares goals, methods funding sources, and governing structures of initiatives in four states developed to address health equity and population health.
- State Policymakers’ Guide for Advancing Health Equity through Health Reform Implementation: Summary, August 2012. This issue brief outlines various state policy levers to advance health equity as well as opportunities for state and federal collaboration on these efforts.
- Using Report Cards to Measure Racial and Ethnic Health Disparities: State Experience, September 2011. This issue brief focuses on New Mexico’s efforts to measure racial and ethnic health disparities through “report cards.”
- Assessing the Costs of Racial and Ethnic Health Disparities: State Experience, June 2011. This issue brief describes the strategies and resources Virginia and Rhode Island used to measure the costs of health disparities on their populations.
- State Documentation of Racial and Ethnic Health Disparities to Inform Strategic Action, March 2011. This report summarizes how states analyze data in strategic plans and reports aimed at reducing racial and ethnic disparities in health status and health care.
- Federal State Discourse to Promote a High-Performance Health System. These slides offer background information, financing strategies, and state models for promoting health equity through delivery system reform.
- Infant Mortality Policy fact sheet from NASHP’s Toolkit: Upstream Health Priorities for New Governors, December 2018. This document describes resources and policy tools to reduce infant mortality, as well as specific policy evidence and resources for state leaders.
State Models
- Michigan Medicaid Addresses Social Determinants of Oral Health through Dental and Medical Contracts, January 2021. Inequities in dental care are prevalent across the United States, with oral health outcomes largely influenced by social determinants of health (SDOH), such as food insecurity and socioeconomic status. In response, Michigan’s Medicaid managed care contracts now require medical and dental plans to address SDOH among enrollees.
- How New York Is Safeguarding Pregnant Women during the COVID-19 Pandemic, November 2020. Months into the COVID-19 pandemic, studies show pregnant women – especially women of color – are at increased risk for severe illness from COVID-19 compared to non-pregnant individuals. New York’s COVID-19 Maternity Task Force and its Department of Health have implemented policies and programs to improve women’s outcomes and address disparities during the pandemic.
- NASHP Roundtable: Georgia and Illinois Work to Improve Maternal Health Outcomes, November 2020. In partnership with the Blue Cross Blue Shield Association, NASHP convened state officials to discuss initiatives to improve maternal health outcomes for Medicaid enrollees and address racial disparities. Illinois and Georgia officials highlighted their strategies, including extending Medicaid postpartum coverage for women beyond the current 60-day period.
- States Guide the Governance of Accountable Health Entities to Promote Community Health and Engagement, April 2019. This NASHP blog examines strategies for governing accountable health models to improve population health and health equity while addressing community and state priorities.
- Oregon’s Accountable Health Model Addresses Health Equity and Health-Related Needs: Four Lessons from CCO 2.0, March 2019. This NASHP blog describes Oregon’s strategy for addressing health-related needs and health equity through its Coordinated Care Organizations’ contracts.
- How Supported Employment Can Address Mental Health Inequities in Minority Populations: Five States’ Experiences, December 2018. This issue brief examines state supported employment programs and implications for addressing health disparities in mental illness.
- NASHP Identifies State Strategies to Address Mental Health and Education Inequities, November 2017. This blog describes interviews with state health officials on the impact of various interventions and their effort to reduce mental health disparities.
- Addressing Inequities through Innovations in Oral Health Policy, January 2017. This blog addresses disparities in oral health and various state initiatives to increase effective, equitable systems of care.
- Moving the Needle on Health Outcomes: State Strategies for Advancing Health Equity, December 2016. This blog describes three approaches to addressing health equity through state policy.
- In the Zone: State Strategies to Advance Health Equity by Investing in Community Health, June 2016. This chart compares goals, methods funding sources, and governing structures of initiatives in four states developed to address health equity and population health.
- State Policymakers’ Guide for Advancing Health Equity through Health Reform Implementation: Summary, August 2012. This issue brief outlines various state policy levers to advance health equity as well as opportunities for state and federal collaboration on these efforts.
- Using Report Cards to Measure Racial and Ethnic Health Disparities: State Experience, September 2011. This issue brief focuses on New Mexico’s efforts to measure racial and ethnic health disparities through “report cards.”
- Using Geographic Information to Target Health Disparities: State Experience, September 2011. This issue brief outlines Rhode Island and Virginia’s data collection techniques and Geographic Information Systems (GIS) to track race and ethnicity data and reduce disparities.
- Assessing the Costs of Racial and Ethnic Health Disparities: State Experience, June 2011. This issue brief describes the strategies and resources Virginia and Rhode Island used to measure the costs of health disparities on their populations.
