The COVID-19 pandemic taught our public health systems a number of critical lessons about how we should engage, communicate, partner, and share data with other agencies and our communities. It also reinforced the importance of applying an intentional health equity lens to the system to better support vulnerable communities in times of crisis.
While the pandemic may have elevated these issues, vulnerable communities have faced inequities in our health systems for decades. If agencies do not center equity in all public health goals and operations, they continue to risk creating policies and services that further those inequities. Applying an equity lens requires public health agencies to consider systemic causes of health disparities (i.e., poverty, education, racism) and how they operationalize policies, practices, and programs that improve health for all.
Centering health equity across your organization
BerryDunn’s public health consulting team believes health equity should be an overarching goal of a public health system—not just a standalone program or a one-time initiative. Achieving health equity requires public health systems to be intentionally inclusive and equitable; all organizational areas need to work together to promote the attainment of the highest level of health for every person.
Our approach to health equity starts with the goal of creating inclusive and equitable public health systems, and takes into account a wide range of considerations:
In any community, the health of individuals is influenced by many factors, including the environment in which people live, work, learn, and recreate. To address the different factors at play, meaningful efforts to achieve health equity can’t exist in a silo. These efforts must be integrated across all departments of a public health agency. From frontline staff working directly with community members to finance staff working behind the scenes, all members of the organization are critical to successfully implementing a sustainable health equity approach.
As an example, centering health equity within human resources and workforce development processes helps promote the recruitment and retention of a diverse public health workforce, and could include:
- Recruiting public health specialists who reflect the focus populations and/or the communities receiving services to better support cultural and linguistic needs.
- Hiring local community members serving as community health workers to help create rapport and trust with marginalized communities.
Health equity approaches can also be implemented in areas such as budget and resource allocation, data collection, and other organizational processes, policies, and procedures. Some strategies include:
- Establishing language standards to help ensure information is clear and accessible to everyone.
- Using plain language in budget documents to help community partners understand how public health funds are limited or restricted.
- Implementing processes such as a health equity lens review of all existing and new organizational policies to help identify hidden systemic or structural implications and open the way to new, more equitable approaches.
Incorporating a health equity lens in strategic planning
An equity-centered approach can be integrated into any public health strategic planning effort, such as state health improvement planning and programmatic strategic planning. A key component of any strategic planning project is community engagement to reach historically marginalized populations and members of communities that may be disparately impacted by certain health conditions or environmental factors. A standard practice is to recruit key community members, disparate populations, and/or people with lived experience who can help provide input on public health services.
The following example draws on our team’s experience supporting West Virginia’s State Health Improvement Plan development process.
In West Virginia, our Public Health team hosted in-person and virtual listening sessions with the public as part of the state health improvement plan development process. These sessions were publicized through a wide range of community partners and scheduled to accommodate varying availability and work schedules. Sessions were held in accessible and familiar public settings, as well as online to maximize opportunities for diverse participation, perspectives, and input. Centering health equity in this approach to strategic planning helped ensure that the final product represented the voices and experiences of those who are most affected.
Determining how and when to apply a health equity lens across a public health system can be challenging. The first step is to assess current organizational conditions that may be creating or fostering the root causes of disparate outcomes. Some questions to ask include:
- How are public health resources shared?
- Who has the power or authority to make decisions?
- What assumptions influence how the system functions, or the services are delivered?
Understanding the answers to these questions can help you build a plan for operationalizing health equity principles across programs, the workforce, and finance. It can be useful to have a third party conduct an independent review of your agency’s policies, practices, and processes through an equity lens. Our team provides recommendations based on best practices from the field, as well as effective change management and equity-centered approaches.