As SARS-CoV-2, the virus that causes COVID-19, continues to circulate globally, high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention tools have substantially reduced the risk for medically significant COVID-19 illness (severe acute illness and post-COVID-19 conditions) and associated hospitalization and death (1). These circumstances now allow public health efforts to minimize the individual and societal health impacts of COVID-19 by focusing on sustainable measures to further reduce medically significant illness as well as to minimize strain on the health care system, while reducing barriers to social, educational, and economic activity (2). Individual risk for medically significant COVID-19 depends on a person's risk for exposure to SARS-CoV-2 and their risk for developing severe illness if infected (3). Exposure risk can be mitigated through nonpharmaceutical interventions, including improving ventilation, use of masks or respirators indoors, and testing (4). The risk for medically significant illness increases with age, disability status, and underlying medical conditions but is considerably reduced by immunity derived from vaccination, previous infection, or both, as well as timely access to effective biomedical prevention measures and treatments (3,5). CDC's public health recommendations change in response to evolving science, the availability of biomedical and public health tools, and changes in context, such as levels of immunity in the population and currently circulating variants. CDC recommends a strategic approach to minimizing the impact of COVID-19 on health and society that relies on vaccination and therapeutics to prevent severe illness; use of multicomponent prevention measures where feasible; and particular emphasis on protecting persons at high risk for severe illness. Efforts to expand access to vaccination and therapeutics, including the use of preexposure prophylaxis for persons who are immunocompromised, antiviral agents, and therapeutic monoclonal antibodies, should be intensified to reduce the risk for medically significant illness and death. Efforts to protect persons at high risk for severe illness must ensure that all persons have access to information to understand their individual risk, as well as efficient and equitable access to vaccination, therapeutics, testing, and other prevention measures. Current priorities for preventing medically significant illness should focus on ensuring that persons 1) understand their risk, 2) take steps to protect themselves and others through vaccines, therapeutics, and nonpharmaceutical interventions when needed, 3) receive testing and wear masks if they have been exposed, and 4) receive testing if they are symptomatic, and isolate for ≥5 days if they are infected.

Recent reviews have emphasized the need for a health equity agenda in genomics research. To ensure that genomic discoveries can lead to improved health outcomes for all segments of the population, a health equity agenda needs to go beyond research studies. Advances in genomics and precision medicine have led to an increasing number of evidence-based applications that can reduce morbidity and mortality for millions of people (tier 1). Studies have shown lower implementation rates for selected diseases with tier 1 applications (familial hypercholesterolemia, Lynch syndrome, hereditary breast and ovarian cancer) among racial and ethnic minority groups, rural communities, uninsured or underinsured people, and those with lower education and income. We make the case that a public health agenda is needed to address disparities in implementation of genomics and precision medicine. Public health actions can be centered on population-specific needs and outcomes assessment, policy and evidence development, and assurance of delivery of effective and ethical interventions. Crucial public health activities also include engaging communities, building coalitions, improving genetic health literacy, and building a diverse workforce. Without concerted public health action, further advances in genomics with potentially broad applications could lead to further widening of health disparities in the next decade.

The disproportionate impact of COVID-19 and associated disparities among Hispanic, non-Hispanic Black, and non-Hispanic American Indian/Alaska Native children and teenagers has been documented. Reducing these disparities along with overcoming unintended negative consequences of the pandemic, such as the disruption of in-person schooling, calls for broad community-based collaborations and nuanced approaches. Based on national survey data, children from some racial and ethnic minority groups have a higher prevalence of obesity, asthma, type 2 diabetes, and hypertension; were diagnosed more frequently with COVID-19; and had more severe outcomes compared with their non-Hispanic White (NHW) counterparts. Furthermore, a higher proportion of children from some racial and ethnic minority groups lived in families with incomes less than 200% of the federal poverty level or in households lacking secure employment compared with NHW children. Children from some racial and ethnic minority groups were also more likely to attend school via online learning compared with NHW counterparts. Because the root causes of these disparities are complex and multifactorial, an organized community-based approach is needed to achieve greater proactive and sustained collaborations between local health departments, local school systems, and other public and private organizations to pursue health equity. This article provides a summary of potential community-based health promotion strategies to address racial and ethnic disparities in COVID-19 outcomes and educational inequities among children and teens, specifically in the implementation of strategic partnerships, including initial collective work, outcomes-based activities, and communication. These collaborations can facilitate policy, systems, and environmental changes in school systems that support emergency preparedness, recovery, and resilience when faced with public health crises.

