INSIGHT & INSPIRATION FROM APHA’S 2012 MIDYEAR MEETING

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Survive All In This Friends Prevention, Strategies
& Thrive Together For Health Opportunity & Equity for Health
Refocus on Social Justice
Eliminating health inequities is a daunting task, even for the most well-funded health department.
Such is the case in Boston, where black residents experience disproportionately higher rates of
illness and death, despite near-universal access to health care services in Massachusetts.
“Black residents have worse health and the neighborhoods in which they live also have the
worst health outcomes,” said Barbara Ferrer, executive director of the Boston Public Health
Commission, the nation’s oldest health department.
To address the problem, the commission restructured its work to zero in on the social determinants
that shape people’s health outcomes with a strong focus on racism, which Ferrer said has
an “impact on pretty much every other social determinant of health, including people’s access
to education and jobs, the healthy environments where they live.” In fact, eight years ago, Boston’s
mayor convened a task force dedicated to ridding inequities in health outcomes. So, what
does that mean for a health department?
“We alone can’t fix much of anything,” Ferrer told meeting attendees. “It is our job to acknowledge
that the reality is that it is those very conditions that’s going to affect people’s health
status and then align ourselves up as institutions to really put our work in places where we’re
going to make a difference in those social conditions.”
The health department developed a set of core strategies and guiding principles to support
activities designed to achieve equity through community, policy and systems change, with an
explicit commitment to racial justice. To build institutional capacity, Ferrer said every program
at the commission must now integrate the elimination of health inequities into their goals.
The health department also realigned its resources to achieve three overarching goals within
five years: reduce the gap in low birthweight rates, reduce obesity/overweight disparities, and
reduce the gap in chlamydia incidence. In addition, all employees must take training focused on
racial and social justice.