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The Health Opportunity Index (HOI) is a multivariate tool that can be more efficiently used to identify and understand the interplay of complex social determinants of health (SDH) at the census tract level that influences the ability to achieve optimal health. The derivation of the HOI utilizes the data-reduction technique of principal component analysis to determine the impact of SDH on optimal health at lower census geographies. In the midst of persistent health disparities and the present COVID-19 pandemic, we demonstrate the potential utility of using 13-input variables to derive a composite metric of health (HOI) score as a means to assist in the identification of the most vulnerable communities during the current pandemic. Using GIS mapping technology, health opportunity indices were layered by counties in Ohio to highlight differences by census tract. Collectively we demonstrate that our HOI framework, principal component analysis and convergence analysis methodology coalesce to provide results supporting the utility of this framework in the three largest counties in Ohio: Franklin (Columbus), Cuyahoga (Cleveland), and Hamilton (Cincinnati). The results in this study identified census tracts that were also synonymous with communities that were at risk for disparate COVID-19 related health outcomes. In this regard, convergence analyses facilitated identification of census tracts where different disparate health outcomes co-exist at the worst levels. Our results suggest that effective use of the HOI composite score and subcomponent scores to identify specific SDH can guide mitigation/intervention practices, thus creating the potential for better targeting of mitigation and intervention strategies for vulnerable communities, such as during the current pandemic.

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the Centers for Disease Control and Prevention (CDC), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) held its Health Equity Symposium entitled "Establishing a Holistic Framework to Reduce Inequities in Human Immunodeficiency Virus (HIV), Viral Hepatitis, Sexually Transmitted Diseases (STDs), and Tuberculosis (TB) in the United States." For those of us working on health equity issues at the state level, it was an honor to participate in such an important national event with distinguished colleagues Paula Braveman, MD, and Scott Burris, JD, who offered perspectives on some of the most pressing issues relating to health equity based on specific aspects of the NCHHSTP Strategic Plan. 1 Overcoming health inequities in the United States is entirely possible by changing the way we define, think, and address the problem. The preceding statement is meant to challenge public health professionals to champion effective health equity strategies in public health systems. We hope the following thoughts will compel you to seize opportunities to address health inequities using a holistic framework, even when it may be unpopular or uncomfortable to do so. NCHHSTP STRATEgiC PlANStrategic plans are often developed with the best intentions, only to suffer the fate of other planning initiatives (i.e., to exist on bookshelves of their creators and stakeholders without any real life or action beyond the planning process). With this in mind, one must ask the question, how is the NCHHSTP Strategic Plan different, and will it suffer the fate of other well-intentioned planning documents? The NCHHSTP Strategic Plan is different in that it speaks to the need of addressing viral hepatitis, HIV/acquired immunodeficiency syndrome (AIDS), STDs, and TB in a holistic fashion, with an emphasis on addressing the root causes of health disparities for these diseases. Addressing the root causes of disparities is not often reflected in national public health planning documents, especially as a central theme. The NCHHSTP is to be commended, for

Issue The rapidly evolving nature and uncertainties of the COVID-19 pandemic have led to unprecedented challenges for health systems, as well as to wellbeing, social and economic impacts for individuals and communities across the globe. Effective, dynamic, innovative and evidence-based solutions are needed to address these challenges. Description of Problem The World Health Organization (WHO) Collaborating Centre on Investment for Health and Well-being, Public Health Wales, has initiated and continues to perform International Horizon Scanning work to inform the evolving COVID-19 public health response and recovery plans in Wales by learning from best practices from other countries. The learning and intelligence is systematically synthesized in rapid regular reports published every week/two weeks. The focus and scope vary, depending on the COVID-19 situation and public health and policy needs. Results The work stream has provided Welsh Government, the National Health Service (NHS), Public Health Wales and other key stakeholders with continuous and timely learning from the experience of other countries along with emerging evidence and guidance, provided by key international organisations. This includes international evidence, epidemiological data, experience, measures and recovery approaches, to understand and explore solutions. Reports have given a consistent overview of approaches across countries such as a comparative analysis of the vaccine roll-out or a systematic overview of the R-value and measures implemented accordingly. Lessons To understand, mitigate and address the impacts of the pandemic in Wales and beyond, a timely, dynamic and evidence-informed actionable intelligence has proven to be essential to inform and support decision-making on government and health system level to address the pandemic and mitigate harms from COVID-19. Key messages International learning has and continues to inform the evolving COVID-19 public health response in Wales. Public Health Wales is contributing to an evidence-informed inclusive recovery from the pandemic in Wales and beyond.