Strategies such as diversifying the public health workforce; building capacity related to diversity, equity, inclusion, and belonging; and conducting research on oppression are necessary but insufficient to improving health in communities that have been marginalized by systems of oppression. Working toward health and racial equity requires changing the structural drivers of health. Public health interventions must advance widespread and lasting structural change—changes in values and beliefs; culture and norms; governance; laws, policies, regulations, and budgets; and institutional practices.
Structural interventions include, for example, shifting government budgets by increasing taxes on multinational corporations and the wealthy while increasing investment in low-opportunity neighborhoods of color and rural communities. They include changing the US electoral systems to reduce corporate influence, ensuring everyone has a voice that counts equally and can vote freely, and making our elected bodies more democratic and accountable. Structural interventions also include influencing narratives about the virtues of free markets and how the economy works so that the public understands that people govern the economy and can work toward an economy where all can thrive.
Structural interventions require the long-term work of shifting power—both building community power within marginalized communities and contesting the power of those who use it to maintain the status quo. Shifting power means changing who is making public decisions, controlling the political agenda, and influencing dominant narratives. If these are the changes needed to advance equity, does public health currently have the lens, know-how, and audacity to work toward these changes?
Public health needs a power lens: a common, nuanced, and critical understanding of how power works; the potential to mobilize collective power fieldwide; and strategies to shift the balance in power relations to address structural inequity and oppression. We submit that public health must increase its capacity to (1) recognize, (2) analyze, and (3) shift power. (author introduction)