By its very definition, “health equity”—a state where every community has an equal opportunity to thrive—is for everyone. No community should face unjust and avoidable barriers to the basic, vital conditions1 (humane housing, reliable transportation, quality health care, etc.) we all need to be healthy and well. Nor is health equity a zero-sum game with winners and losers: we all stand to gain. Yet despite the universal benefit, finding common ground for the kinds of laws and policies that would achieve health equity seems impossible given our entrenched political divides. As a result, health equity remains an ideal for some future, better, and healthier United States.
That future will be shaped not only by those of us currently in political power but also by generations to follow, starting with Generation Z (Gen Z). Of late, much has been made about that group’s burgeoning political muscle. In recent elections, young voters have “connected the dots between movement insurgency and voter mobilization” in ways that “could be a game changer.”2
In December 2022, the Association of American Medical Colleges, Center for Health Justice conducted a nationally representative poll of members of Gen Z, aged 18–24 years, to identify emerging areas of multiracial, bipartisan, cross-geography and -demography consensus on topics relevant to achieving health equity.3 Given current political debates, we were surprised by unexpected areas of agreement among these younger self-identified Democrats, Independents, and Republicans.
Although 10 states have still not expanded Medicaid,4 76% of Republican Gen Zers agreed with Democrats (93%) and Independents (86%) that access to health care is a basic human right, with more than two thirds of Republicans (68%) saying it is the responsibility of the federal government to ensure that everyone has health care coverage. Although some in Congress recently proposed a regressive flat sales tax to replace the Internal Revenue Service, we saw bipartisan support among Gen Z members for economic policies that instead “try to reduce the gap in wealth between the richest and poorest Americans” (84% D, 70% I, 57% R) and “give economic support to those with lower incomes” (88% D, 74% I, 56% R).3
Even where differences remained, surprising areas of common ground emerged. For example, although a majority of Republican Gen Zers (54%), unlike their Democratic (29%) and Independent (37%) counterparts believe that racial health inequities result from individual choices and not systemic racism, all three groups agreed (83% D, 68% I, 60% R) that COVID-19 “highlighted inequities that were already present in the US health care system.”3 Similarly, although 60% of Republican Gen Zers endorsed the idea that “the role that racism plays in our society is overplayed,” a majority (55%) agreed with Democrats (89%) and Independents (75%) that it is important that the federal government address “racial residential segregation and discrimination in housing.”3
Those of us committed to health equity and population health should take these data as a call to action. While we work to overcome current political division and dysfunction, let us also adopt a future-oriented health equity agenda that prioritizes these agreements of tomorrow. Let us build (on) common ground between our future leaders’ camps now so that when Gen Z assumes power the distance is shorter and smoother to travel. Health care policy, economic policy, and housing policy may be fertile ground and less about building consensus than about growing and solidifying it.
Specifically, efforts to promote Gen Z agreement on health equity–promoting policy and advocacy should focus on three areas: engagement, state and local action, and creating local to national professional development pathways. First and foremost, there should be intentional, easy ways for youths to be engaged and their voices heard in all aspects of policymaking and movement-building processes. Other recent polling has found that Gen Z is the generation least likely to be proud to live in the United States or to trust its institutions.5,6 Those of us in power now must demonstrate that we—and the sectors we represent—are worthy of Gen Z’s trust and therefore their active participation in the health promotion process. Luckily, models and frameworks exist to create meaningful, trustworthy partnerships and coalitions.7,8
Second, given the seemingly intransigent partisanship at the national level, bipartisan health equity movement building must start at the state and local levels and prioritize action where agreement can be most readily mobilized. For example, in our poll, Gen Z strongly agreed across party lines that the government should address the shortage of homes and apartments for rent (89% D, 78% I, 73% R). Housing reform advocates in states as politically disparate as Washington and Montana have had bipartisan success by grounding their work in local perspectives and cultures; for example, the so-called Montana Miracle was achieved by advocating free market reforms that incentivize building affordable housing, such as duplexes, as a way “to conserve rural areas and avoid Los Angeles–style sprawl.”9 A locally resonant message developed through authentic engagement can catalyze action on topics important to Gen Z across party lines, easing the path to their participation and power.
Finally, to develop local leaders into national ones and ensure that scarce resources are equitably deployed, we must intentionally connect local, state, and national action and create professional development opportunities that span the three. For example, our poll found bipartisan agreement among Gen Zers that climate change was both an immediate (84% D, 71% I, 56% R) and long-term (90% D, 75% I, 64% R) threat to the safety of the planet. As of 2021, 11 mostly “blue” states had passed environmental justice legislation and an additional 11 mostly “red” and “purple” states had such legislation pending.10 Strengthening formal connections among national youth-led environmental organizations like the Sunrise Movement, and these state environmental justice efforts can maximize resources, help with the bidirectional amplification and spreading of successes, and create a pathway for the next generation of national health equity leaders.
By some measures, the United States is the wealthiest nation in the history of our planet, so health inequities are not inevitable. Our people and government make choices that perpetuate the racial, social, and economic injustices that create them. If we take our cues from Gen Z and focus our efforts on their common ground, perhaps the rising generation will make better, healthier choices for all our communities.
See also Building Common Ground, pp.
CONFLICTS OF INTEREST
The authors have no conflicts of interest to report.
