Pursue Policy Changes that Transform the Root Causes

How public health departments can affect policy changes that transform power imbalances and structural oppression

Power imbalances and structural oppression are the root causes of health inequities. They shape the social, political, economic, and environmental conditions that pattern and drive inequities in the social determinants of health. Thus, to eliminate inequities and effect transformative change, public health departments need to pursue policies that change these underlying structures. Additionally, their policy agendas need to align with the priorities of those most impacted by inequities and the community power-building organizations (CPBOs) organizing for social justice.

This root cause approach to policy change can lead to significant, sustainable improvements in community health. In housing, for example, rather than a singular focus on health outcomes linked to specific housing conditions (for example, smoke-free housing, or removal of lead or mold), health departments can partner with community organizing groups to address tenants’ rights and the decommodification of housing. In the economic and work realm, a root cause approach may focus on wages, corporate accountability, and building worker power over a sole focus on workplace safety or providing social services to low-income people.

In both examples, the root cause approach shifts power to those most impacted by health inequities and works to dismantle systemic oppression — the policies and institutional barriers that perpetuate and preserve inequities. This approach requires health departments to actively pursue policy change in deep and authentic partnerships with communities, including through relationships with community power-building organizations and other government agencies in a Health Equity in All Policies approach.

Action Steps health departments can take to pursue transformative policy change:

• Understand the priorities of local communities, partner with them, and direct policy change resources to support their priorities
• Champion a policy agenda, developed in partnership with CPBOs, that focuses on transforming power imbalances that cause health inequities, and undertake direct and/or indirect advocacy in decision-making contexts to advance policies
• Use narrative strategies to build awareness among diverse audiences of the connection between social determinants and health, including the way that power imbalances shape these systems and health outcomes
• Develop relationships and multi-sectoral collaborations with a wide array of government agencies at the city, county, and state levels to influence their decision-making in ways that address harmful structural barriers, shift power, and promote health equity
• Incorporate health equity data, research, and goals that speak to the social and economic conditions necessary for health into strategic government documents (e.g. plans, budgets, assessments, and programs) especially for non-health agencies
• Use public health legal authority to improve the social determinants of health