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Public health laboratories are necessary in the call to dismantle health inequities

Dr. Jeffrey Hall, acting deputy director of the CDC Office of Health Equity, speaks to the audience at the 2023 APHL Annual Conference.

By Melanie Padgett Powers, writer

Public health laboratory professionals have the opportunity and the power to reduce health inequities and support health justice, said Jeffrey Hall, PhD, MSPH, MA, acting deputy director of the Office of Health Equity at the US Centers for Disease Control and Prevention (CDC), in his May 22 opening plenary session, “Reducing Health Inequity, Pursuing Health Equity and Seeking Health Justice” at the 2023 APHL Annual Conference.

Hall presented a call to action for health justice: “Everyone deserves a fair and just opportunity to be and stay as healthy as possible. … We all have a right to a system of health promotion, protection and preservation that provides equity of opportunity to enjoy the highest attainable level of health.”

Seeking health equity and health justice are complementary approaches that both require addressing the fundamental root causes of health inequities in our society, Hall explained.

Pursuing health inequity includes placing outcomes at the center of assessment and policy development. It entails actively and routinely highlighting, in practice and policy, the needs of historically marginalized populations.

Seeking health justice includes participating in movements to eliminate health inequities and expand access to health care. It entails recognizing and building the power of individuals and communities affected by health inequities, as well as focusing on the roles and influence of laws, policies and institutions in creating and perpetuating inequities.

The role of public health laboratories

Public health laboratory professionals play critical roles connected to health justice, Hall contended, such as surveillance of diseases and environmental exposures and supporting efforts for clean water, air and other environmental factors.

“The diseases, conditions and exposures that we track reflect socially driven inequities,” Hall said. “What we see in our labs reflect a highly complex, socially stratified world. [It] reflects differential social — and in many cases, physical — placements relative to hazards and sources of acute, as well as chronic, risks or toxic sources of stress.”

Pursuing health equity and seeking health justice requires removing obstacles to health, he said. “This means stepping out — or for some of us even further out — of our comfort zones to help cultivate access to factors that vary access to conditions that are vital for health and for well-being. That can mean taking on factors with which we are not necessarily used to dealing with or comfortable dealing with.”

This includes addressing discrimination and the “interlocking systems of differential privilege, advantage and oppression” that plague our society, such as racism, sexism, heterosexism, cisgenderism, ableism, ageism, nativism and classism, he said.

“Health justice requires a probing and critical eye to root out the influence of these ‘isms’ on the design and on the implementation of efforts addressing health disparities,” Hall said.

Hall called for a “health for all policy” approach, which is an evolution from a “health in all policy” approach. The change is warranted in 2023 because although many people acknowledge that everything affects health, “not everyone actually thinks that health is their specific problem to solve,” he said.

He shared several prompts that public health laboratory professionals can ask as they consider how to incorporate health equity in all policies. These include:

  • What social conditions and economic policies make some people more likely to be unhealthy?
  • What institutional policies and practices prevent people from accessing services?
  • What fundamental policy changes do we need to eliminate disparities?
  • How can we work within our communities to define and prioritize public health concerns?

Hall acknowledged that his call to action might feel overwhelming to many, as they are already working hard in their public health laboratory roles.

“I know as you think about everything that I’ve mentioned, you may have many, many other responsibilities and that this particular task that I’m asking you to look at is huge,” he said. “But I want to reiterate that we cannot do this without each and every one of you. No matter what your position is, no matter the length of time you’ve been in the field or in your position, there is a unique spot for you with this work. Together, we can do this. Together, we must do this.”

Melanie Padgett Powers is a freelance writer and editor specializing in health care and public health.

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