Implications For Health Equity Research Articles

Integrative review protocol for Indigenous youth participation in health equity promotion

IntroductionIndigenous youth participation in decision-making is internationally recognised as a pathway to promote health equity, decolonisation and social inclusion. Hearing Indigenous youth voices and actively involving them in decisions that...

Health Equity Implications of the COVID-19 Lockdown and Visitation Strategies in Long-Term Care Homes in Ontario: A Mixed Method Study.

The COVID-19 pandemic has negatively impacted the lives and well-being of long-term care home residents. This mixed-method study examined the health equity implications of the COVID-19 lockdown and visitation strategies in long-term care homes in Ontario. We recruited long-term care home residents, their family members and designated caregivers, as well as healthcare workers from 235 homes in Ontario, Canada. We used online surveys and virtual interviews to assess the priority, feasibility, and acceptability of visitation strategies, and to explore the lived experiences of participants under the lockdown and thereafter. A total of n = 201 participants completed a survey and a purposive sample of n = 15 long-term care home residents and their family members completed an interview. The initial lockdown deteriorated residents’ physical, mental, and cognitive well-being, and disrupted family and community ties. Transitional visitation strategies, such as virtual visits, were criticised for lack of emotional value and limited feasibility. Designated caregiver programs emerged as a prioritised and highly acceptable strategy, one that residents and family members demanded continuous and unconditional access to. Our findings suggest a series of equity implications that highlight a person-centred approach to visitation strategies and promote emotional connection between residents and their loved ones.

Technology-enabled Hospital at Home: Innovation for Acute Care at Home

Summary Since 2016, two hospital at home programs at Mass General Brigham have cared for more than 2,000 patients and have developed significant experience leveraging technology to improve clinical outcomes, operational efficiency, and the care experience for both patients and clinicians. These technologies have spanned from supporting remote visits and facilitating remote patient monitoring to enhancing clinical team coordination and supply chain management. Key lessons have been learned along these verticals, and there have been several important interoperability/integration and health equity implications, as the patient population and technology portfolio have expanded. Early experience points toward the use of these technologies in hospital at home as being safe and acceptable to patients and clinicians, as well as holding significant promise in enhancing clinical resource efficiency and coordination that will be critical to the scaling of acute care delivery in the home.

The Impact of Transport on Population Health and Health Equity for Māori in Aotearoa New Zealand: A Prospective Burden of Disease Study.

Background: The land transport system influences health via a range of pathways. This study aimed to quantify the amount and distribution of health loss caused by the current land transport system in Aotearoa New Zealand (NZ) through the pathways of road injury, air pollution and physical inactivity. Methods: We used an existing multi-state life table model to estimate the long-term health impacts (in health-adjusted life years (HALYs)) and changes in health system costs of removing road injury and transport related air pollution and increasing physical activity to recommended levels through active transport. Health equity implications were estimated using relative changes in HALYs and life expectancy for Māori and non-Māori. Results: If the NZ resident population alive in 2011 was exposed to no further air pollution from transport, had no road traffic injuries and achieved at least the recommended weekly amount of physical activity through walking and cycling from 2011 onwards, 1.28 (95% UI: 1.11–1.5) million HALYs would be gained and $7.7 (95% UI: 10.2 to 5.6) billion (2011 NZ Dollars) would be saved from the health system over the lifetime of this cohort. Māori would likely gain more healthy years per capita than non-Māori, which would translate to small but important reductions (2–3%) in the present gaps in life expectancy. Conclusion: The current transport system in NZ, like many other car-dominated transport systems, has substantial negative impacts on health, at a similar level to the effects of tobacco and obesity. Transport contributes to health inequity, as Māori bear greater shares of the negative health impacts. Creating a healthier transport system would bring substantial benefits for health, society and the economy.

