Sinai Urban Health Institute, 1500 S. Fairfield Ave, Chicago, IL, 60608, USA.
American Medical Association, Chicago, IL, USA.
J Racial Ethn Health Disparities. 2024 Aug;11(4):1933-1945. doi: 10.1007/s40615-023-01662-x. Epub 2023 Aug 4.
Racial inequities in life expectancy vary significantly across US cities, with city-level gaps ranging from zero to more than 10 years. Given that these inequities are rooted in racism and maintained through social structures and policies, population-level solutions are needed. Local health departments (LHD) are well-situated to lead these types of changes.
We conducted an environmental scan and document review of formal health plans of the LHDs with jurisdictions covering the 30 most populous US cities. We assessed the inclusion of equity priorities and specific and measurable equity goals. Secondary outcomes related to organizational structures, data, formal declarations, and other practices were also assessed. Data were collected between January and August 2022.
The extent of focus on racial equity in the identified strategic health plans varied. Less than half of the cities with a formal public health plan (13 of 29) listed racial health equity as an area of focus. Only seven cities (all of which had a health plan focusing on racial health equity) had specific goals related to racial health equity. Twenty-five LHDs provided local data on racial health inequities. All but seven cities had declared racism a public health crisis. About half of the LHDs had positions or divisions focused on racial equity, or specified equity as an area of focus for Covid-19 efforts.
These findings reveal that few large cities translate growing support for anti-racism into their formal planning. While most LHDs acknowledge (and provide data pointing to) gaps in racial health equity in their jurisdictions, more attention is needed to incorporate specific and measurable racial health equity goals into strategic plans, and provide adequate structure and resources to attain those goals.
美国各城市的预期寿命存在显著的种族不平等，城市层面的差距从零到超过 10 年不等。鉴于这些不平等现象源于种族主义，并通过社会结构和政策得以维持，需要采取人口层面的解决方案。地方卫生部门（LHD）非常适合领导此类变革。
我们对管辖范围涵盖美国 30 个人口最多城市的 LHD 的正式卫生计划进行了环境扫描和文件审查。我们评估了公平优先事项以及具体和可衡量的公平目标的纳入情况。还评估了与组织结构、数据、正式声明和其他实践相关的次要结果。数据收集于 2022 年 1 月至 8 月之间。
在所确定的战略卫生计划中，对种族公平的关注程度存在差异。在有正式公共卫生计划的城市中，不到一半（29 个城市中的 13 个）将种族健康公平列为重点关注领域。只有七个城市（所有这些城市都有一个关注种族健康公平的卫生计划）有与种族健康公平相关的具体目标。25 个 LHD 提供了有关种族健康不平等的本地数据。除了七个城市外，所有城市都宣布种族主义是公共卫生危机。大约一半的 LHD 有专门针对种族公平的职位或部门，或者将公平作为新冠疫情应对工作的重点领域之一。
这些发现表明，很少有大城市将对反种族主义的日益支持转化为正式规划。虽然大多数 LHD 承认（并提供数据表明）其管辖范围内存在种族健康公平方面的差距，但需要更加关注将具体和可衡量的种族健康公平目标纳入战略计划，并为实现这些目标提供充足的结构和资源。
