(P204) THE “IMPACT” OF MEASURING HEALTH EQUITY IN SEXUAL HEALTH LEGISLATION: FINDING TOOLS THAT WORK

Background:
Public health professionals continue to demand policy initiatives at local, state, and territorial levels that meaningfully integrate health equity. The National Coalition of STD Directors (NCSD) regularly tracks sexual health-related policies at the state legislative level and recognized an opportunity to answer this call by cultivating a health equity assessment tool unique to STI-related policy.

Methods:
A point-based tool was developed and piloted during 2023 state legislative sessions (January – June). The tool was named IMPACT, or Inclusive Metrics for Policy Analysis and Cultural Transformation and included a “3P category” system by which policies were ranked: 1) People; 2) Patients; and 3) Providers. The 3P system was created to ensure identity-based communities disproportionately impacted by STIs were prioritized, as well as medically accurate STI treatments and interventions. Each P category asked questions in a yes-or-no format that corresponded to a point system and the average score calculated its ranking: under 2.0 = harmful policy; 2.0 – 2.4 = passively harmful by sustaining status quo; 2.4 – 2.7 = potential to be equitable; 2.7 – 3.0 = equitable policy.

Results:
NCSD tracked over 100 bills directly or indirectly pertaining to STIs across six categories. Bills that included broad coalitions and expanded access to STI treatment through insurance policies ranked highest but lost points for limiting which plans qualify for zero cost-sharing. Bills that intended to expand harm reduction policies demonstrated a flaw in the tool by not naming sexual health services in bill language. Several bills that curbed LGBTQ youth rights in healthcare settings received low scores.

Conclusion:
NCSD’s pilot found that the IMPACT tool offered valuable information for assessing health equity but requires more legislative analysis to guide refinement. NCSD is currently applying the tool in 2024 state legislative sessions and will apply a second year of data to modify its point system.