5-Part Toolkit for Promoting Health Equity at the Community Level

Nine communities across the country received resources, coaching, and technical assistance from experts to test best methods to promote wellness and equity.

Nemours Children's Health has led an effort to develop a five-part toolkit to help community organizations advance health equity.

Health equity has emerged as a pressing issue in U.S. healthcare during the coronavirus pandemic. In particular, there have been COVID-19 health disparities for many racial and ethnic groups that have been at higher risk of getting sick and experienced relatively high mortality rates.

Jacksonville, Florida-based Nemours Children's Health worked with nine communities across the country to develop its five-part health equity toolkit. The communities were Bridgeport, Connecticut, Flathead County, Montana, Guilford County, North Carolina, Los Angeles, Paterson, New Jersey, Philadelphia, Sarasota, Florida, Ventura County, California, and Washington, DC.

1. Community organizations need to establish a common definition and understanding of equity.

Communities seeking to address equity must bring together multiple sectors such as healthcare, schools, and housing to achieve their goals, says Allison Gertel-Rosenberg, MS, vice president of national prevention and practice at Nemours Children's Health.

"When groups come together and agrees on a shared definition of equity, what they are really trying to get to is their North Star. It allows groups to coalesce better around strategy, around thinking who has the capacity and expertise to lead different components of an initiative, and around how the work and the leadership is going to spread across the groups. This way, all the groups can focus on what they do best; and, at the same time, they can focus on what they do best to get to the same goal," she says.

2. Community organizations need to heed the voices of real-world experts through governance and decision-making structures that solicit the perspectives of the community members whom the effort seeks to serve. Community members who participate in this process should be compensated for their expertise.

Enlisting community members to participate in equity efforts elevates the role of end users, Gertel-Rosenberg says. "If you think about other industries, a tech company would not develop a new phone without asking consumers what they wanted to do with the phone."

When communities create and design systems to tackle equity goals, initiatives should seize on the opportunity to ask community members what they want to happen, she says. "We can ask about what is not working. We can ask about what capacities and assets they have as a community that we can build on. Then we can take those answers and combine them with the expertise of people who do this work as their job to come up with the best strategies and best opportunities that will work in the community."

Community members should be compensated for their participation, Gertel-Rosenberg says. "Compensation is important. When we ask a community member who feels strongly about equity to take time away from their family or their job, we need to compensate them for their expertise."

3. Community organizations need to enact data-sharing and data-driven resource allocation to identify groups experiencing inequities as well as carry out community-led mitigation strategies.

She says data related to equity challenges is collected at several sources, including health systems, schools, social programs, and community organizations. "It would be great if we could take these data sets and combine them to start to draw a picture of what is happening in the communities that we are serving. The ability that data sharing presents to us is getting enough data to not only look at overarching data about a community but also start to disaggregate data to see where there are opportunities to address disparities and the inequities that are driving those disparities."

"For example, if we look at rates of food insecurity in a community, what the average looks like could be hiding significant disparities between different parts of the population that could be based on race, ethnicity, or geography. When we start to put that data together and disaggregate the data, we can look at solutions that target at-risk populations and start to raise them up," Gertel-Rosenberg says.

4. Community organizations should conduct "equity impact reviews" to assess the results and potential unintended consequences of current and proposed practices, policies, and strategies, which should be revised as needed.

Equity impact reviews are a tool in a community's equity toolbox, she says. "In the broadest way, equity impact reviews allow a community to break down what is happening with an initiative and what the intended or unintended consequences might be not only for the population as a whole but also for different parts of the population."

Equity impact reviews unify equity efforts, Gertel-Rosenberg says. "If we have communities that are using equity impact reviews, they are sharing data, they are ensuring the voice of the community is at the table, and they are having a shared language. By having equity impact reviews, communities can shape the best strategies that are going to address their shared goals."

5. Community organizations need to embed equity-promoting workflows into daily operations.

Embedding equity-promoting workflows into daily operations elevates equity efforts, she says.

"When we start to embed equity into our daily workflows, we ensure that we are talking about equity at every meeting. We ensure that we are asking questions about disaggregated data and the impact on different parts of the population at every meeting. We need to ask questions about equity and ensure that when we consider a new strategy or a new goal, we ask the same questions about the data, about how the community voices are integrated, and about the impact on different sub-populations. It is not enough to set a strategy or a goal and leave it."