In the 10 months since the first confirmed case of coronavirus disease 2019 (COVID-19) was reported in the United States on January 20, 2020 (1), approximately 13.8 million cases and 272,525 deaths have been reported in the United States. On October 30, the number of new cases reported in the United States in a single day exceeded 100,000 for the first time, and by December 2 had reached a daily high of 196,227.* With colder weather, more time spent indoors, the ongoing U.S. holiday season, and silent spread of disease, with approximately 50% of transmission from asymptomatic persons (2), the United States has entered a phase of high-level transmission where a multipronged approach to implementing all evidence-based public health strategies at both the individual and community levels is essential. This summary guidance highlights critical evidence-based CDC recommendations and sustainable strategies to reduce COVID-19 transmission. These strategies include 1) universal face mask use, 2) maintaining physical distance from other persons and limiting in-person contacts, 3) avoiding nonessential indoor spaces and crowded outdoor spaces, 4) increasing testing to rapidly identify and isolate infected persons, 5) promptly identifying, quarantining, and testing close contacts of persons with known COVID-19, 6) safeguarding persons most at risk for severe illness or death from infection with SARS-CoV-2, the virus that causes COVID-19, 7) protecting essential workers with provision of adequate personal protective equipment and safe work practices, 8) postponing travel, 9) increasing room air ventilation and enhancing hand hygiene and environmental disinfection, and 10) achieving widespread availability and high community coverage with effective COVID-19 vaccines. In combination, these strategies can reduce SARS-CoV-2 transmission, long-term sequelae or disability, and death, and mitigate the pandemic's economic impact. Consistent implementation of these strategies improves health equity, preserves health care capacity, maintains the function of essential businesses, and supports the availability of in-person instruction for kindergarten through grade 12 schools and preschool. Individual persons, households, and communities should take these actions now to reduce SARS-CoV-2 transmission from its current high level. These actions will provide a bridge to a future with wide availability and high community coverage of effective vaccines, when safe return to more everyday activities in a range of settings will be possible.

Each year, influenza poses a substantial burden on communities and health care systems. During the 3 most recent influenza seasons (2016-2017, 2017-2018, and 2018-2019), influenza is estimated to have been associated with 29 million to 45 million illnesses, 14 million to 21 million medical visits, 490 600 to 810 000 hospitalizations, and 34 200 to 61 000 deaths each season in the US.1 During the fall of 2020, both influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; the virus associated with coronavirus disease 2019 [COVID-19]) are anticipated to circulate.

This review describes the context of health equity and options for integrating equity into public health practice. We first discuss how the conceptualization of health equity and how equity considerations in US public health practice have been shaped by multidisciplinary engagements. We then discuss specific ways to address equity in core public health functions, provide examples of relevant frameworks and promising strategies, and discuss conceptual and measurement issues relevant to assessing progress in moving toward health equity. Challenges and opportunities and their implications for future directions are identified. Expected final online publication date for the Annual Review of Public Health, Volume 41 is April 1, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

The relationship between educational achievement and health outcomes is well documented but not well understood.1,2 Hahn and Truman describe education as “a process and a product,” that is, the process of education occurs in multiple settings within and outside of the classroom, and the product of the educational process is “the array of knowledge, skills, and capacities (ie, intellectual, socio-emotional, physical, productive, and interactive) acquired by a learner through formal and experiential learning.”1(p2) Education is essential to achieving health equity. | According to the Center on Society and Health at Virginia Commonwealth University, | Americans with less education are—now, more than ever—dying earlier than their peers. Between 1990 and 2008, the life expectancy gap between the most and least educated Americans grew from 13 to 14 years among males and from 8 to 10 years among females. The gap has been widening since the 1960s.3 | In addition, adults with only a high school diploma can expect to die 9 years sooner than college graduates, and adults with less education are more likely to report having diabetes and heart disease and to have worse health overall.3 These and other health outcomes are associated with educational attainment.

In 1985, the Report of the Secretary's Task Force on Black and Minority Health was published after the federal government convened the first group of health experts to analyze racial/ethnic health disparities among minorities. This analysis, also known as the Heckler report, revealed higher illness and death rates among minorities. The year 2015 marks the 30th anniversary of the Heckler Report and presents an opportunity to evaluate and continue to improve minority health at the national, state, tribal, territorial, and local levels.

