Promoting health equity means reshaping the conditions that cause preventable differences in health outcomes between groups of people. Clinical care accounts for only about 20 percent of what determines health at the county level, while social and economic factors drive as much as 50 percent. That gap explains why equity work reaches far beyond hospitals and clinics, into housing, education, food access, language services, data collection, and workforce development.
Why Social Conditions Matter More Than Medical Care
A widely cited analysis from the U.S. Department of Health and Human Services breaks down the drivers of health outcomes this way: socioeconomic factors account for roughly 47 percent, health behaviors for 34 percent, clinical care for 16 percent, and the physical environment for 3 percent. These numbers don’t minimize the importance of quality healthcare, but they reveal that most health disparities are rooted in conditions outside the exam room.
The World Health Organization frames it similarly. Health equity is shaped by the conditions in which people are born, grow, live, work, play, and age. Structural forces like political systems, legal protections, and economic policies determine how power and resources are distributed across communities. Promoting equity, then, requires intervening at multiple levels simultaneously: inside healthcare systems, across communities, and through public policy.
Collect and Use Better Data
You can’t close gaps you can’t measure. The CMS Framework for Health Equity (2022-2032) lists expanding the collection, reporting, and analysis of standardized demographic data as its first priority. Without detailed data broken down by race, ethnicity, language, disability status, and geography, organizations cannot identify who is falling through the cracks or whether interventions are working.
Federal standards for this data collection were updated for the first time since 1997. The Office of Management and Budget’s 2024 revisions expanded the minimum categories for race and ethnicity data to seven, adding Middle Eastern or North African as a distinct category. The updated standards also allow respondents to select multiple categories from a single combined race and ethnicity question rather than answering two separate questions. These changes give health systems more precise data to work with when tracking disparities.
At the organizational level, this means integrating demographic data collection into intake processes, linking it to outcome measures, and regularly analyzing the results. If your hospital’s readmission rates look fine overall but you’ve never disaggregated them by race, income, or primary language, you may be missing serious inequities hidden inside the averages.
Expand Insurance Coverage
Coverage is the most basic prerequisite for accessing care, and policy decisions directly shape who has it. States that expanded Medicaid under the Affordable Care Act saw significant reductions in uninsured rates, particularly for the lowest-income residents. Between 2012 and 2018, uninsured rates dropped by nearly 11 percentage points for people below 138 percent of the federal poverty level in expansion states.
Even so, coverage gaps persist. People in that lowest income bracket were still about 13 percentage points more likely to be uninsured than those with moderate incomes, and nearly 20 percentage points more likely than higher-income groups. Expanding eligibility is a powerful first step, but it needs to be paired with outreach, enrollment assistance, and removal of administrative barriers that prevent eligible people from actually signing up and using their coverage.
Build a More Diverse Healthcare Workforce
Who provides care matters. A systematic review of patient-physician communication found that racial discordance predicted poorer communication in 11 out of 12 studies, across measures like satisfaction, information sharing, shared decision-making, visit length, and the overall respect and supportiveness of conversations. Patients were 1.4 times more likely to report feeling excellent respect when seeing a doctor of the same racial background.
These communication differences have real consequences. Patients who feel heard and respected are more likely to share symptoms honestly, follow treatment plans, and return for follow-up care. Diversifying the healthcare workforce through pipeline programs, scholarships, mentorship, and equitable hiring practices is one of the most direct ways to improve the quality of care for underserved communities. The CMS framework specifically calls for building the capacity of healthcare organizations and their workforce to reduce disparities.
Invest in Community Health Workers
Community health workers (CHWs) are trusted members of the communities they serve, and integrating them into care teams is one of the most cost-effective equity strategies available. CDC evidence shows that CHW programs help participants lower blood pressure and cholesterol, increase physical activity and healthy eating, improve medication adherence, and boost smoking cessation rates.
The economics are favorable too. The median reduction in healthcare costs after a CHW intervention was $82 per person per year. One well-designed study of a large health plan serving an underserved urban population found a return on investment of 1.8 to 1. CHWs succeed because they bridge cultural and logistical gaps that clinical staff often cannot. They help people navigate insurance, arrange transportation, connect with social services, and understand their treatment plans in the context of their actual lives.
Deliver Culturally and Linguistically Appropriate Care
The National Standards for Culturally and Linguistically Appropriate Services (CLAS) outline 15 requirements for healthcare organizations. At their core, they mandate that organizations provide care responsive to patients’ cultural beliefs, languages, health literacy, and communication needs. Some of the most actionable standards include offering free language assistance to people with limited English proficiency, ensuring interpreters are trained and certified (not untrained staff or family members, and never minors), and providing written materials in the languages commonly spoken in the service area.
Beyond language, CLAS standards push organizations to recruit leadership and staff that reflect the communities they serve, conduct regular community health needs assessments, and partner with community members to design and evaluate services. These aren’t aspirational suggestions. Organizations that embed these practices into their operations, budgets, and quality improvement cycles create environments where patients from all backgrounds receive more effective care.
Close the Digital Divide
Telehealth expanded rapidly during the pandemic, but it risks widening disparities if access isn’t equitable. People without reliable internet, devices, or digital skills are shut out of virtual appointments, patient portals, and online health information. Promoting digital health equity requires creative, community-level solutions.
Libraries have emerged as unexpected but effective partners. The Pottsboro Area Library in Texas offered its only private room for patrons to conduct telehealth visits. The Denver Main Library set up a dedicated computer in a spare room and scheduled different health agencies to use the space on different days of the week, with the total cost covered largely by repurposed program funds. As one librarian noted, just being able to say “I’m going to the library” removes the stigma that might prevent someone from seeking counseling or therapy.
Health systems are adapting too. Hennepin Healthcare in Minneapolis developed a telehealth pathway that connected patients through a simple text message link, with reminders translated into Spanish and Somali. They redesigned all patient-facing materials to a fourth-grade reading level and created visual toolkits in multiple languages. The Glynn County School District in Georgia operates a telehealth van bringing medical and behavioral health services directly to students. These examples share a common principle: meet people where they are, with tools they can actually use.
Address Root Causes Through Policy
Individual programs and organizational reforms are necessary but insufficient on their own. The structural determinants of health, including political, legal, and economic systems, shape who has access to safe housing, quality education, nutritious food, clean air, and stable employment. Policies that address these upstream conditions are among the most powerful levers for health equity.
This includes zoning reforms that prevent the concentration of environmental hazards in low-income neighborhoods, minimum wage increases that reduce the poverty linked to poor health outcomes, investments in public transportation that connect underserved areas to healthcare facilities, and food policies that address the lack of grocery stores in communities that need them most. The CMS framework captures this principle in its second priority: assessing the causes of disparities within existing programs and addressing inequities embedded in policies and operations themselves.
Effective equity work treats health not as an individual achievement but as a product of systems. Changing those systems requires sustained effort across every sector that touches people’s lives, which is nearly all of them.