By Marilyn Rubin
In New Jersey, the state government has been proactively advancing equity for several years through a range of initiatives including the creation of the Office of Diversity, Equity, Inclusion and Belonging in the Office of the Governor in 2021. However, success in addressing inequities in government services across population subgroups is difficult to track as New Jersey governmental departments are not required to specifically incorporate equity into their annual performance reports. The purpose of our project is to research if/how other U.S. state governments are using equity measures as part of department/agency performance protocols, and to identify initiatives that been undertaken by state agencies to advance equity for all residents. Based upon our findings, we will provide recommendations for the State of New Jersey to consider in its efforts to advance equity for all its residents.
In our research, we have looked at agency websites, annual and performance reports posted on the internet, and other publicly available information for all 50 states. We have also looked at websites discussing equity initiative in all states. To date, we have yet to identify any state that requires agencies to include equity as a performance metric. We have, however, identified a wide array of initiatives adopted by states and state agencies to address inequities. In this upcoming report, we focus specifically on health equity to illustrate the types of actions that have been undertaken by the states. We provide both general comments on health equity actions in the states and examples of state-specific actions.
General findings about state efforts to address health disparities
Just about all states recognize health disparities among population subgroups including, but not limited to, those defined by race, ethnicity, gender, age, and socioeconomic status. To address these disparities, most states have established offices or divisions focused on these disparities housed primarily in their state’s respective Department of Health. Many, such as those in Utah, Wisconsin, California, Colorado, North Carolina, Pennsylvania, and Virginia, have the same title, “Office of Health Equity.” Nearly all states define what they mean by ‘health equity’ on publicly available websites, and “about half have a publicly posted definition of health disparities.”[1] A number of states are making concerted efforts to collect data that will enable them to measure equity. For example, Idaho’s “Get Healthy Idaho Index and Community Data” dashboard uses more than 100 measures to assess community health and well-being.[2] Additional information across the states on initiatives specifically focused on health disparities can be found in State Reported Efforts to Address Health Disparities: A 50 State Review.[3]
State-specific initiatives to address health inequities: some examples
Maryland
In 2021, the Maryland General Assembly passed the Shirley Nathan-Pulliam Health Equity Act that established the Maryland Commission on Health Equity (MCHE). The MCHE is required, among other tasks, to “Provide advice on issues of racial, ethnic, cultural, and socioeconomic health disparities.”[4] In 2024, the scope of the MCHE was broadened to align it with the governance requirements of the Centers for Medicare and Medicaid Innovation Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. The AHEAD model is an 11-year program (2024–2034) offering states the opportunity to leverage federal funding to make broad changes in the way health care is provided and paid for.
Illinois
In the Illinois Department of Public Health, Strategic Plan for 2020 to 2025, the first of the Department’s six goals is “Eliminating health disparities and advancing health equity.”[5]
Indiana
In 2021, Indiana established the interagency state council on Black and minority health to address disparities in health care.
New Mexico
New Mexico has established an Office of Health Equity (OHE) in recognition of systemic racism and the social determinants of health and to work to eliminate these disparities by addressing and promoting health equity among all people in every community in New Mexico.
Utah
The Utah Department of Health and Human Services Strategic Results-Based Accountability Plan has eight core values, one of which is equity.
Where to go from here?
In a report prepared for the New Jersey State Policy Lab in 2023, we wrote:
Many states have made efforts to advance equity by funding DEI offices that are tasked with various responsibilities such as conducting equity training for state employees, identifying equity implications of state laws, policies, processes, and practices, and ensuring that the state workforce is representative of state demographics.
Since then, however, 23 states have enacted at least one anti-DEI policy to either restrict or regulate diversity, equity and inclusion;19 have introduced at least one anti-DEI bill in state legislatures. Only New Jersey and six other states along with the District of Columbia did not introduce any anti-DEI bills in 2023-24: California, New Mexico, Vermont, Rhode Island, Delaware, and Maryland.[6]
Wyoming and Utah provide interesting examples of states with anti-DEI actions. In Utah, the governor signed an anti-DEI bill prohibiting diversity efforts he once championed when he signed — and encouraged others to sign — the Utah Compact on Racial Equity, Diversity and Inclusion[7] when he took office.
Effective July 2024, Wyoming enacted SF0130 – the “equality state not equity state act,”[8] thus moving the state away from recognizing that everyone does not begin in the same place:
AN ACT relating to the administration of government; prohibiting governmental entities from engaging in any diversity, equity or inclusion program, activity or policy; providing definitions; requiring rulemaking; providing applicability; and providing for effective dates.
No governmental entity shall engage in any diversity, equity or inclusion program, activity or policy.
Given these and other recent actions by many states to ban DEI and related initiatives, we suggest that additional research be conducted to see if the programs and policies we have documented in this and earlier reports have changed and how this will impact our recommendations to New Jersey on advancing its equity efforts.
References:
[1] https://www.kff.org/racial-equity-and-health-policy/issue-brief/state-reported-efforts-to-address-health-disparities-a-50-state-review/#Summary
[2] https://www.gethealthy.dhw.idaho.gov/get-healthy-idaho-index
[3] https://www.kff.org/racial-equity-and-health-policy/issue-brief/state-reported-efforts-to-address-health-disparities-a-50-state-review/#Summary
[4] https://health.maryland.gov/mche/pages/default.aspx
[5] https://dph.illinois.gov/content/dam/soi/en/web/idph/files/idph-strategic-plan.pdf
[6] https://www.mapresearch.org/file/2024-DEI-report-MAP.pdf
[7] https://kmyu.tv/news/local/utah-unveils-compact-to-commit-to-racial-equity-diversity-and-inclusion
[8] Wyoming is known as the “Equality State” due its passage in 1869 of the first unconditional law in the U.S. permanently guaranteeing women their inherent right to vote and hold office.