Messages to Advance Health Equity Via Public Policy

Background: Voices for Healthy Kids is an American Heart Association and Robert Wood Johnson Foundation initiative to help all children grow up at a healthy weight. One of its primary goals is to advance health equity via policies that include language prioritizing where implementation must begin. Without this specific language, communities that, for structural and historic reasons, have had fewer investments over the years also have the least resources and access to tap into the new programs or funding created by the policy. Securing this language in policy—and building public will more broadly for health equity—requires a compelling message about what equity is, why it matters and how policy can be a tool to create change. 

Program background: This program aimed to develop messages for use by nonprofit organizations, community organizers, advocates, coalitions and others to make the case for including very specific health equity language in policies (e.g. parameters that ensure the policy explicitly benefits a racial/ethnic or low-income population experiencing health disparities, explicitly addresses determinant(s) of inequity, etc.) However, the concepts of equity and prioritized implementation present a challenge for some decision makers, so we needed to identify commonly held values that would help decision makers conceptualize the idea, if not the actual language, of equity. The research literature (Jonathan Haidt, Frameworks Institute and others) guided us to the values of human potential, community and opportunity for all. These were selected because they are dominant American values; help people think at a systems, not individual, level; and resonate across the political spectrum. 

Evaluation Methods and Results: Building on these values, we designed a message frame for organizers and advocates negotiating specific health equity language in public policy. The message has three versions, one aligning with each shared value, so it is highly malleable depending on the situation and audience. We tested those messages in one-on-one interviews with state and local policy makers representing the spectrum of political ideology, geography and constituent base. Voices for Healthy Kids advocates and partners are pilot testing the messages during legislative sessions (April-June 2017). At the conference we will share pilot test results including which components of the messages work best in which contexts, and next steps including additional insights we will seek via a national survey in late summer. 

Conclusions: Based on early rounds of testing, the values and messages are demonstrated to motivate decision makers to consider, pursue and champion health equity language in public policy. Messages must link to a shared value and emphasize the relevant return on investment (social impact or effectiveness of policy) for the decision maker. 

Implications for research and/or practice: The messages and insights emerging from this project are relevant for those working on a variety of public health and equity issues and, used consistently, may help normalize and build expectations for more equitable policy development. Beyond policy, they inform conversations about health equity and will be instructive for those working with the news media, key influencers and others.