Equity Pursuits

Equity is when everyone has a fair and just opportunity for health and wellbeing (Braveman et al., 2017). Effective change efforts address barriers to health equity and put conditions in place to ensure diverse community residents have equitable experiences, benefits, and health possibilities – from birth to the end of life (Annie E. Casey Foundation, 2014).

Equity Pursuits involves putting the following elements in place over time (Foster-Fishman et al., 2018):
Four arrows reading Local Inequities prioritized for change, structural changes pursued, partner organizations create culture for equity, and public support for equity Why is this important? We can no longer afford to ignore the growing disparities in health outcomes across different groups of people in our communities (RWJF, 2016). If disparities and their system root causes are not uncovered, understood, and addressed directly, strategies used to improve population health outcomes can inadvertently lead to greater inequities and undermine targeted goals (Solar & Irwin, 2010).
Image of a diverse group of people

Effective change initiatives engage their members in identifying, understanding, and prioritizing inequities related to their shared vision goals.
- Identifying local inequities involves using disaggregated data to understand which groups in the community are experiencing the greatest needs and worst health outcomes over time compared to other groups (PolicyLink, 2018).
- Once revealed, effective change efforts engage their members in understanding the underlying systemic root causes - including current policies and practices - contributing to local inequities before developing strategies (Foster-Fishman & Watson, 2017).
- Prioritizing local inequities involves the initiative making the pursuit of equity a core part of its work and initiative members committing themselves to addressing the inequities within the community.
To engage in this process, it is important that stakeholders first recognize that inequities are primarily caused by community conditions rather than individual-level behavior (AECF, 2014). This is crucial, as it re-focuses the change efforts on community- and systems-level change without pathologizing inequities at the individual level.

Tools to Support Prioritized Local Inequities

Disaggregate Data to Identify Local Inequities

Disaggregate local outcome data related to the Shared Vision goals to help stakeholders understand which groups in the community are experiencing the greatest needs and worst health outcomes over time compared to other groups. The following resources can help you break out and summarize your data by the sub-groups (e.g., race/ethnicity, gender, income, geographic location, etc.) most relevant for your community.

By the Numbers: A Race for Results Case Study
Case study on why the collection, analysis and use of race and ethnicity data should be an integral part of any strategy, initiative or legislative agenda affecting children, families and communities.
Source: The Annie E. Casey Foundation

Counting a Diverse Nation: Disaggregating Data on Race and Ethnicity to Advance a Culture of Health
Recommendations for how to find, use, and promote disaggregated data to further health equity.
Source: Robert Wood Johnson Foundation

Inequities Synthesis Template
Template to summarize data on local inequities so it is easy for stakeholders to understand and use within a shared visioning process. 
Source: ABLe Change

Understand Root Causes to Local Inequities

Engage stakeholders in a process to understand why prioritized inequities are happening. This information can then be used to guide the design of strategies to address these inequities and put conditions in place to promote equity.

Be sure to include local residents from groups experiencing prioritized inequities in this process, as they bring a critical perspective on current community and system conditions. Use the following frameworks and tools to guide your exploration of root causes for why local inequities are happening in your community.

Countering the Production of Health Inequities
Examples of different types of structural root causes often contributing to health inequities. 
Source: Prevention Institute

Equity Impact Assessment
A process to help assess the equity impacts of your efforts during any phase of the change process. See pages 2 and 6-12 for questions about understanding local inequities.
Source: ABLe Change

Racial Equity Impact Assessment
Process to anticipate, assess and prevent potential adverse consequences of proposed actions, strategies, or policies on different racial groups.
Source: The Annie E. Casey Foundation

Root Cause Analysis Template
Simple questions you can use to ask about system root causes driving local problems during meetings, planning process, and conversations.
Source: ABLe Change

Effective change initiatives initiate action to address the structural root causes of inequities - such as the policies, procedures, practices, community conditions, and opportunities that disadvantage certain groups and advantage others (Prevention Institute, 2015).

Examples of these types of actions could include (Dahlgren & Whitehead, 2007):
- Reducing differences in access to needed services experienced by different groups (e.g., low-income vs. high income neighborhoods) within the community
- Reducing differences in the quality of services experienced by different groups within the community.
- Ensuring interactions with healthcare providers and community agency staff are the same for everyone, regardless of income, race, ethnicity, age, gender, sexuality, language, immigration status, or disability.
- Reducing differences in social determinant of health conditions (e.g., affordable housing, access to healthy food, etc.) across neighborhoods
- Aligning funding decisions with commitment to health equity.
These actions are also focused on putting conditions in place to promote equity by building the power and capacity of communities experiencing inequities (Solar & Irwin, 2010). Examples could include:
- promoting economic opportunities and livable wage employment for communities experiencing inequities (Kneebone & Holmes, 2015)
- building resident leadership capacity within communities experiencing inequities (Raderstrong & Boyea-Robinson, 2016)
- supporting social connections, trust, and cohesion within communities experiencing inequities (Perkins & Long, 2002)
- creating opportunities for the most disadvantaged residents to gather and use data to influence decision-making (NACCHO, 2006)
Tools to Support Structural Changes

Design Strategies and Take Action to Promote Equity

Engage stakeholders in designing strategies to address the root causes of prioritized local inequities and to put conditions in place to promote equity. Help stakeholders then initiate action to carry out these strategies across multiple settings and ecological layers of the community. Use the following tools to guide these efforts.