- State Documentation of Racial and Ethnic Health Disparities to Inform Strategic Action, March 2011. This report summarizes how states analyze data in strategic plans and reports aimed at reducing racial and ethnic disparities in health status and health care.
- Federal State Discourse to Promote a High-Performance Health System. These slides offer background information, financing strategies, and state models for promoting health equity through delivery system reform.
- Q&A: How Rhode Island Tackles Social Determinants of Health through its Accountable Entity Model, November 2018. This blog describes Rhode Island’s Accountable Entity (AE) Program, designed to encourage Medicaid managed care organizations (MCOs) and providers to deliver more cost-effective care through value-based payments, improve coordinated care delivery, and focus on population health.
- How States Address Social Determinants of Health in their Medicaid Contracts and Contract Guidance Documents, August 2018. This chart examines Medicaid contracts and contract guidance documents in 11 states to highlight each state’s efforts to address social determinants of health, such as housing and employment.
- The Roadmap Ahead: New York’s Value-Based Payments Reward Communities and Providers for Addressing the Social Determinants of Health, June 2018. This blog describes how New York rewards Medicaid providers and community-based organizations for addressing social and economic impacts on health.
- States Develop New Approaches to Improve Population Health Through Accountable Health Models, January 2018. This issue brief highlights policy levers, performance measurement strategies, and sustainable financing options that ten states use to support accountable health structures to promote population health and increase health equity.
- Community Health Worker Resources for States, November 2017. NASHP compiled a list of resources that support state efforts in incorporating community health workers into their health and health equity improvement work
Social Determinants of Health
- The State of the States: Amid the Pandemic, Governors Tackle Health, Social, and Economic Issues, March 2021. This chart and blog identify a wide range of health, social and economic issues raised by governors in their 2021 state of the state addresses.
- With CDC Eviction Ban Extended One Month, States Step Up with Additional Protections, January 2021. This blog details how states are stepping up to provide additional protections to landlords and renters through rent relief programs and some governors are issuing executive orders extending bans on evictions.
- States Address Social Determinants of Oral Health in Managed Care Contracts, November 2020. Inequities in oral health and health outcomes are driven by social determinants of health (SDOH), including diet, education, transportation, and access to care. A growing number of states are working to improve the health of their Medicaid enrollees and reduce costs by addressing these social determinants in their managed care contracts. This map and blog highlight key findings in dental contracts and potential opportunities for states to leverage medical contract SDOH language in dental contracts to support oral and overall health.
- NASHP: Six Slides to Help State Legislators Improve Health, May 2019. Eighty percent of what affects health – such as housing, education, and income – is beyond the reach of clinical care, yet drives those costs higher. These six slides can give state legislators insights into what they need to know to promote prevention, ease health care costs, avoid lost productivity, and make their states among the healthiest.
- Oregon’s Accountable Health Model Addresses Health Equity and Health-Related Needs: Four Lessons from CCO 2.0, March 2019. This NASHP blog describes Oregon’s strategy for addressing health-related needs and health equity through its Coordinated Care Organizations’ contracts.
- State Immunization Services and Policies, December 2018. The National Academy for State Health Policy (NASHP) has compiled resources that address disparities in access to immunizations for pregnant women and children.
- Six Slides to Help New Governors Improve Health, November 2018. Transition teams can use this snapshot of health policy issues to incorporate critical health equity issues into their agendas.
- Infant Mortality Policy. This document describes resources and policy tools to reduce infant mortality, as well as specific policy evidence and resources for state leaders.
- Q&A: How Rhode Island Tackles Social Determinants of Health through its Accountable Entity Model, November 2018. This blog describes Rhode Island’s Accountable Entity (AE) Program, designed to encourage Medicaid managed care organizations (MCOs) and providers to deliver more cost-effective care through value-based payments, improve coordinated care delivery, and focus on population health.
- How States Address Social Determinants of Health in their Medicaid Contracts and Contract Guidance Documents, August 2018. This chart examines Medicaid contracts and contract guidance documents in 11 states to highlight each state’s efforts to address social determinants of health, such as housing and employment.
- The Roadmap Ahead: New York’s Value-Based Payments Reward Communities and Providers for Addressing the Social Determinants of Health, June 2018. This blog describes how New York rewards Medicaid providers and community-based organizations for addressing social and economic impacts on health.
- States Develop New Approaches to Improve Population Health Through Accountable Health Models, January 2018. This issue brief highlights policy levers, performance measurement strategies, and sustainable financing options that ten states use to support accountable health structures to promote population health and increase health equity.
- Community Health Worker Resources for States, November 2017. NASHP compiled a list of resources that support state efforts in incorporating community health workers into their health and health equity improvement work.