How Can We Prioritize Upstream Policy Change?
Prioritize improving the social determinants of health through upstream policy change (Read actions you can take below)
By focusing on individual behaviors, health departments direct enormous resources to respond to the symptoms of inequity, never fully eliminating the roots of inequity. Focusing on upstream policy change should be at the heart of a health department’s work to advance health equity, at the local, state and federal level, and with diverse partners. These policy changes would require health departments to examine a wide range of social determinants of health that are traditionally outside their culture, narrative, and practice — from housing to criminal justice to education.
Health departments can achieve policy change using a number of tactics, including:
- Building awareness of the connection between social issues and health with different audiences
- Conducting research on this connection and reporting research publicly
- Undertaking direct and indirect advocacy in decision-making contexts
- Strengthening staff capacity to identify and focus on upstream factors across the agency’s programs
Key to success is partnering with local communities and directing policy-change resources to support their priorities. Health departments can leverage existing service providers (e.g. home visiting nurses, lead inspectors, low-income clinic providers) to collect data and document conditions to inform and influence policy.
Case studies that prioritize upstream policy change
Actions to Advance Equity Using This Practice
Your leadership, staff, and department take the following actions to prioritize upstream policy change:
- Build awareness of the connection between the social determinants and health with different audiences, including health department staff, healthcare institutions, government agencies, elected officials, and community stakeholders
- Advance a narrative that says: 1) health is more than health care, and 2) to improve health, we must focus on community conditions that lead to health
- Create and champion a legislative agenda that focuses on upstream social determinants, and undertake direct and/or indirect advocacy in decision-making contexts to advance targeted policies
- Develop relationships and multi-sectoral collaborations with city/county/state agencies of labor, transportation, education, corrections, economic development, housing, and public safety to influence their decision making in ways that promote health equity
- Incorporate goals, language, and data about health equity and the social and economic conditions necessary for health into city/county/state’s plans, budgets, assessments, and other strategic documents
- Develop or adopt policies, practices, and tools that explicitly address health and racial equity
- Lead or participate in health impact assessments or the application of equity impact tools to analyze the health and equity impacts of proposed policies, programs, and plans on community health. Recommend mitigations to address negative impacts and promote health and equity
- Conduct and disseminate research that directly links health outcomes to environmental, social, and economic factors in specific communities, neighborhoods, or within other groups
- Strengthen staff capacity and encourage direct service staff to explore the underlying causes of inequities and to identify and advocate for policy, systems, and environmental changes that advance equity
- Understand the priorities of local communities, partner with them, and direct policy change resources to support their priorities