Health equity implications of COVID-19 on dementia care in community for people of African descent

Dementia afflicts affected individuals and their family caregivers worldwide. Although a non-pharmacological intervention has been recommended as a first-line approach to minimize adverse outcomes (e.g., stress) in dementia care dyads (persons with dementia [PWD] and their family caregivers), most evaluations of such interventions have relied on subjective (e.g., self- or proxy-report) rather than objective (e.g., biomarkers) measures. We aimed to explore the feasibility of saliva collection of cortisol and dehydroepiandrosterone sulfate (DHEA-S) as a non-intrusive method in dementia care dyads. Dementia care dyads living at home were recruited from the memory center in Sweden. Prior to the saliva collection, participants received a one-hour education session with a hands-on demonstration led by a trained study coordinator. Participants were instructed to collect saliva three times (two for morning, one for evening)/day, five days/week for eight consecutive weeks. Out of 32 care dyads (32 PWD and 32 family caregivers), 24 (75.0%) completed the saliva collection. On average, 105.5 (87.92%) and 105.9 (88.25%) samples were collected from PWD and family caregivers during eight weeks. There were no statistically significant differences (p>0.05) in the average number of saliva samples (i.e., total samples, morning or evening samples) between PWD and family caregivers. The findings of this pilot study showed that saliva collection of cortisol and DHEA-S as a stress measurement was feasible in dementia care dyads living at home. Robust and person-centered procedures, tailored educational materials, and effective communication with dementia care dyads should be considered in future biomarker research on stress in dementia care dyads.

Health equity implications of COVID-19 on dementia care in community for people of African descent

This presentation shares results from an analysis of interviews conducted to understand the health equity implications of COVID-19 responses on dementia care in the community for people of African descent in Nova Scotia, Canada. Interviews were embedded within a larger multi-method rapid research project that aimed to assess the impact of COVID-19 on dementia care for geographically and socially marginalized groups in the province. Data from the interviews was analyzed using a constructivist thematic analysis method, guided by an intersectional theoretical scaffold. Three themes were identified related to systemic barriers, mental health, system navigation and self-care, and collected under the overarching theme of ‘facing the unknown with dementia’. Results emphasized the value and notable absence of community driven, culturally specific dementia programs, resources and navigators for people living with dementia, family caregivers and care workers of African descent. Participants identified lack of health system and care provider knowledge and understanding of the cultures and histories of people of African descent as a barrier to quality care and to addressing dementia-related stigma. Conversations focused on the need for practical and accessible tools, strategies and perspectives responsive to the actually lived realities and needs of people in community, and for research that actually contributes to individual and collective life in tangible, timely and culturally meaningful ways. Recommendations focus on the importance of centering community in dementia care programs, policy, practice and research to improve services and supports for people of African descent.

Health Disparities of Cardiometabolic Disorders Among Filipino Americans: Implications for Health Equity and Community-Based Genetic Research.

Health disparities are well-documented among different racial and ethnic minority groups in the United States. Filipino Americans (FAs) are the third-largest Asian-American group in the USA and are commonly grouped under the Asian categorization. FAs have a higher prevalence of cardiometabolic disorders than non-Hispanic Whites and other Asian subgroups with rates comparable to African Americans. Although no major epidemiological studies have ascertained the prevalence of cardiometabolic diseases in FAs, limited reports suggest that FAs have a higher prevalence of dyslipidemia, hypertension, diabetes, metabolic syndrome, hyperuricemia, and gout than non-FAs. A recent genetic study has shown that FAs could have the highest prevalence of a genetic polymorphism strongly associated with the development of gout and gout-related comorbidities. While developing cardiometabolic disorders is a heterogeneous and multifaceted process, the overall prevalence of certain cardiometabolic disorders parallel the prevalence of population-level risk factors, including genetics, dietary lifestyles, health beliefs, and social determinants of health. Therefore, assessment of the Filipino cuisine, health behaviors among Filipinos, socio-cultural factors, and acculturation to living in the USA are equally critical. Ascertaining the contribution of the biological causes to disease onset and the different psychosocial factors that could modulate disease risk or disease management are needed. Ultimately, a multilevel research approach is critical to assess the role of biological and non-biological risk factors of cardiometabolic disorders in FAs to inform culturally appropriate health promotion, disease prevention strategies, and a personalized approach to health.

