Resources from the Culture of Health Program

Systems’ Impact on Historically and Currently Marginalized Populations

An NAM Special Publication

Systems’ Impact on Historically and Currently Marginalized Populations (forthcoming in 2024) explores the role that various systems have on influencing disparate health outcomes of historically and currently marginalized populations. The NAM special publication focuses on the historical and current context of how systemic and structural racism perpetuate oppression via unequal power relationships; identifies ways that marginalization flows through systems to perpetuate inequities; and identifies opportunities to dismantle structural and systemic racism for improved health outcomes for all.

Culture of Health Program Instagram Campaign​

The NAM’s first high school intern, Alicia Gebara, completed a CoHP Instagram Campaign as part of her internship. Scroll through the images to learn more about health equity, social determinants of health, and what you can do to get involved with these topics in your community.

Acknowledging Structural Racism’s Direct and Negative Impact on Health 


Everyone in this country deserves the opportunity to be healthy and reach their full potential no matter who they are or where they live. Yet, Black, Indigenous, and people of color often face barriers that have a direct and negative impact on their health. These barriers are not random or accidental. They reflect social and economic inequality and structural racism in this country. Systems and policies determine whose air and water is clean; who has access to good schools, jobs, and affordable housing; where parks, grocery stores, and hospitals are located; which communities are safe to be active outdoors; and much more. All of these factors play a critical role in determining people’s health and well-being.

As the CoHP moved into its second phase, the NAM highlighted statements from past CoHP reports that acknowledge structural racism’s direct and negative impact on health – and in particular the disproportionate effects on the health and well-being of Black, Indigenous, and people of color.

Resources on Health Equity in the Context of COVID-19 and Disproportionate Outcomes for Marginalized Groups


As COVID-19 commands the attention of our nation, we face an extraordinary opportunity to advance health equity by eliminating the structural barriers to good health for marginalized populations. One of the root causes of health inequity is structural racism, illuminated most recently by the disproportionate outcomes for people of color related to COVID-19 and increasingly highlighted in the national dialogue around racial injustice.

The Culture of Health Program is committed to advancing the scientific underpinnings for progress in health equity and sharing evidence-based strategies to bring about the transformation in policy decision-making and public recognition necessary to dismantle structural racism and ultimately achieve health equity for all – mitigating the effects of the current crisis and safeguarding the well-being of our nation for the future.

Consensus Reports


Communities in Action: Pathways to Health Equity is the first in a series of consensus reports to emerge from the National Academy of Medicine’s Culture of Health Program. Health equity is the state in which everyone has the opportunity to attain full health potential no matter who they are or where they live. Many factors determine people’s health and well-being, and existing barriers that often have a direct and negative impact on the health of Black, Indigenous, and people of color are not random or accidental. This report finds that system-level changes are needed to reduce poverty, eliminate structural racism, improve income equality, increase educational opportunity, and fix the policies that perpetuate structural inequities. Together, all actors in society—residents and community-based organizations, in partnership with businesses, state and local government, anchor and faith-based institutions—can create solutions that address structural racism and promote health and well-being for all.

The Promise of Adolescence: Realizing Opportunity for All Youth is second in the series. Adolescence is a critical period of development during which key areas of the brain mature and develop. These changes in brain structure, function, and connectivity mark adolescence as a period of opportunity to discover new vistas, to form relationships with peers and adults, and to explore one’s developing identity. It is also a period of resilience that can ameliorate childhood setbacks and set the stage for a thriving trajectory over the life course. The nation needs policies and practices that will better leverage these developmental opportunities to harness the promise of adolescence—rather than focusing myopically on containing its risks. This report examines the neurobiological and socio-behavioral science of adolescent development and outlines how this knowledge can be applied, both to promote adolescent well-being, resilience, and development, and to rectify structural barriers and inequalities in opportunity, enabling all adolescents to flourish.

Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity is third in the series. Children are the foundation of the United States, and supporting them is a key component of building a successful future. However, millions of children face health inequities that compromise their development, well-being, and long-term outcomes, despite substantial scientific evidence about how those adversities contribute to poor health. Reducing health disparities by addressing their systemic root causes, including poverty and racism, is foundational to advance health equity. The science-driven recommendations provided in this report lay out practice, policy, and systems changes needed to close the health equity gap and nurture vibrant and healthy children.

Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health, fourth in the series, was released before the World Health Organization declared COVID-19 a global pandemic, but improving social conditions and integrating social care into health care delivery is more relevant than ever in the context of the pandemic and increased strains placed on the U.S. health care system. The report assesses approaches to social care integration currently being taken by health care providers and systems, and new or emerging approaches and opportunities; current roles in such integration by different disciplines and organizations, and new or emerging roles and types of providers; and current and emerging efforts to design health care systems to improve the nation’s health and reduce health inequities. The report and its related products ultimately aim to help improve health and health equity, during COVID-19 and beyond.

Visualize Health Equity


The National Academy of Medicine called on artists from across the nation to illustrate what health equity looks, sounds, and feels like to them. We received over 100 art submissions, including paintings, drawings, poetry, photos, videos, spoken word, and more. 

By sharing insights directly from people in diverse communities around the United States, the goal of this community art project is to get more people thinking and talking about health equity and the social determinants of health. It is our hope that through a creative lens, we can better understand what people across the country see as the most important health barriers and opportunities facing their communities.

The pieces found within offer moving insights into how individuals and communities view and prioritize health and demonstrate how health is an essential building block to a thriving community and nation. 

Picture of Health | John Colavito | New York, NY

Young Leaders Visualize Health Equity


How do the social determinants of health shape your life and the lives of your family and community? How would you make sure your friends, family, and community all have the same chance to be healthy, safe, and happy?

The National Academy of Medicine called on young leaders, ages 5-26, to use art to explore how the social determinants of health play a role in shaping their lives and their communities, and what it might look and feel like to one day live in a world where everyone has the same chance to be healthy, safe, and happy. We received over 175 submissions.

The voices of young leaders across the country are vital to the ongoing conversation about health equity and the future of our world. 

The Innocence of Adolescence | Gabriella Collins | White Plains, New York

Community-Driven Health Equity Action Plans


The National Academy of Medicine created and piloted a model for developing Community-Driven Health Equity Action Plans with diverse communities across the United States. The model offers insights to groups looking to strategize how to reduce health inequities locally. The model provides a framework to develop a plan to advance health equity at the community level in seven steps: 1) vision and goals, 2) community context, 3) research grounding, 4) strategies and tactics, 5) stakeholders, 6) timeline, and 7) sustainability. 

Five pilot communities used the model to develop plans to address a priority of their communities: and have agreed to share their Community-Driven Health Equity Action Plans as detailed examples for other communities or organizations interested in creating or sustaining plans to advance health equity. We hope communities and organizations ultimately use the model and Community-Driven Health Equity Action Plans to support equitable good health among local residents across the country. 

Community Documentaries


We are proud to present the stories of these three diverse communities that face complex, pervasive challenges but are all making progress in advancing health equity.

While every community must develop an approach suited to its own unique needs, our hope is that in sharing these stories, communities facing similar challenges might be inspired and informed to build solutions that are right for them.

People United for Sustainable Housing (PUSH Buffalo)

Residents of West Buffalo, NY inhabit some of the oldest houses in the nation. Many live with lead, asbestos, and mold every day. PUSH Buffalo is helping them take their health and their homes back into their own hands.

Indianapolis Congregation Action Network (IndyCAN), now Faith in Indiana

IndyCAN is reminding every member of their community that they have power to fight health inequity. From listening campaigns to research and rallies, IndyCAN organizes people for a purpose.

Kokua Kalihi Valley Comprehensive Family Services

Kokua Kalihi Valley Comprehensive Family Services serves over 10,000 community members each year and works to foster physical, mental, emotional, and spiritual health for everyone. A healthier Kalihi Valley, envisioned by the community leaders who founded KKV over 40 years ago, is an inclusive community in which neighbors help to heal neighbors, and people see themselves as part of a larger whole, connected to each other, to their culture, and to their shared land.

Community Health Heroes


Inspired by the 2017 National Academies report Communities in Action, this series highlights individuals or groups who are working to advance health and health equity in communities across the nation. The series features preventive strategies and programs that are conceived and implemented at the local level and focus on a range of factors that contribute to health, like education, employment, health systems and services, housing, income and wealth, the physical environment, public safety, the social environment, and transportation. Interviewees describe challenges, success stories, and lessons about what has worked for their organizations and communities. The purpose of the series is to share information, support networking, and spark new ideas.

Photo cred: Archie’s Acres

Communities in Action: Pathways to Health Equity Conceptual Model: Conceptual model from the National Academies that depicts the context of structural inequities, socioeconomic and political drivers, and the determinants of health in which health inequities and community-driven solutions exist. Learn more about the root causes of health inequities here.

What You Can Do to Promote Health Equity

Vital Signs: Core Metrics for Health and Health Care Progress: Interactive infographic based on the Vital Signs report

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