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Exploring Political Determinants of Health, the Impact on Health Equity, and Key Strategies for Effective Advocacy

December 8, 2023

Written by Jolie Ritzo, VP of Strategy and Network Engagement, Civitas Networks for Health

As we work to improve health throughout the country there is increasing recognition for addressing health-related social needs and a growing understanding that about 80% of what makes someone well will be determined outside of the realm of health care. In the past five years, there has been increased attention to addressing social determinants of health (SDOH), recognizing factors like housing, food security, transportation, education, and employment as crucial to health outcomes. However, a deeper layer of systems and structures exists beneath these social factors that need to be examined to advance health equity: the political determinants of health (PDOH).  

In this blog post, we’ll underscore the importance of addressing PDOH to achieve health equity, through the viewpoint of recent roundtable discussions Civitas held with its members.   

Defining the Political Determinants of Health 

The political determinants of health refer to the policies, laws, and political systems that shape the distribution of power and resources, ultimately impacting public health outcomes. This concept extends beyond the traditional health care system, encompassing the broader socio-political and economic environment in which people live. It recognizes that health disparities are often rooted in political decisions that allocate resources, influence social norms, and create or dismantle systems that either support or hinder public health. 

In the seminal work of Daniel E. Dawes, “The Political Determinants of Health,” he describes PDOH as the systematic structuring of relationships, distribution of resources, and administration of power that collectively influence health equity. This concept was the cornerstone of our recent discussions during the Political Determinants of Health Member Roundtable series, where we dove deeper into the nuances of policy influence and coalition building, particularly in the context of gaining bipartisan support for maternal health, advancing interoperability to improve tribal health and Medicaid partnerships. 

Bringing Light to the Political Determinants of Health Concept 

Consider the impact of urban zoning laws, a political determinant with profound health implications. In many cities, zoning policies have historically contributed to segregated neighborhoods, with marginalized communities often confined to areas with limited access to fresh food, green spaces, and health care facilities. Such policies can lead to higher rates of chronic illnesses like asthma and diabetes in these communities.  

By understanding and addressing these political determinants, policymakers, and public health professionals can work towards more equitable health outcomes, ensuring that everyone, regardless of their socio-economic status or neighborhood, has access to the conditions conducive to good health. 

The Importance of Building Bipartisan Support for Maternal Health  

Key to influencing health policy is the ability to build effective coalitions. Skillful advocacy often hinges on understanding divergent perspectives and looking for the common thread that can tie interests together. The first session of Civitas’ PDOH roundtable emphasized the importance of convening diverse partners to foster relationships and educate on fundamental and complex health topics. Partners from Dartmouth Health shared about their policy work and use of the ECHO model to increase stakeholder education. In New Hampshire, this approach of educating and coalition building catalyzed ongoing dialogue and shared understanding, increasing the potential for meaningful influence and ultimately resulting in a bipartisan maternal health bill passing.  

Key strategies discussed included: 

  • Educational Initiatives: Providing partners with clear summaries of legislative activities and opportunities, coupled with educational efforts to measure and enhance understanding over time. 
  • Advocacy Ecosystem: Viewing coalition members, key partners, and legislators as integral components of an advocacy ecosystem, fostering a collaborative approach to policy influence. 
  • Active Listening and Responsiveness: Ensuring timely and thoughtful responses in all interactions and being acutely aware of the political environment, including the judicious use of political capital. 

Tribal Health and the Need for Increased Data Interoperability 

In discussions about tribal health, the importance of data standards, privacy, and security emerged as paramount. During the second session, Krystal Schramm, Senior Data Analyst, described efforts she is leading at Civitas member organization Michigan Health Information Network Shared Services (MiHIN) to connect the 12 federally recognized tribes in Michigan to improve health outcomes and support a more equitable healthcare experience for the tribal communities. Building trust with tribal populations and leaders involves transparent data usage and ownership communication.  

Key takeaways from this targeted discussion included: 

  • Data at the Point of Care: Ensuring data is available at the point of care to build trust. 
  • Collaborative Problem-Solving: Working with tribes on specific use cases and bringing people together to understand real-life data, leading to shared understanding and solution development. 
  • Educating State Representatives: It’s crucial to educate state representatives about the populations they serve, particularly in tribal communities. 

Medicaid Partnerships 

There are many federal and state policy levers tied to Medicaid that can drive health improvement and advance health equity. As we work to address unmet health-related social needs in new ways, we can use data to build the case for funding and support, and then generate data to show meaningful outcomes and efficacy. During the last session of the PDOH Member Roundtable series, we heard from Civitas members Health Impact Ohio and West Virginia Health Information Network about how they are partnering with their state Medicaid leaders and policymakers. In the case of the Central Pathways Community Hub, an initiative of Health Impact Ohio, they determined that there was a need to develop a community health worker workforce. Here are some of their key strategies: 

  • Acknowledge the political climate in your state, and then 
  • Align with the goals of both parties, in other words, find a common interest. 
  • Build relationships on both sides of the aisle. 
  • Fill gaps in meaningful ways. 
  • Show ROI. 
  • Align payment and policy. 
  • Make use of new opportunities presented by federal and state legislative and regulatory developments, such as the MCO maternal and infant mortality “hub” reimbursement mechanism created by SB 332 in Ohio and CMS’ expanding Certified Community Behavioral Health Center program. 

In West Virginia, they have been skillful with braiding, blending, and stacking multiple funding streams from varying partners, including state Medicaid. In having a broader viewpoint across initiatives, they can assist with aligning various state initiatives. WVHIN started small, opening one door, showing value, and then opening another. 

Both members called attention to the importance of getting messaging right and being very thoughtful in working with different stakeholders. They also, like other presenters from the earlier sessions, called on the need for educating partners and policymakers. And lastly, recognizing the need for patience is critically important, as this work takes time; yet we need to be ready when the call comes. 

Addressing Political Determinants of Health for Systemic Change 

We must recognize the necessity of using advocacy and policy to create systemic and structural changes that advance health equity. The roundtable discussions underscored that true progress in advancing health equity requires a multifaceted approach, incorporating education, coalition-building, and a deep understanding of the political landscape. Core to all the discussions was the acknowledgment that trust is what drives this work. Relationships, both developing and maintaining them, cannot be overlooked.  

By building strong, multistakeholder, and bipartisan coalitions and understanding the critical role of data and trust, we can move closer to a health and health care system that is equitable and just for all.  

To learn more about Civitas’ member-only workgroups and webinars, visit our website. If you’re a Civitas member and would like to be included in future roundtable events, email our team