The Impact of Artificial Intelligence on Health Equity in Oncology: A Scoping Review

Introduction: The expanding use of Artificial Intelligence (AI) in hematology and oncology research and practice creates an urgent need to consider the potential impact of these technologies on health equity at both local and global levels. Fairness and equity are issues of growing concern in AI ethics, raising problems ranging from bias in datasets and algorithms to disparities in access to technology. The impact of AI on health equity in oncology, however, remains underexplored. We conducted a scoping review to characterize, evaluate, and identify gaps in the existing literature on AI applications in oncology and their implications for health equity in cancer care.Methodology: We performed a systematic literature search of MEDLINE (Ovid) and EMBASE from January 1, 2000 to March 28, 2021 using key terms for AI, health equity, and cancer. Our search was restricted to English language abstracts with no restrictions by publication type. Two reviewers screened a total of 9519 abstracts, and 321 met inclusion criteria for full-text review. 247 were included in the final analysis after assessment by three reviewers. Studies were analysed descriptively, by location, type of cancer and AI application, as well as thematically, based on issues pertaining to health equity in oncology.Results: Of the 247 studies included in our analysis, 150 (60.7%) were based in North America, 57 (23.0%) in Asia, 29 (11.7%) in Europe, 5 (2.1%) in Central/South America, 4 (1.6%) in Oceania, and 2 (0.9%) in Africa. 71 (28.6%) were reviews and commentaries, and 176 were (71.3%) clinical studies. 25 (10.1%) focused on AI applications in screening, 42 (17.0%) in diagnostics, 46 (18.6%) in prognostication, and 7 (2.9%) in treatment. 40 (16.3%) used AI as a tool for clinical/epidemiological research and 87 (35.2%) discussed multiple applications of AI. A diverse range of cancers were represented in the studies, including hematologic malignancies. Our scoping review identified three overarching themes in the literature, which largely focused on how AI might improve health equity in oncology. These included: (1) the potential for AI reduce disparities by improving access to health services in resource-limited settings through applications such as low-cost cancer screening technologies and decision support systems; (2) the ability of AI to mitigate bias in clinical decision-making through algorithms that alert clinicians to potential sources of bias thereby allowing for more equitable and individualized care; (3) the use of AI as a research tool to identify disparities in cancer outcomes based on factors such as race, gender and socioeconomic status, and thus inform health policy. While most of the literature emphasized the positive impact of AI in oncology, there was only limited discussion of AI's potential adverse effects on health equity . Despite engaging with the use of AI in resource-limited settings, ethical issues surrounding data extraction and AI trials in low-resource settings were infrequently raised. Similarly, AI's potential to reinforce bias and widen disparities in cancer care was under-examined despite engagement with related topics of bias in clinical decision-making.Conclusion: The overwhelming majority of the literature identified by our scoping review highlights the benefits of AI applications in oncology, including its potential to improve access to care in low-resource settings, mitigate bias in clinical decision-making, and identify disparities in cancer outcomes. However, AI's potential negative impacts on health equity in oncology remain underexplored: ethical issues arising from deploying AI technologies in low-resources settings, and issues of bias in datasets and algorithms were infrequently discussed in articles dealing with related themes. DisclosuresNo relevant conflicts of interest to declare.

Systemic Barriers to Risk-Reducing Interventions for Hereditary Cancer Syndromes: Implications for Health Care Inequities.

Hereditary cancer syndromes result from germline genetic alterations predisposing individuals to higher lifetime cancer risk than the general population. Hereditary cancer syndromes account for 5%-10% of all malignancies and are characterized by early-onset, aggressive tumors affecting multiple tissue types.1 For example, patients with hereditary breast and ovarian cancer syndrome (HBOC) have high lifetime risk of breast (41%-90%) and ovarian (8%-62%) cancers and elevated risk for several other cancers.2 Similarly, patients with Lynch syndrome (LS) have high lifetime risk of colorectal (12%-52%) and endometrial (0%-57%) cancers, as well as other cancers.3 Reduced cost of genetic technologies4 and new guidance on collecting family history in primary care5 have enabled better detection of these syndromes, providing opportunities to reduce cancer risk. CONTEXT Key Objective Individuals with hereditary cancer syndromes are predisposed to higher lifetime cancer risk than the general population. Early diagnosis of these syndromes can lead to downstream care that greatly reduces cancer morbidity and mortality. In this narrative review, we explore the factors affecting uptake of and adherence to hereditary cancer risk reduction strategies and how these factors interact with systemic barriers to care in medically marginalized populations. Knowledge Generated We identified factors at the health system, clinician, and patient levels that interact to affect downstream hereditary cancer care and have implications for health equity. We found that several interventions designed to improve downstream care utilization did not address systemic barriers affecting marginalized populations and suggest strategies to address these barriers in future intervention design. Relevance Our review creates a template for the design of more equitable interventions to improve downstream hereditary cancer care.

Child Poverty and Health in the United States: Introduction and Executive Summary.

