The Roots of Health Inequity Course Series was crafted and reviewed by a team of subject matter experts from a diverse background in an effort to provide representative and authoritative content about a crucial topic for public health. Have questions? Read the content below, check out our FAQ page, and/or contact us

Description and Purpose

The Roots of Health Inequity course is a free, online learning collaborative and educational resource.

Its purpose is to strengthen the capacity of public health practitioners and course users to more directly identify and confront the underlying, unjust root causes of inequity in the distribution of disease, illness, and death. Additionally, it encourages participants to see themselves as champions of social change and as full partners with the communities they serve. The course series recognizes that this goal cannot be realized through conventional mitigation approaches, typified by programs and services. By linking theory, knowledge, and practice, the course supports participants in their efforts to eliminate the continuous production of health inequities.

Roots specifically explores: 

  1. how unaccountable social, economic, and political structures of power produce the preconditions for health or illness; 

  2. concepts and strategies for how public health practitioners and their partners can transform public health practice, and 

  3. a philosophical and theoretical framework, based on the principles and values of social justice.

With enhanced capabilities ranging from course overview videos and interactives to new voices, worksheets, an extensive new glossary and more, Roots has been updated to meet the changing landscape of e-learning. Each course covers a core topic related to health equity and social justice, using various learning modalities that emphasize critical systems thinking and group dialogue. Constructed like a museum, users can customize their experience and choose from a menu of topics to construct their own pathways to best suit their needs. With new and updated features, learning with Roots can be engaging and dynamic, wherever you are on your health equity journey.


The primary audience is public health practitioners and students in schools of public health. However, a secondary audience includes those in healthcare and any groups or individuals committed to health and social justice, including grassroots organizations, community organizers, and other civil society organizations. 

Course Objectives

  • Explain and define root causes of health inequities and their relationship to public health practice;

  • Recognize internal and external barriers public health practitioners face in acting on root causes; and

  • Identify strategies to transform public health practice toward the elimination of health inequity.

History, Design, and Revisions to Roots Course

First launched in 2011, the origin of the course was based on NACCHO’s health equity program, which began in 2000. Its goal was to strengthen the capacity and effectiveness of public health practitioners to act directly on root causes of inequity in the distribution of disease, illness and death. As such, at least three major principles guided the course: 

  1. the elimination of health inequity entails repurposing power to act on root causes. That is, mitigation through programs and services, however essential, could never eradicate or significantly reduce health inequity; 

  2. public health has a legitimate and necessary obligation in ending the production of health inequity; and 

  3. health inequity does not result from unfortunate events, but is generated and sustained by unjust structures of power. 

Since the first iteration of the course, the U.S. has changed dramatically, with a convergence of crises requiring revisions, both in its scope and content. Those changes include the sharp increase in social and economic inequalities, the destruction of democratic institutions, the persistence of white supremacy and state sanctioned violence, and the COVID-19 global pandemic. 

At the same time, new resistance movements have arisen, along with broader public awareness of the activities of white supremacists, the nature of racialized capitalism, and the fluid nature of gender. These developments have led to demands for deeper structural change and repurposing political power. Most importantly, it has exposed the links among racial, class, and gender inequities. Many local health departments and city and county governments, for example, have declared racism to be a public health emergency and have begun to consider ways to reshape public health practice to confront structural racism directly.

Due to these and other changes, the course has been revised and updated extensively. The scale and scope of the changes reinforce the importance of focusing on our structural economic and social conditions—the root causes of health inequity.


The pedagogical model for the course derives from what is known as “critical pedagogy” based on the works of its core contributors including Paolo Freire, bell hooks, Antonia Darder, Peter McClaren, and many others. A central goal of critical pedagogy is emancipation from oppression. Teaching and learning are intertwined with principles of social justice and democracy. Its practice requires an interactive learning community where learning is a social act in the interest of social change. Educational practice provides opportunities for reflection, insight, and discovery through social and political dialogue, posing questions that advance social transformation. 

Instead of amassing knowledge from facts or searching for solutions to problems, learning is ongoing. Users reflect on social and political contexts that enable them to see options for social change rarely considered. That is, they explore the power to imagine alternative futures anticipating a more just social structure not yet existing.

 “There must exist a paradigm, a practical model for social change that includes an understanding of ways to transform consciousness that are linked to efforts to transform structures.”―bell hooks, Killing Rage: Ending Racism


The Roots of Health Inequity Course is a resource designed to create the conditions for collaborative learning to challenge concepts and frameworks that constrict critical thinking about the possibilities in eliminating health inequity. It connects knowledge to activism through dialogue, so health practitioners and their community partners may identify the most effective strategies. Achieving that goal is inseparable from social transformation and holding accountable those responsible for the generation of inequity. Roots provides guidance in what, in some sense, is a project of human emancipation.

The National Association of County Health Officials was founded in 1965. In early 1984, the organization experienced remarkable growth in membership and the organization opened its own office. In 1994, it was renamed to National Association of County and City Health Officials (NACCHO). 

