“Health equity” is a phrase that’s increasingly woven into public health initiatives, strategies, and goals. To give a few national examples, Healthy People 2030 identifies achieving health equity as one of its overarching goals. The American Public Health Association lists creating health equity as a guiding priority and core value. The CDC has launched an agency-wide strategy to integrate health equity into the fabric of its work at all levels, and many state and local public health departments are following suit.

But what, exactly, does health equity mean? While there are a number of definitions that share similarities, the Iowa Department of Health and Human Services (IDHHS) defines health equity as “the attainment of the highest possible level of health for all people. It means achieving the environmental, social, economic, and other conditions in which all people have the opportunity to attain their highest possible level of health. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequities, historical and contemporary injustices, and the elimination of health and health care disparities.”

A Foundational Understanding

Because individuals’ familiarity with health equity varies within every health department and agency, trainings can help strengthen employees’ knowledge of health equity principles. One such program, the Building Health Equity (BHE) Training Program, provides health department employees in Iowa with a foundational understanding of health equity issues, causes, and outcomes, as well as the tools to connect this knowledge to personal and professional situations.

The program consists of six asynchronous modules and four live discussion sessions, and is led by a team of public health practitioners, faculty, staff, and students from the Institute for Public Health Practice at the University of Iowa College of Public Health. The project is supported by IDHHS through funds provided by the American Rescue Plan Act of 2021.

This training is important because, as the BHE Training Program web site explains, “Racism, ableism, classism, and other forms of oppression, bias, or discrimination against certain groups or populations contribute to health disparities and other disproportionate negative outcomes in those affected. We must work to acknowledge our own experiences and biases to better understand the role each of us has in promoting equity in our work as public health professionals.

“Additionally, it is imperative that we recognize the historical and current systems that contribute to these disparities so we can work to dismantle them to better the health and well-being of all members of the communities we serve.”

The trainings involve individual work and self-reflection as well as facilitated group conversations, some of which can be sensitive or difficult. Establishing boundaries of respect and confidentiality are important to the process.

“It’s two basic principles combined together,” says Laurie Walkner, one of the facilitators and interim director of the Institute for Public Health Practice, about the training. “It’s people doing inside work for their own health equity journey, and it’s how people translate that at work into the practices, partnerships, and policies they’re involved in.”

The training is about participants’ personal growth and learning and “how to make it apply to their everyday life, but also within their work that they do for the health department and the community and clients they interact with,” adds Tricia Kitzmann, who serves as a training facilitator and program coordinator.

New Perspectives

As of spring 2023, the Building Health Equity Training Program has been delivered to the public health departments in Black Hawk and Linn Counties and is underway at Johnson County Public Health.

Jared Parmater completed the training in his role as environmental health program manager for Black Hawk County Public Health. He says the training provided a “slow and consistent build towards understanding the basic tenets of health equity.”

“It’s given me a better perspective on the cause of a lot of the issues that we encounter in our work and the importance of understanding the history behind equity,” Parmater says.

He adds that learning about and practicing health equity “is a process, particularly for those professionals that might not have a traditional public health background,” he says. “Give yourself grace and time to work through everything and understand that there will be difficulties and that that’s ok.”

Anne Harris Carter joined Linn County Public Health in April 2022 as the department’s first-ever health equity program manager. One of her initial projects was working with the BHE Training Program team to deliver the training.

“I was excited to come alongside the College of Public Health team to customize and refine the workshop content, help develop group activities to complement the curriculum, and co-facilitate every session,” Carter says. “I’m also new to public health, having spent my career up to this point in the corporate sector. The series was structured in a way that allowed our entire department to learn together, regardless of our level of familiarity with health equity.”

Health Equity in Every Community

The Building Health Equity team also produces a webinar series for public health practitioners that focuses on health equity issues. Topics have included environmental justice, food access, disabilities, the LGBTQ+ community, rural health, mental health, and more. The webinars are archived as videos and turned into podcasts for listening on the go.

“We get positive feedback from folks that it’s been beneficial, that this is good information. They like the tools and links that are shared,” says Kitzmann. Although the webinars are geared for Iowa, she notes that they’ve had participants from across the U.S. and Canada.

The team emphasizes that health equity isn’t an issue only for cities or metropolitan areas, but that it affects communities of all sizes.

“Ageism, poverty, and disabilities are issues that every community is challenged with,” Walkner says. “We try to stress the positive impact of health equity on community. Everybody benefits from a healthy society. There is diversity within every community, some of which isn’t visible. It may not be race or ethnicity, but there are diverse needs.”

“The mental health webinar was popular because the size of your community doesn’t matter,” Kitzmann cites as an example. “One in five people will experience a mental health condition in a given year, so it’s a common concern and people see that it’s applicable to their community.”

By addressing topics that some communities might not discuss often, “it’s giving public health workers those small but mighty steps to move [health equity] forward,” Walkner says. “I think that’s the key takeaway. We want to make sure that participants are able to take what we’ve talked about and start thinking about it, implementing it, whether they’re already in the process or are just beginning.”

Some of the ways Carter and her colleagues at Linn County Public Health are putting health equity principles into action include conducting a “roadshow” to present highlights from the Community Health Improvement Plan (CHIP), including development of the plan, opportunities to support implementation, and ways to engage.

“The goal is to prioritize relationship-building to expand the diversity—visible and invisible— of organizations and individuals who serve as co-creators for the 2025-2027 CHIP,” Carter explains. “We also have cross-sector efforts, such as the Alliance for Equitable Housing and examining the Linn County Board of Health position statement on Racism as a Public Health Crisis.”

Making Transformative Change

For Carter, “The BHE training series provided a tremendous foundation for me, and I’m grateful to continue learning and growing with my colleagues.”

Walkner echoes the idea that pursuing health equity is a continuous process. “One key message is that health equity is a lifelong journey, and that it’s important in both our professional and personal lives. To make transformative change, we have to start within ourselves and build out.”

“It’s not just one thing—whether we’re talking racism, sexism, ageism—it’s multifaceted, and there are multiple layers of issues that we’re trying to address,” says Kitzmann. “All of that, in some shape or form, is going to impact your health and well-being. If we want to have a healthy community, if we want to impact the next generation, we have to address inequities.”

This story originally appeared in the spring 2023 issue of InSight magazine