Health Equity, Health Literacy and the Ethical Imperative to Coalesce

This blog post was originally posted on the Horowitz Center for Health Literacy website on April 15, 2019

Written by Dr. Stephen B. Thomas, Director, Maryland Center for Health Equity

Photo of Dr. Stephen Thomas

Imagine you had the opportunity to build a new health care facility from the ground up?  Would you build your grandfather’s hospital or your great grandmother’s clinic? That’s what can happen if things are left to “business as usual.”  The Maryland Center for Health Equity decided to do something “Fearless,” something disruptive … we decided to enter into a collaborative partnership with Catholic Charities, Archdiocese of Washington DC and Doctors Community Hospital to redesign health care delivery.

A little over two years later, the Susan D. Mona Center for Health and Wellness is the result of our Fearless Idea. The Mona Center provides primary care, dental care, and legal services to the Prince George’s County Temple Hills community.

The project is a work in progress. The future learning farm, teaching kitchen, physical activity studio and mental health service rooms need financial support to complete construction. What was once a dilapidated building boarded up on a trash strewn corner is a beacon light of hope for a community on the rebound. The Mona Center anchors new businesses, giving the neighborhood a new heartbeat of safety and compassion.

Disruptive change of this magnitude does not come by accident or serendipity. People of faith, empathy, science and love for humanity came together to bring the Mona Center to life. They applied servant leadership, infused with the spirit of social entrepreneurs. The Mona Family donated the building to Catholic Charities and reached out to Doctors Community Hospital and the University of Maryland School of Public Health, specifically the Center for Health Equity.

Mona Center Fall Health Fair

Dr. Thomas at the Mona Center Fall Health Fair

Think back to the last time you were in a hospital … the smell… the cacophony of sounds, the confusing signs and maybe out of the corner of your eye… you see human suffering.  It need not be this way. To create something fearlessly different, I called on the Center for Health Literacy. Drs. Cynthia Baur and Alice Horowitz came to the Temple Hills site and interviewed clients, asking them how they would like things phrased and what kind of signage is best. This work supports the goal of the Mona Center as a health literate organization!

If you create materials using plain language principles, but the institution in which you’re operating is not fair to the people you’re trying to serve, it doesn’t matter if they can read your materials. You have a system that’s still inequitable, still has barriers preventing people from accessing services. Ultimately, we’re stronger together. The more we do when we have health equity and health literacy together, the stronger we will be as a field and as a discipline.

The bottom line is health equity is about fairness. Does everyone have equitable access to services or knowledge about services? It’s about leveling the playing field across race, age, gender, sexual orientation, ability and more. And it begins with how you build relationships, trust, and a healthy community.

In 2002, the Public Health Leadership Society, a highly regarded group of senior public health officials and others, published the often cited Principles of the Ethical Practice of Public Health (PHLS, 2002). This code delineates twelve principles to guide the ethical practice of public health. Two principles stand out as useful for addressing health disparities:

  • Principle 1: Public health should address principally the fundamental causes of disease and requirements for health, aiming to prevent adverse health outcomes.

  • Principle 4: Public health should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all.

These two ethical principals can help guide our mission to coalesce health equity and health literacy in the service of something greater than our unique disciplines. Indeed, we are not only stronger together, but the synergy we create has the potential to transform health care in Maryland.  The Susan D. Mona Center is one example of health literacy and health equity being tied at the hip. Although they have different origin stories, the two fields cannot creatively disrupt the status quo without the other.

Maryland is positioned to make groundbreaking impacts in the world of health equity and health literacy. In the 2017 legislative session, we secured Senate and Delegate support for the University of Maryland School of Public Health, Center for Health Equity Health in All Policies Act of 2017. Signed into law by Govenor Hogan, the Act requires representatives from all state agencies to come around one table and examine how their work affects population health.

If you work for the transportation or housing department, it’s easy to think that your policies don’t have an impact on human health, but science tells us they do. Maryland is in the forefront of new strategies for innovating health care delivery that is sensitive to the social determinants of health and promoting statewide campaigns for health literacy and health equity.

The Health in All Policies Act is an example of addressing issues beyond the individual level.  It’s important that we tackle health equity and health literacy issues at each level of our social ecology. Focusing on the individual level without addressing the institution is not enough. Creating institutions that lack empathy toward human suffering is unethical. I agree with Powers and Faden (2006), the moral foundation of public health and health policy is social justice. By explicitly linking, blending, and knitting health equity and health literacy together, we can tranform health care and bend the moral arc of history toward justice.



Racial and Ethnic Disparities as a Public Health Ethics Issue

Stephen B. Thomas (2019)

The Oxford Handbook of Public Health Ethics

Edited by Anna C. Mastroianni, Jeffrey P. Kahn, and Nancy E. Kass

PHLS (Public Health Leadership Society). 2002. Principles of the Ethical Practice of Public Health. ethics_brochure.ashx.

Powers, M., and Faden, R. 2006. Social Justice: The Moral Foundations of Public Health and Health Policy (Oxford: Oxford University Press).


Dr. Wilson is an associate professor with the Maryland Institute for Applied Environmental Health (MIAEH) and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland-College Park. Dr. Wilson is an environmental health scientist with over ten years of experience working in community-university partnerships on environmental health and justice issues. He has expertise in exposure science and applied environmental health including community-based exposure assessment, environmental justice science, social epidemiology, environmental health disparities, built environment, air pollution monitoring, and community-based participatory research (CBPR). For the past two years, he has been building a program on community engagement, environmental justice, and health (CEEJH) to engage impacted communities, advocacy groups, and policymakers in Maryland and the Washington, DC region on environmental justice issues and environmental health disparities.

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