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I agree that what we need to do is improve health for less healthy groups. And it is true that many public health policies and programs actually increase disparities because these policies/programs are more effective in healthier populations. But, we can do better.

We should look at each policy/program and see if it is increasing or decreasing health equity. Where it is decreasing health equity, we should modify the policy/program to address the disparity.

You mention that media programs to promote cessation are often less effective with low SES populations. How can we do better?

First, cessation advertisements can be placed where the ads reach low SES populations. This is fairly easy with radio and TV where there are good data on the demographics of viewers and listeners.

Second, cessation advertisements can be better designed to be effective in low SES populations. We should look at the language, the settings, the actors, etc. used in these ads. Of course, the ad concepts and final ads can be tested with various audiences.

On the policy front, let’s look at smokefree workplace laws. In the past, many smokefree workplace laws exempted bars and restaurants. This meant that these laws were not protecting some low-income workers and certain racial/ethnic groups. Smokefree workplace laws help support people who are trying to quit smoking. And, there are data to show that low-income workers quit at the same rate as higher-income workers when their workplace goes smokefree. Removing the exemption for bars and restaurants helps increase health equity.

I believe we should look at every policy and program with an eye toward decreasing disparities. This focus on solutions can help bend the curve and lead us towards our goal of eliminating health disparities.

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