Health equity is defined as having the personal agency and fair access to resources and opportunities needed to achieve the best possible physical, emotional, and social well-being. The Health Equity Framework (HEF) centers on four spheres of influence to impact population health outcomes: 1) relationships and networks, 2) systems of power, 3) physiological pathways, and 4) individual factors.
HEF is a practical tool for communication leaders, educators, and health literacy professionals in public health research and practice. It reflects on COVID-19 digital communication tools and supports a shift toward addressing health inequities resulting from the interplay of structural, relational, individual, and physiological factors. Practical examples of the HEF are reflected in the Tools and Templates section.
Our focus is on residents’ need for accurate, timely, transparent, and equitable COVID-19 communication. HEF is reflected in the following diagram:
Relationships and Networks: refer to the connections and support structures made up of family (biological, adopted, or chosen), friends, romantic partners, and people within cultural communities, neighborhoods, schools, and workplaces.
Maintaining social relationships is important for maintaining health. Relationships may promote health equity with protective factors against health-harming behaviors, or intensify poorer health outcomes by enabling health-harming behaviors.
The USDR Digital Communication Toolkit reflects best practices to integrate communities and networks in content development for equitable COVID-19 vaccination distribution. The example below from the State of Pennsylvania represents a diverse population of potential website visitors, from parents to school representatives, with direct navigation to networks.
Physiological Pathways: a person's biological, physical, cognitive, and psychological abilities.
Physiological pathways can impact health outcomes substantially. The timing and intensity of key determinants can change developmental, biological, and cognitive trajectories, leading to poorer health outcomes. For example, adults with specific learning disabilities (SLD) reported lower scores in reading comprehension, functional reading skills, and general intelligence than non-SLD groups. Individuals with SLDs identify their condition as worse in adulthood due to extended childhood adversities.
When applying physiological pathways in practice, we focus on:
Increasing awareness of how physiological responses can be driven by other spheres of influence, and
How interventions can maximize and support the resilience of physiological functions and abilities after exposure.
Systems of Power: refer to policies, processes, and practices that determine the distribution and access to resources and opportunities needed to be healthy.
Systems of power—as opposed to social conditions such as poverty—contribute to the systematic and differential treatment of groups and include institutionalized and interpersonal manifestations of bias.
Systems of power can promote health equity by ensuring fair access to resources and opportunities. Some have also been restructured to repair the historical and current causes of health disparities. The HEF views these systems as functioning at varying levels in both political (federal, state, and local) and institutional (school, private companies, health care systems) spaces.
Individual factors: concern a person’s attitudes, skills, and behaviors, which are shaped by their personal experiences, including their relationships with others and access to opportunities, often driven by systems of power.
Social determinants of health, such as poverty, unequal access to health care, lack of education, stigma, and racism shape individual factors and contribute to health inequities. Healthy childhood development of social and emotional skills is associated with better mental and physical health outcomes, life satisfaction, and life expectancy in adulthood.
Below is an example from the State of Hawaii that successfully demonstrates content on mental health support on one of their vaccine webpages.