The CEHD understands health in a broad context, related to the physical, social and economic environment, and also related to social justice and the stratification of power and privilege in society which often create health inequities.

Health inequities are unfair inequalities in health risk, outcomes, or impacts of poor health among groups stratified by income/wealth, race/ ethnicity, educational level, or other socially moderated factors. Their causes are multifactoral and complex, and reducing health inequities requires broad participation, understanding of the goals, and a sustained
commitment to the process. The CEHD uses several approaches to organizing its work, including

Addressing the health system, but also the causes of health inequities.

In order to reduce health inequities, barriers and challenges in the health system must be addressed, including improving access to health care services and quality of care, fair distributions of public health services, and reducing the economic consequences of ill health, such as bankruptcies due to the high cost of health care services and lost income due to illness.

However, we know that health care services and health systems alone are not the solution to creating health equity. In fact, social determinants of health - that is, the conditions in which people are born, grow, live, work and age - affect people’s health outcomes less through health care services than through other factors such as income, neighborhood and
living conditions, racism, and other factors (see figure).

Social determinants of health include issues such as food security and regulation and nutrition; employment conditions; educational attainment; housing; transportation; and all of the policies and decisions that shape the physical, social and economic environments in which people live.

Consequently, it is an absolute necessity to address both health systems and social determinants of health in order to effectively reduce health inequities and prevent their recurrence. At the same time, if we do not continually apply “an equity lens” to social determinants interventions by monitoring the impact of action on equity improvement, we run the risk of actually worsening health inequities.Therefore, the CEHD engages combined approaches to reducing health inequities.

Local models to be scaled-up and replicated

The CEHD also recognizes the imperative and responsibility to help rebuild our own community after Hurricane Ike, and to reach out to other communities in need around the world. Much of our work is currently focused on local research-to-action projects that have the potential to be scaled up. When possible, we develop tools to facilitate training and the scale-up process, including user-friendly online tools, guidelines and workbooks, training videos, and documentaries of processes we have engaged. Many of these tools are in development as our projects evolve, and will become available over the next year.

Action-based, community centered research

Finally, the CEHD recognizes that research is valuable and necessary to guide understanding and identify effective solutions, but that when research is not actively linked to a change process and with the community, it rarely creates significant or long-lasting change. Further, research that is not undertaken in partnership with potential users of the information has less potential for sustainable impact. Consequently, the CEHD staff orient our work towards action-based research, which is research undertaken in the context of testing interventions or working with partners for change, and we intentionally collaborate with partners who have a stake in the issues as well as those who are engaged in policy development and planning.

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