Building state capacity for health equity: A guide for health practitioners and partners

Background: Achieving health equity will require a concerted effort from stakeholders within and outside of public health agencies. Upstream strategies addressing social determinants of health in the community, including a “Health in All Policies” approach, are critical for meaningful and sustainable change. At the same time, there are many opportunities for addressing health inequities in clinical settings, often described as downstream interventions. While the stream metaphor for prevention is particularly useful for describing changes needed for health equity, it should not be used in a way that suggests a dichotomy between community-oriented public health and healthcare. It is important to recognize that interventions along the entire continuum are needed. Public health agencies are seeking guidance and support in promoting a multifaceted approach to health equity. Methods: As part of a strategic planning effort of the Delaware Division of Public Health, we developed a guide for health practitioners and partners for promoting health equity. We researched promising practices, interviewed key informants, and incorporated feedback from local stakeholders. Results: The guide includes attention to place-based strategies, clinical strategies, policy-oriented strategies, research and evaluation, and leadership. It relies heavily on resources developed by others around the country and builds on local efforts. It integrates promising practices and existing recommendations in a way that promotes a full continuum of strategies. Conclusions: Although developed for the state of Delaware, we believe the approach used in the guide may be useful for others working to advance health equity through multifaceted and partnership-driven approaches.