Child Poverty and Health in the United States: Introduction and Executive Summary.

An Overview of Post–COVID-19 Condition (Long COVID)


 Long-term symptoms after developing COVID-19, known as post–COVID-19 condition or colloquially as long COVID, is a new condition estimated to affect millions of people worldwide. While standard diagnostic criteria have not yet been developed, current estimates suggest that 21% to 23% of people suspected of having had COVID-19 may have symptoms 4 weeks after their COVID-19 infections and 14% may have symptoms 12 weeks post-infection. Among people with self-reported post–COVID-19, an estimated 40% may continue to experience symptoms for at least a year.
 To provide health care providers and people with post–COVID-19 condition advice regarding diagnosis and treatment, guidelines have been published by the National Institute for Health and Care Excellence (NICE) and by the Centers for Disease Control and Prevention (CDC). The CDC guidelines were published more recently and refer to newer data on post–COVID-19 condition.
 Post-COVID symptoms can affect multiple organ systems and symptoms may vary by patient characteristics such as age and sex, as well as change over time. Some people may develop more severe symptoms or have increased risk of developing other illnesses. As there are currently no known unique symptoms and no tests available to diagnose post–COVID-19 syndrome, guidelines from NICE and the CDC recommend diagnosing based on symptoms, suspected previous COVID-19 infection, and ruling out other potential causes of symptoms.
 Current treatment recommendations focus on multidisciplinary care and personalized treatment to address the potential range of symptoms unique to each patient. Different methods of delivering treatment have been suggested and implemented around the world, including specialized post–COVID-19 clinics and integrating treatment into primary care.
 Post–COVID-19 condition can result in a reduced ability to work or attend school, and reduced independence, which can impact quality of life. These effects may have a disproportionate impact on disadvantaged groups, which will have important implications for health equity.
 Limited evidence on the clinical effectiveness and cost-effectiveness of therapies for post–COVID-19 condition was identified. However, many trials have been registered and are in progress to address this knowledge gap.

Pediatric Telehealth in the COVID-19 Pandemic Era and Beyond

The coronavirus disease 2019 (COVID-19) pandemic led to an unprecedented demand for health care at a distance, and telehealth (the delivery of patient care using telecommunications technology) became more widespread. Since our 2018 state-of-the-art review assessing the pediatric telehealth landscape, there have been many changes in technology, policy, payment, and physician and patient acceptance of this care model. Clinical best practices in telehealth, on the other hand, have remained unchanged during this time, with the primary difference being the need to implement them at scale.Because of the pandemic, underlying health system weaknesses that have previously challenged telehealth adoption (including inequitable access to care, unsustainable costs in a fee-for-service system, and a lack of quality metrics for novel care delivery modalities) were simultaneously exacerbated. Higher volume use has provided a new appreciation of how patients from underrepresented backgrounds can benefit from or be disadvantaged by the shift toward virtual care. Moving forward, it will be critical to assess which COVID-19 telehealth changes should remain in place or be developed further to ensure children have equitable access to high-quality care.With this review, we aim to (1) depict today's pediatric telehealth practice in an era of digital disruption; (2) describe the people, training, processes, and tools needed for its successful implementation and sustainability; (3) examine health equity implications; and (4) critically review current telehealth policy as well as future policy needs. The American Academy of Pediatrics (AAP) is continuing to develop policy, specific practice tips, training modules, checklists, and other detailed resources, which will be available later in 2021.

Power and the people's health

Public policy plays a central role in creating and distributing resources and conditions of daily life that matter for health equity. Policy agendas have tended to focus on health care delivery and individualised interventions. Asking why there is a lack of policy action on structural drivers of health inequities raises questions about power inequities in policy systems that maintain the status quo.In this paper we investigate the power dynamics shaping public policy and implications for health equity. Using a Health Equity Power Framework (HEPF), we examined data from 158 qualitative interviews with government, industry and civil society actors across seven policy case studies covering areas of macroeconomics, employment, social protection, welfare reform, health care, infrastructure and land use planning.The influence of structures of capitalism, neoliberalism, sexism, colonisation, racism and biomedicalism were widely evident, manifested through the ideologies, behaviours and discourses of state, market, and civil actors and the institutional spaces they occupied. Structurally less powerful public interest actors made creative use of existing or new institutional spaces, and used network, discursive and moral power to influence policy, with some success in moderating inequities in structural and institutional forms of power.Our hope is that the methodological advancement and empirical data presented here helps to illuminate how public interest actors can navigate structural power inequities in the policy system in order to disrupt the status quo and advance a comprehensive policy agenda on the social determinants of health equity.However, this analysis highlights the unrealistic expectation of turning health inequities around in a short time given the long-term embedded power dynamics and inequities within policy systems under late capitalism. Achieving health equity is a power-saturated long game.