Since its inception, NACCHO has sought to improve the public's health while adhering to a set of core values: equity, excellence, participation, respect, integrity, leadership, science & innovation.

Project Team 

NACCHO: Jasmine Akuffo, Brianna Aldridge, Mya Smith, Charles Udeze

Interactive Knowledge: Melissa Eller, Katy Listwa, Erika Looney, Kate Rees, Tim Songer, Eric Veal

WonderWorld: Dorne Pentes, Ivica Bilich, Michael Reynolds

With Special Thanks to: Richard Hofrichter, our Expert Advisory Group (EAG), Course Content Developers, NACCHO’s Health Equity and Social Justice (HESJ) Team, Bianca Lawrence, Anjana Rao, Rachel Siegel, Julie Karr, Peter Holtgrave, and Andrea Grenadier.

Expert Advisory Group:

Chis Aldridge, National Association of County and and City Health Officials (NACCHO)

Patria Alguila, New York City Department of Health and and Mental Hygiene (NYC DOHMH)

Anneta Arno, DC Health

Renée Branch Canady, Michigan Public Health Institute (MPHI)

Gem P. Daus, Health Resources and Services Administration (HRSA) 

Fernando De Maio, American Medical Association (AMA) 

Cassandra Frazier, the Centers for Disease Control and Prevention (CDC)

Megan Gaydos, Human Impact Partners (HIP)

Lonias Gilmore, Big Cities Health Coalition (BCHC)

Mehrete Girmay, Health Resources and Services Administration (HRSA)

Lawrence GrandPre, Leaders of a Beautiful Struggle (LBS)

Sonya Hunt Gray, Health Resources and Services Administration (HRSA)

Michael Hansen, Greater-Birmingham Alliance to Stop Pollution (GASP)

David Hicks, Jefferson County Department of Health (JCDH)

Rebecca Hollenbach, Louisville Metropolitan Department of Public Health and Wellness (LMDPHW)

Melissa Jones, Bay Area Regional Health Inequities Initiative (BARHII)

Steffie Kinglake, American Medical Association (AMA)

Nancy Krieger, Harvard T.H. Chan School of Public Health (HSPH) 

Melissa Lewis, Association of State and Territorial Health Officials (ASTHO) 

Jennifer Masdea, Health Resources in Action (HRiA) 

Evan Miller, New York City Department of Health and Mental Hygiene (NYC DOHMH)

Jordan-Lindsay Morris-Greer, Public Health Madison and Dane County (PHMDC)

David Muhammad, Milwaukee County Department of Health and Human Services (MC DHHS)

Naoko Muramatsu, School of Public Health | University of Illinois Chicago, School of Public Health: (UIC SPH)

Lexi Nolen, Boulder County Public Health (BCPH)

Cara Page, Healing Histories Project

Samuel K. Roberts, Columbia University’s Mailman School of Public Health

Chris Salyers, National Organization of State Offices for Rural Health (NOSORH)

Katherine Schaff, Berkeley Media Studies Group (BMSG)

Carlos Javier Torres, The Hispanic and and Immigrant Center of Alabama (¡HICA!)

Matias Valenzuela, Public Health –- Seattle and King County (PHSKC)

Charisse Walcott, the Centers for Disease Control and Prevention (CDC)

Julian Watkins, New York City Department of Health and and Mental Hygiene (NYC DOHMH)

Content Developers:

Beacon Public Health (Course 3)

The Equity Collective (Courses 4–-6)

Health Justice (Facilitator’s Guide)

Human Impact Partners (Course 9)

Jonathan Heller (Course 8)

NACCHO (Courses 2 and and 10)

Richard Hofrichter (Courses 1 and and 7)


Jasmine Akuffo

Brianna Aldridge

Hassanatu Blake

Lluvia Botello

Cheryl Gibbs

Kayla Hall

Alexandra Halprin

Mya Smith

Charles Udeze

Glenda Young-Marquez

We also want to thank our Group Leader Advisors, all of our Voices features, and those who participated in our alpha and beta user testing groups. It is impossible to express our degree of gratitude for everyone who was involved in this project, whether large or small, so if you are not mentioned above, please know that your contribution was valued regardless.

Funding for the revision of this course was supported by: 

  • The Centers for Disease Control and Prevention (CDC) under award 6 NU38OT000306-04-02 entitled National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities. 

  • The Health Resources and Services Administration (HRSA) under awards 6 UD3OA22892-09-06 and 5 UD3OA22890-12-00 entitled National Organizations for State and Local Officials (NOSLO). 

The funders of this resource did not determine the content of this course series, which does not reflect the official views of the CDC or HRSA. 

Roots of Health Inequity Course Series: Contact Form


1201 Eye Street, NW, 4th Floor | Washington, DC 20005

P: 202-783-5550

F: 2020-783-1583

E: rootsofhealthinequity@naccho.org

A number of different colored question marks

The FAQs have quick answers about how to use the course, how to manage your account or a group, and why we think the roots of health inequity are important.