In recent years, there has been a growing focus on addressing health disparities and advancing health equity. This growth was spurred by incidents in 2020, including the COVID-19 pandemic, which highlighted the disproportionate impact of the virus on low-income people and people of color in the U.S. in addition to the police killings of George Floyd, Breonna Taylor, and others that increased attention to systemic racism that contributes to inequities such as health disparities. While the federal government can play a key role in addressing inequities, state-level health equity initiatives also play a pivotal role, as they set policies, allocate resources, and administer many services and programs that are important for addressing the conditions that determine health both within and beyond the health care system.

Moreover, states have varying demographics, population needs, and political leadership, which may shape state-level health equity initiatives. Efforts at the federal level are expected to shift under the Trump Administration, given that, during his first term, he took executive action to prohibit federal agencies and contractors from providing training addressing racism and sexism and has proposed policies that may widen disparities in coverage and access to care. As such, understanding state actions in this area may be of increasing importance.

This analysis focuses on current state-level health equity initiatives, many of which were implemented during or after 2020, to address health disparities and advance health equity based on a review of publicly available materials from all 50 states and DC. In addition, case study interviews were conducted with 14 stakeholders in three states (California, North Dakota, and Michigan) to increase understanding of the factors contributing to success of these state initiatives, lessons learned, and potential implications for other states.

The case study initiatives reflect some of the broad themes of state-level activities identified through the analysis of publicly available materials and include states with varied geography, racial and ethnic demographics, and political leadership (See Methods for more details.) Key takeaways from the review include the following:

Read the full article about state-level health equity initiatives by Samantha Artiga and Alisha Rao at KFF.