Parent Website Engagement and Health Equity Implications in a Child Care–Based Wellness Intervention

ObjectiveTo evaluate demographic differences in parent website engagement in a child care–based wellness intervention. DesignParent-reported demographic characteristics and observed website engagement were averaged by child care centers participating in the web-based intervention arm of a cluster randomized controlled trial of wellness interventions. Setting and ParticipantsParents of preschoolers in 17 Maryland child care centers. Main Outcome MeasuresWebsite engagement: (1) webpage views, (2) average time on webpage, and (3) intervention activity completion. InterventionParents received access to a website containing content on wellness-promoting topics (eg, parenting, nutrition, physical activity) and their child care center's activities. AnalysisCross-sectional differences in website engagement by demographic characteristics were assessed using ANOVA. ResultsCenters with a high proportion of parents who identified as other than non-Hispanic White and had less than a bachelor's degree had significantly fewer webpage views, and completed significantly fewer intervention activities compared with centers with parents who were predominantly non-Hispanic White and had more than a bachelor's degree. Conclusions and ImplicationsDemographic differences in parents’ child care center website engagement represent disparities that could contribute to health inequities in parents’ access to wellness-promoting material. Future efforts could identify factors that eliminate demographic disparities in parent engagement in web-based interventions.

How the Trump Administration's Pandemic Health Care Response Failed Racial Health Equity: Case Studies of Structural Racism and a Call for Equity Mindfulness in Federal Health Policy Making

The racial health equity implications of the Trump administration's response to the COVID-19 pandemic. We focus on four key health care policy decisions made by the administration in response to the public health emergency: rejecting a special Marketplace enrollment period, failing to use its full powers to enhance state Medicaid emergency options, refusing to suspend the public charge rule, and failing to target provider relief funds to providers serving the uninsured. In each case, the administration's policy choices intensified, rather than mitigated, racial health inequality. Its choices had a disproportionate adverse impact on minority populations and patients who are more likely to depend on public programs, be poor, experience pandemic-related job loss, lack insurance, rely on health care safety net providers, and be exposed to public charge sanctions. Ending structural racism in health care and promoting racial health care equity demands an equity-mindful approach to the pursuit of policies that enhance-rather than undermine-health care accessibility and effectiveness and resources for the poorest communities and the providers that serve them.

Interventions using behavioural insights to influence children's diet-related outcomes: A systematic review.

The global prevalence of children with overweight and obesity continues to rise. Obesity in childhood has dire long-term consequences on health, social and economic outcomes. Promising interventions using behavioural insights to address obesity in childhood have emerged. This systematic review examines the effectiveness and health equity implications of interventions using behavioural insights to improve children's diet-related outcomes. The search strategy included searches on six electronic databases, reference lists of previous systematic reviews and backward searching of all included studies. One-hundred and eight papers describing 137 interventions were included. Interventions using behavioural insights were effective at modifying children's diet-related outcomes in 74% of all included interventions. The most promising approaches involved using incentives, changing defaults and modifying the physical environment. Information provision alone was the least effective approach. Health equity implications were rarely analysed or discussed. There was limited evidence of the sustainability of interventions-both in relation to their overall effectiveness and cost-effectiveness. The limited evidence on health equity, long-term effectiveness and the cost-effectiveness of these interventions limit what can be inferred for policymakers. This review synthesises the use of behavioural insights to improve children's diet-related outcomes, which can be used to inform future interventions.

Pediatric ACES assessment within a collaborative practice model: Implications for health equity.

