Views of Health Equity and Population Health in America

How receptive Americans are to certain public health initiatives to improve personal and community health varies a lot depending on the beliefs they hold regarding government involvement and health. A study in Health Affairs examined what Americans think about personal and public health and analyzed how to mobilize them to support efforts to improve population health and health equity.

The Robert Wood Johnson Foundation (RWJF)’s vision for a culture of health includes an emphasis on making personal and community health a shared value. To better understand how people view efforts to promote health equity and population health, researchers crafted a survey that contained 70 measures based on the identification of values and beliefs related to RWJF’s framework to develop a culture of health.

“The development of all communication efforts begins with a clear understanding of audiences, not only their size and composition, but also their receptivity,” the authors wrote.

Based on where people’s views landed regarding the importance of one’s personal health and how active the government’s role should be, the researchers separated the population into 6 segments: health egalitarians (23%), equity advocates (16%), committed activists (18%), self-reliant individualists (12%), disinterested skeptics (17%), and private-sector champions (14%).

Health egalitarians and equity advocates believe personal health is of less importance and strongly support the government’s role in health policy. Committed activists also strongly support the government’s role in health policy, but they place high importance on personal health. Private-sector champions and self-reliant individualists place a lot of importance on their personal health and have less support for the government’s role in health policy. Finally, disinterested skeptics believe personal health is a low priority and they have low support for the government’s role.

There are important nuances in the way that segments that feel similarly, regarding personal health and government role, view healthcare issues. While health egalitarians, committed activists, and equity advocates all believe income disparities affect access to care, only equity activists also believe that racial/ethnic disparities affect access to care.

“Other studies have documented this same pattern, showing the need for increased public education efforts on the effect of racial and ethnic disparities on access to care,” the authors wrote.

Meanwhile, self-reliant individualists and disinterested skeptics are less likely to believe race/ethnic disparities and income-based disparities influence health.

Those segments that support the government’s role (health egalitarians, committed activists, and equity advocates) have potential to be mobilized to support an increase in efforts. However, the researchers determined that their findings also suggest there are people in segments that have low support for the government’s role in health policy. Self-reliant individualists and disinterested skeptics may be receptive to community health improvements with a private-sector engagement. Private-sector champions strongly believe that social determinants influence health and so they would be more likely to be receptive to efforts that address those.

More analysis needs to be done to better understand the relationships between the measures that differentiate the segments, and to refine communication methods, according to the researchers.