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August 27, 2025
Quarterly Article
LORI DORFMAN
Sarah E. Gollust
MAKANI THEMBA
PRITPAL S. TAMBER
Anthony Iton
Aug 27, 2025
Aug 4, 2025
Back to The Milbank Quarterly
Policy Points:
A growing body of scholarship and practice in public health attests to the importance of addressing differences in power as a fundamental determinant of health inequities.1-6 To pursue health equity, public health practitioners must move beyond identifying differences in health outcomes among populations (disparities) to articulating why those differences are unfair or unjust (inequities) and then identifying structures, such as laws, policies, practices, and norms, that advantage some and disadvantage others.7, 8 The act of doing so forces public health practitioners to consider the allocation of public resources, a process that is ultimately political.3, 9 Fundamentally, going this far “upstream” to the root causes of inequity means confronting, understanding, and then addressing differences in power among and across populations.2, 10
Reynolds MM. Health power resources theory: a relational approach to the study of health inequalities. J Health Soc Behav. 2021;62(4):493-511.
Michener J. Health justice through the lens of power. J Law Med Ethics. 2022;50(4):656-662.
Iton A, Ross RK, Tamber PS. Building community power to dismantle policy-based structural inequity in population health. Health Aff (Millwood). 2022;41(12):1763-1771.
Heller JC, Little OM, Faust V, et al. Theory in action: public health and community power building for health equity. J Public Health Manag Pract. 2023;29(1):33-38.
Heller JC, Fleming PJ, Petteway RJ, Givens M, Pollack Porter KM. Power up: a call for public health to recognize, analyze, and shift the balance in power relations to advance health and racial equity. Am J Public Health. 2023;113(10):1079-1082.
Lynch J. The political economy of health: bringing political science in. Annu Rev Polit Sci. 2023;26:389-410.
Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429-445.
Braveman PA, Arkin E, Proctor D, Kauh T, Holm N. Systemic and structural racism: definitions, examples, health damages, and approaches to dismantling. Health Aff (Millwood). 2022;41(2):171-178.
Rittel HWJ, Webber MM. Dilemmas in a general theory of planning. Policy Sci. 1973;4:155-169.
Heller JC, Givens ML, Johnson SP, Kindig DA. Keeping it political and powerful: defining the structural determinants of health. Milbank Q. 2024;102(2):351-366.
