Advancing Health Equity in Oregon: Building a Foundation

Julie Bataille and Caitlin Hodes, GMMB

As health inequities continue to be exacerbated by the COVID-19 pandemic, there is concerted energy to address this topic across states. Oregon has had a longstanding focus on health equity and employed two foundational strategies that can serve as examples for other states seeking to further their health equity efforts. Oregon first developed a common language and defined what “health equity” meant in the state. The state also engaged community partners to ensure that the community voice was apparent in policy decisions on the state level. When combined, these strategies have helped Oregon develop a foundation to build and implement subsequent health equity efforts in the state. 

Strategy: Establish Definitions and Common Language

The state has been very intentional with language used to describe equity efforts and how key terms are defined. The definition of “health equity” itself was an evolution, ultimately adopted in 2019 by the Oregon Health Policy Board for the board’s committees and the Oregon Health Authority. The process was led by the board’s Health Equity Committee and the Oregon Health Authority’s (OHA) Equity and Inclusion Division who sought community and stakeholder input and feedback throughout the development.

Oregon’s Health Equity Definition

Oregon will have established a health system that creates health equity when all people can reach their full health potential and well-being and are not disadvantaged by their race, ethnicity, language, disability, gender, gender identity, sexual orientation, social class, intersections among these communities or identities, or other socially determined circumstances.

Achieving health equity requires the ongoing collaboration of all regions and sectors of the state, including tribal governments to address:

• The equitable distribution or redistribution of resources and power; and
• Recognizing, reconciling and rectifying historical and contemporary injustices.

Understanding the Source of Health Inequities

One primary goal of the definition is to get at the root cause of inequities including racism, discrimination and bias, and understand that health inequities are differences in health that are not only unnecessary and avoidable but, in addition, are unfair and unjust. Health inequities are rooted in social injustices that make some population groups more vulnerable to poor health than other groups. 

• Ex: Babies born to Black Americans are more likely to die in their first year of life than babies born to White Americans. This remains true even when controlling for education and wealth. This is a health inequity because the difference between the populations is unfair, avoidable and rooted in social injustice.​

The framework below demonstrates the importance of moving all the way upstream to the understanding that racism, discrimination and bias impact health outcomes of populations and communities of people who have been subjected to long-standing, even centuries-old oppression.

Strategic Action: End Health Inequities by 2030

The development of the definition and adoption of a framework for understanding where work needs to focus has allowed for robust internal and external coordination and impact around how to think about and work towards achieving health equity. This definition has allowed the agency to begin asking:

• How do we address the equitable distribution and redistribution of resources and power?
• How does this impact our policy, practice and decision making?
• What do we need to do differently?

As part of this conversation and work OHA has adopted the strategic goal to end health inequities in the state of Oregon by 2030.  The strategic goal was informed by an extensive community engagement process throughout the state to ensure that the agency was especially responsive to people in Oregon most impacted by health inequities stemming from long-standing and contemporary racism and oppression.

Strategy: Engage the Community

Community-driven decision-making is essential to ensuring that equity efforts are meaningful and truly benefit the populations they are intended to serve. Building these authentic and symbiotic relationships with community partners and stakeholders over time are crucial in building communication pathways and demonstrating states’ true commitments to health equity. This has been key in Oregon, not only in developing their health equity definition, but especially in implementing these values into their work. The Equity and Inclusion division within OHA describes and demonstrates the need for government to follow community. For example, some of community sessions which informed the agency’s strategic goal were conducted totally in the primary language of the specific community involved in the session. In other sessions, such as one with the Black and African American community in Lane County, changes in process were made in the design with OHA following the lead of the community. In this case, the host organization requested that no government employee be in the session so that people could speak without the fear of government looking over their shoulders. The NAACP in that community then passed the information along to the Equity and Inclusion division.

This community-led orientation played out in practice during the state’s COVID-19 response, as OHA determined how to best support tribal communities and communities of color struggling during the pandemic. The agency asked tribal communities and partners in communities of color what would be most needed if financial support were to become available. The communities responded with requests for canned food, thermometers, data tools, rent and business assistance and more to support a broad range of needs. From this work the equity programs of the Oregon Health Authority including the Equity and Inclusion division, Tribal Affairs and the Community Partner Outreach Program developed a proposal that was submitted by OHA leadership to the Emergency Board of the Oregon Legislature. The agency ultimately received $45M to infuse in these communities throughout the state, demonstrating how leadership, community relationships, and equity and inclusion as a discipline converge to make a difference in this work.

States can adapt these processes and resources that have proven successful in Oregon for their own health equity efforts. For more on state strategies to address health inequities, check out this issue brief from Manatt Health.