Equity Impact Assessment
A process to help assess the equity impacts of your efforts during any phase of the change process. See pages 3-4 and 13-20 for questions about designing strategies and taking action to address local inequities.
Source: ABLe Change

Prevention Institute Health Equity Tools
Practical tools to help practitioners, advocates, community groups, and policymakers take action to promote equity.
Source: Prevention Institute

Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health
Provides resources and case studies of how communities have pursued equity by addressing the social determinants of health.
Source: Centers for Disease Control

Systems Thinking and Race
Ideas and strategies to help communities use a systems thinking approach within their equity efforts.
Source: Project Linked Fate

Building Inclusive Communities
Resources on how to put conditions in place to ensure your local community is inclusive for residents from multiple backgrounds.
Source: Community Tool Box

Effective change initiatives embed a focus on equity across the community by helping local organizations adopt a culture for equity within their work.

This can involve local organizations:
- making the pursuit of equity a core part of its work.
- aligning its resources to support more equitable outcomes (Preskill et al., 2014).
- assessing how their policies and practices are contributing to local inequities and adjusting them accordingly (Preskill et al., 2014).
- helping their staff understand how racial and income inequities create advantages and disadvantages within the community (AECF, 2014)
- helping their staff understand how local inequities are primarily caused by community conditions rather than individual-level behavior (AECF, 2014)
Embedding a culture for equity across vertical and horizontal layers of the community can help ensure new practices and habits become integrated into everyday practice and support the overall change efforts (Foster-Fishman et al., 2007; Lounsbury & Mitchell, 2009).

Tools to Support Organizational Culture for Equity

Help Organizations Assess their Policies and Practices

Help local organizations assess to what extent their current policies, practices, and efforts are contributing to local inequities and/or promoting equity. Some communities create an anonymous summary of these assessment results (e.g., bar graph, infographic, etc.) to help local organizations see patterns of needs and opportunities and identify shared priorities for action. Use the following tools to support these assessment efforts.

Equity Organizational Self-Assessment
Tool to help organizations assess the alignment of internal policies, practices, and capacities with promoting equity.
Source: ABLe Change

Race Matters: Organizational Self-Assessment 
Tool to help organizations assess the alignment of internal policies, practices, and capacities with promoting racial equity.
Source: The Annie E. Casey Foundation

Support Organizations in Taking Action to Promote Equity

Aid local organizations in taking action to align their policies, practices, capacities, and efforts to address local inequities and build conditions for equity. In some communities, organizations form a peer-to-peer learning group or community of practice to support these efforts. Use the following resources to help organizations embed an equity focus within their work.

Race Equity and Inclusion Action Guide
Seven steps to embed racial equity within your organization.
Source: Annie E. Casey Foundation

Better Health through Equity
Case studies of how public health departments have embedded a culture of equity within their work.
Source: American Public Health Association

Effective change initiatives help to sustain a pursuit of equity in the community by building public support and engaging local decision-makers and funders in incorporating a focus on equity in their policies, practices, and resource allocations.

Examples of this could include:
- Greater public will to shift local resources, policies, and budgets in support of more equitable outcomes (Preskill et al., 2014)
- Increased commitment within the community to promote equity and reduce inequities (RWJF, 2016)
- More funders, payers, hospitals, government bodies, and/or municipal government departments aligning their resources to support more equitable outcomes (RWJF, 2016)
Tools to Support Public Support for Equity

Talk about Importance of Pursuing Equity

Engage stakeholders within your collaborative initiative in talking with others about the importance of addressing local inequities. Some stakeholders find it difficult to discuss these topics with diverse audiences, and appreciate resources and talking points to help guide their conversations. Use the following resources to support local communications about pursuing equity in your community.

Race Matters: How to Talk about Race
Practical tips and recommendations for how to talk with others about racial equity.
Source: Annie E. Casey Foundation

A New Way to Talk about the Social Determinants of Health
Research-based suggestions for how to talk about equity and the social determinants of health.
Source: Robert Wood Johnson Foundation

Unnatural Causes Website: Explore Health Equity
A list of multimedia resources, reports and videos on how racism can have an impact a person’s health.
Source: Public Broadcasting Service

Statisticks Lottery
Brief video describing why some children experience worse outcomes related to success in school and life than others. Helpful for illustrating the types of obstacles often leading to inequities.
Source: The Campaign for Grade-level Reading

Annie E. Casey Foundation Equity Resources
Toolkits, briefs, policy reports, case studies, and data sources related to promoting equity.
Source: The Annie E. Casey Foundation

Framing Public Issues
Research-based recommendations for how to frame and talk about sensitive issues like equity (see especially pages 33-34).
Source: FrameWorks Institute

Michigan CHIR Learning Community

Tools for Action

Equity Pursuits Tools Will Help You:

Effective Convening Tools Will Help you:

Shared Vision and Goals Tools Will Help You:

Engaged Diverse Partners Tools Will Help You:

Aligned Systems Tools Will Help You:

Adaptive Learning and Improvement Processes Tools Will Help You:

Equity Pursuits

Disaggregate Data to Identify Local Inequities

Understand Root Causes to Local Inequities

Design Strategies and Take Action to Promote Equity

Help Organizations Assess their Policies and Practices

Support Organizations in Taking Action to Promote Equity

Talk about Importance of Pursuing Equity