It is now well understood that exposure to Adverse Childhood Experiences (ACEs) is negatively linked to health and well-being across the lifespan. In an effort to disrupt ACEs exposure and its effects, there is a nationwide movement to screen for ACEs in primary care, despite a lack of well-established guidelines for assessing and responding to risk within routine care. Additionally, developing culturally responsive models of ACEs assessment is imperative, particularly because racial and ethnic minority populations face disproportionate risk of exposure to ACEs and disparities in quality of health care. Using mixed methods, we explored the feasibility, acceptability, and utility of conducting ACEs routine inquiry with an ethnically and economically diverse pediatric population through a unique collaborative practice model (CPM) consisting of an integrated, multidisciplinary team within primary care. In the CPM study, 163 children from a safety-net health system were enrolled; of those, an ACEs questionnaire was collected from 158 (97%) study participants as part of their mental health evaluation. The sample was highly ACEs exposed, with 40% of children and 56% of teens having scores of four or more. There were significant associations between level of ACEs exposure and degree of mental health impairment in both children and teens. Providers viewed the ACEs assessment process as feasible, acceptable, and to have utility for the care of the study's diverse pediatric population. Findings highlight benefits, challenges, cultural considerations and recommendations for promoting health equity through a primary-care integrated ACEs assessment model. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Misinformation, Health Equity, News Media: Application of Critical Race Theory (CRT) to Examine News Media’s Role in Normalizing Religious Bigotry

One of the unintended consequences of infodemics is the subtle misinformation, especially through nonverbalized images, which often goes unexamined. In an age of (mis)infodemics, the role of news media is critical in the spread or containment of misleading information ranging from public health to religious intolerance. News media wields the power to influence public opinions, attitudes, beliefs, and even determine public agenda. News media have a history of biased reporting and influencing public opinion. Much like propaganda, it upholds status-quo perceptions on issues such as race, police brutality, terrorism, and religious bigotry. During the current COVID-19 pandemic, news media have subtly spread misleading information through story image selection, which perpetuates and exacerbates Islamophobia. We document a pattern of misleading news story images and draw from interdisciplinary research to reflect on the public health and health equity implications of the spread of such misleading information on the Muslim community in the United States. News media’s role in a free society as a neutral, transparent entity is critical that provides objective information instead of misleading stories such as sensationalized clickbait. We must hold news media to a higher standard to achieve an open, fair, and free society. News media can ‘flatten the curve’ of religious bigotry, racial biases, and misinformation by adhering to a system of accountability.

Physiological Dysregulation and Aging: Implications for Health Equity

Social determinants of health (SDOH) are a major public health issue that affect the magnitude and prognosis of many diseases in the U.S., including cardiovascular disease and cognitive disorders of aging. These associations are especially deleterious among minority persons in the US due to consistently unfavorable social determinants in this population including socioeconomic position, residential segregation, and quality of education. Physiological dysregulation measures the “true global state” of an individual that includes, but goes beyond, chronological age, reflects the health burden produced, in part, by SDOH, and is associated with the development and prognosis of disease. A better understanding of how and when physiological dysregulation occurs may allow us to prevent or reverse dysregulation among the most vulnerable aging populations leading to improved health equity in cardiovascular and cognitive outcomes.

An Analysis of How Characteristics of Local Health Department Jurisdictions Influence Involvement in PHAB Accreditation: Implications for Health Equity.

To explore how characteristics of local health department (LHD) jurisdictions impact involvement in Public Health Accreditation Board (PHAB) accreditation and to characterize the implications for health equity. Data from the 2016 National Profile of LHDs survey were linked with data from the American Community Survey, National Center for Health Statistics, Behavioral Risk Factor Surveillance System, and the 2016 presidential election. Outcome measures included LHDs that were formally engaged in PHAB accreditation and LHDs that planned to apply for PHAB accreditation but were not formally engaged. Logistic regression was used to assess for the impact LHD jurisdictions' socioeconomic position, demographics, population health status, political ideology, and LHD organizational characteristics have on PHAB accreditation. Approximately 37% of the participants were formally engaged (n = 297) and planned to apply (n = 337) for PHAB accreditation. Involvement in PHAB accreditation was equal among LHDs based on poverty and income inequality, but median household income was negatively associated. Diverse jurisdictions were more likely to be involved in PHAB accreditation but less likely to be involved after controlling for covariates. Jurisdictions with worse population health status were either as likely or more likely to be involved in PHAB accreditation. Jurisdictions with a greater conservative political ideology were less likely to be involved. LHD involvement in PHAB accreditation varies by their jurisdiction's characteristics. This has implications for health equity based on socioeconomic, racial, and population health status. Policies and practices are needed to improve the uptake of PHAB accreditation in LHD jurisdictions impacted most by health inequities.