O'Neill Institute  |  January 22, 2019

“Of all the forms of inequality, injustice in health is the most shocking and inhuman.”
— Martin Luther King, Jr. (1966)

Yet grave health inequalities persist, whether neighborhoods only miles apart yet separated by decades in residents’ life expectancies, the vast differences in access to skilled birth attendants in many countries based on whether a woman is rich or poor, or the worse health of marginalized populations, such as indigenous people and people with disabilities, virtually everywhere.

We offer a new approach to reducing these health inequities, an approach that would be comprehensive, aim to empower the people who experience these inequities, and that could help establish a sustained national focus on health equity. This approach is embodied in the concept of health equity programs of action (HEPA), which is what we propose here.

These programs of action would be based on seven principles:

  • Empowering Participation and Inclusive Leadership: People from disadvantaged and marginalized populations would be among the decision-makers and part of the leadership in all structures and processes part of and that emerge from these programs of action.
  • Maximize Health Equity: Inequities across all diseases and other health threats and conditions, along with deeply-rooted structural determinants of health, must be addressed.
  • Health Systems and Beyond: All Social Determinants of Health: Health equity requires action within the health sector and across the social, environmental, and commercial determinants of health, including through intersectoral approaches.
  • Every Population Counts: The programs of action would systematically and comprehensively address each population experiencing health inequities.
  • Actions, Targets, and Timelines: Specific actions would be linked to timelines to carrying them out, along with measurable targets.
    Comprehensive Accountability: Programs of action would include government, multi-stakeholder, and independent monitoring and evaluation, while establishing and strengthening a comprehensive suite of health accountability mechanisms.
  • Sustained High-Level Political Commitment: Such commitment is necessary for sustained action on heath equity, successful implementation of the programs of action, and intersectorial action.

Below you will find material on HEPA, with more in-depth descriptions and the complete implementation framework, as well as on the concept from which it emerged: national health equity strategies.


Read the Health Equity Programs of Action infographic here.

Read the Health Equity Programs of Action briefing paper here.

Read the Health Equity Programs of Action summary here.

Read the Health Equity Programs of Action full implementation framework here.


For more information, please contact Eric Friedman (eaf74@law.georgetown.edu).


Health Equity