Health Disparities; Health Equity; State Health Departments; Funding


Background: Chronic diseases are an important contributor to morbidity and mortality among racial/ethnic minority, low-income, and other under-resourced populations. Given that state health departments (and their chronic disease programs) play a significant role in providing population and preventive health services, their capacity to promote health equity is an important consideration in national efforts to address chronic diseases. The purpose of this study was to examine capacity needs of state chronic disease programs with respect to promoting health equity.

Methods: In 2015, the National Association of Chronic Disease Directors (NACDD) conducted a survey of its members that work within a state chronic disease division (CDD) or the larger state health department. The survey was structured to provide information on major funding sources for chronic diseases, the extent to which key funders required a focus on health equity, dedicated staffing for health equity, and training and technical assistance needs of practitioners to support health equity integration in chronic disease programming. All data were analyzed using SPSS 19.0.

Findings: A total of 147 chronic disease directors and practitioners responded to the survey from 43 states, the District of Columbia and three of the U.S. Affiliated Territories and Commonwealths. Forty-two percent (N=25) of the 59 directors of state, territorial and tribal chronic disease programs at the time of the study responded. Only 52% of respondents believed their CDD adequately addressed health inequities. Among the 70 respondents who did not know or did not believe their health departments adequately addressed health inequities, barriers identified include insufficient funding (62%), inadequate training (54%), and health inequities not being a priority (22%). Respondents also identified opportunities to strengthen funding requirements to address health disparities

Conclusions: Overall, the data highlight some opportunities to enhance the capacity of state CDDs to promote health equity, such as through more direct funding requirements for health equity integration, staff training, increased funding, and specialized technical assistance. Because the response rate was less than 100%, we cannot generalize the findings to every state chronic disease program. However, the responses are relatable to their collective experience.