California Attorney General Rob Bonta this week urged the federal government to adopt a process to assess how agency policies, regulations, and actions affect health equity.

In response to a request for information, the Attorney General submitted a comment letter to Acting Director Shalanda Young of the Office of Management and Budget (OMB), in which he encouraged OMB to begin conducting Health Impact Assessments as a method to consider whether a proposed federal action would advance health equity or reinforce existing health inequities in underserved communities.

“COVID-19 brought into sharp focus the disparities in our nation’s healthcare systems,” Bonta stated. “As we work to recover from the pandemic, we as a country need to make some changes. Taking a closer look at the way federal policies impact the health of local communities can help ensure that these actions improve rather than harm people of color, and other underserved and marginalized groups.”

In the letter, Bonta explained that health equity is inextricably intertwined with overall equity, and the link between the two has been magnified by the COVID-19 pandemic. Before the pandemic, multiple federal laws were not sufficiently structured to protect workers and families from insecurity and inequity in jobs, income, housing, food, or access to healthcare.

Those same laws and policies left vulnerable groups in an even worse position when they were forced to grapple with the impacts of COVID-19.

Health Impact Assessments (HIA), are a tool that can be used to determine how a policy, program, or project will impact the health of a specified group or population. Bonta contends that the use of HIAs can advance health equity in the United States by: 

• Identifying affected groups and communities; 

• Assessing health disparity by evaluating impacts;

• Detecting disparities in baseline health while measuring for differential impact;

• Involving stakeholders who can contribute information or data to be considered; and

• Identifying policies that deepen inequality, which is a major determinant of poor health outcomes.

In California, HIAs have been used during consideration of new environmental, energy, agricultural, and transportation policies. Formalizing the required use of HIAs at the federal level would standardize the practice in the United States.

The use of HIAs could be one way to ensure communities affected by proposed policies have a voice and a seat at the table to be heard by the government agencies making policies that would directly impact their health. HIAs can serve as a tool for ensuring equity across diverse geographic, social, political, and economic parts of the country.