Over the past decade, momentum to address social determinants of health (SDH) and health equity increased. Definitions of health equity are wide ranging. The US Department of Health and Human Services defines health equity as "attainment of the highest level of health for all people." The definition goes on to add, "Achieving health equity requires valuing everyone equally with focused an dongoing societal efforts to address avoidable inequalities, historical and contemporary injutsices, and the elimination of health and healthcare disparities." Achieving health equity then requires addressing SDH, "conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

As racial and ethnic minorities constitute ever larger percentages of the U.S. population, the overall health statistics of the nation increasingly reflect the health status of these groups. Overcoming persistent health and health-care disparities that affect racial/ethnic minorities benefits the entire society. For example, the economic well-being of a nation relies on the health of its populace. According to one report, "The nation's dependence on an increasingly minority workforce means that healthy communities of color are vital to the nation's economic fortunes". Other U.S. population groups, such as persons with disabilities or special health-care needs, persons living in certain geographic locations, and persons with certain sexual identities or sexual orientations, also have higher rates of preventable morbidity and premature death, and efforts should be directed toward improving their health outcomes and eliminating health disparities.

In 2011, CDC published the first CDC Health Disparities and Inequalities Report (CHDIR). This report examined health disparities in the United States associated with various characteristics, including race/ethnicity, sex, income, education, disability status, and geography. Health disparities were defined as "differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes". Among other recommendations, the 2011 CHDIR emphasized the need to address health disparities with a dual intervention strategy that focuses on populations at greatest need and improves the health of the general population by making interventions available to everyone. The 2013 CHDIR included updates on most topics from the 2011 CHDIR and on new topics. Compared with the 2011 CHDIR, the 2013 CHDIR included more reports on social and environmental determinants of health and emphasizes the importance of multisector collaboration. The 2013 CHDIR highlights the need for a "comprehensive, community-driven approach" to reducing health disparities in the United States.

Using an illness narratives framework, we provide 1 method that health care providers can use to obtain insight into the perceptions and experiences of their patients living with diabetes. We propose that understanding patients' cultural perspectives help explains their health behavior and can lead to more productive partnering between provider, patient, and community health resources that support adherence and improved health outcomes. We conclude with resources available to assist health care providers in their efforts to deliver culturally appropriate diabetes care and examples of culturally tailored community-based public health initiatives that have been effective in improving diabetes outcomes among African-American patients.

I am writing this foreword just days after returning from the 20th International Union for Health Promotion and Education World Conference on Health Promotion in Geneva, Switzerland (July 11-15, 2010). The primary goals of the conference were to “build bridges between sustainable development and health promotion, the outreach of health in all policies, and the transfer of knowledge with long-term impact” (http://www.iuhpe.org). More than 2200 health promoters from 123 countries and all continents contemplated how we might achieve health equity and sustainable development in a global environment of overtaxed natural resources, struggling political economies, and competing ideologies about the way forward. Notable speakers from around the world described the interconnectedness between how we use the finite resources of the planet; policies governing globalization; social, political, and economic inequality within and between nation-states; and the people's health. Promising strategies were showcased, and provocative conversations reframing more traditional approaches to protecting the public's health were presented. Translate this broad thinking to the community level, and we see a snapshot of the day-to-day realities, experience, leadership, and community-based participatory approaches of Racial and Ethnic Approaches to Community Health Across the United States (REACH U.S.) in eliminating racial and ethnic health disparities. | This special issue of the Journal of Family and Community Health provides a much needed collection of community voices describing how they are working to transform their social environments—one victory at a time—to improve health outcomes in communities that are disproportionately affected by preventable premature death and treatable disability. In preparing the reader for this special issue, I first of all situate the work of REACH U.S. in the global movement to reduce health inequalities through attention to the social determinants of health. I describe how the REACH experience in addressing the social determinants of health reflects a familiar clash of interests of people at the nexus of industry (including art), politics, and science. In these articles, we discover through detailed case studies how local communities resolved some of these competing interests. At the end, I briefly broach the issue of culture as a social determinant of health, and how community health workers have been vital resources in eliminating health disparities as both cultural translators and frontline advocates for health equity.