Did you know that health equity initiatives are gaining significant attention in the July issue of Health Affairs, which features annual national health expenditure projections from the Centers for Medicare and Medicaid Services (CMS)?
Additionally, the growing focus on rural hospitals, particularly through models like the Pennsylvania Rural Health Model (PARHM), demonstrates how health equity definitions are evolving to address geographic disparities. Understanding what health equity truly means—equal opportunity for everyone to be as healthy as possible—is the first step toward creating meaningful change.
In this article, we’ll walk through the essential steps of developing a comprehensive health equity plan. From conducting thorough community assessments to implementing actionable strategies, we’ll provide a practical roadmap for organizations committed to reducing health disparities. Furthermore, we’ll explore how maternal and child health initiatives, as highlighted in recent Health Affairs articles, can serve as effective models for broader equity efforts.
Whether you’re just starting your health equity journey or looking to enhance existing programs, this guide will help you move from assessment to action with confidence and clarity.
Understand What Health Equity Means
Understand What Health Equity Means
Defining health equity in simple terms
Health equity represents the state in which everyone has a fair and just opportunity to attain their highest level of health. Unlike equality, which provides the same resources to everyone regardless of circumstances, equity recognizes that people start from different places and may need different support.
The World Health Organization defines health equity as “the absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other dimensions of inequality”. Essentially, health equity acknowledges that health is a fundamental human right that should be accessible to all.
What makes health equity distinct from similar concepts is its focus on removing barriers created by social and economic disadvantages. These barriers often prevent certain populations from accessing the resources they need to be healthy, consequently leading to health disparities.
Why health equity matters in public health
Health equity matters because a person’s racial group remains a strong predictor of mortality. Despite improvements in overall health outcomes, the relative differences between populations have persisted over time. This pattern demonstrates that without addressing equity, public health initiatives may improve overall statistics while leaving vulnerable populations behind.
Moreover, health equity has economic implications. When communities have equal opportunities for good health, they become more productive and resilient. By investing in preventive care and early interventions, societies can reduce healthcare costs. Specifically, reducing emergency room visits for non-emergency care among low-income populations can significantly lower healthcare expenses.
Health equity also strengthens communities by fostering social cohesion. When we eliminate systemic barriers to health, we create more inclusive environments where everyone can thrive. Indeed, research shows that when everyone has the opportunity to live their healthiest lives, the entire society benefits.
Common misconceptions about health equity
Several misconceptions hamper progress toward health equity:
- Misconception: Equity means treating everyone the same In reality, equity requires treating people differently according to their needs and circumstances. Standard approaches applied to non-standard situations produce inequitable outcomes, even with good intentions.
- Misconception: Access equals equity Though crucial, access to healthcare accounts for only about 20% of risk of premature death among Americans. Health inequities are shaped by multiple complex determinants including social, economic, environmental, and structural factors.
- Misconception: Health disparities exist solely because of race While race is important, disparities also exist along dimensions of sex, gender identity, age, disability, socioeconomic status, and geographic location. Rural and inner-city populations often experience significant disparities that receive less attention.
- Misconception: Some groups have worse health outcomes because they make unhealthy choices This overlooks how options impact choices. Many patients lack resources, support, and information that limit their ability to make healthy choices in their environments. Understanding social determinants helps identify root causes of health behaviors.
- Misconception: Biological differences drive racial disparities Racial categories used in research are determined by political and social processes rather than biology. Studies show that neighborhoods and exposures are the real drivers of disparities, not something inherent to the person.
Understanding these misconceptions helps organizations create more effective health equity plans grounded in accurate perspectives rather than oversimplified assumptions.
Assess Your Community’s Health Landscape
Image Source: https://pixabay.com/
Assess Your Community’s Health Landscape
Once you understand the concept of health equity, the next crucial step involves conducting a thorough assessment of your community’s health landscape. This process forms the foundation for any effective health equity plan.
Collect demographic and health data
To begin with, gathering comprehensive demographic and health data helps identify where disparities exist in your community. Initially, focus on collecting data across multiple dimensions:
- Population demographics (age, race, ethnicity, gender, disability status)
- Geographic distribution of health outcomes
- Insurance coverage and healthcare utilization patterns
- Prevalence of chronic conditions across different populations
- Economic indicators (income levels, employment rates, education)
When collecting this data, ensure it’s disaggregated by demographic groups to reveal hidden disparities. For instance, county-level data might mask significant neighborhood-level differences in health outcomes.
Look beyond traditional health data sources. Local hospitals, public health departments, schools, and community organizations often maintain valuable datasets. Notably, the CDC’s Social Vulnerability Index can help identify communities likely to need support during public health emergencies or natural disasters.
Remember that quantitative data only tells part of the story. Numerical indicators should be interpreted within their historical and social context, especially when examining persistent health inequities in marginalized communities.
Identify social determinants of health
Social determinants of health (SDOHs) account for approximately 80-90% of health outcomes, making their identification central to any equity assessment. These determinants fall into five key domains:
- Economic stability (employment, income, expenses, debt)
- Education access and quality (literacy, language, early childhood education)
- Healthcare access and quality (insurance coverage, provider availability, cultural competence)
- Neighborhood and built environment (housing, transportation, safety, parks)
- Social and community context (social integration, support systems, discrimination)
When mapping these determinants, look for patterns of resource distribution. Are quality grocery stores accessible in all neighborhoods? Do public transportation routes effectively connect low-income areas to healthcare facilities? Such questions highlight structural barriers that perpetuate inequities.
Primary care physicians can also play a vital role in addressing SDOHs through screening tools that identify social needs during patient visits. Subsequently, this information helps create targeted interventions at both individual and community levels.
Use surveys and focus groups for deeper insights
Quantitative data alone cannot capture the lived experiences of community members. Surveys and focus groups provide valuable context and nuance to statistical findings.
When designing community surveys:
- Use simple, clear language
- Include both closed and open-ended questions
- Ensure cultural appropriateness and accessibility
- Offer multiple response options (online, paper, phone)
- Provide language translation when necessary
Focus groups offer participants the opportunity to share personal experiences with health barriers. These sessions often reveal issues that quantitative data might miss, such as experiences with discrimination in healthcare settings or cultural barriers to seeking care.
Under those circumstances where traditional data collection methods fall short, community-based participatory research (CBPR) approaches can be particularly effective. CBPR involves community members as active partners in the research process rather than just subjects of study.
The insights gathered through these qualitative methods help contextualize quantitative findings and often highlight community strengths and resources that can be leveraged in your health equity plan. Together with demographic data and SDOH mapping, they provide a comprehensive picture of your community’s health landscape—both challenges and opportunities.
Identify Gaps and Set Priorities
Identify Gaps and Set Priorities
After completing your community health assessment, the next critical step involves analyzing the data to identify gaps and establish priorities. This phase transforms raw information into actionable insights that will guide your health equity plan.
Analyze disparities across populations
Examining health disparities across different demographic groups reveals where inequities exist. Black infants face mortality rates more than twice as high as White infants (10.9 vs. 4.5 per 1,000 live births). Similarly, American Indian/Alaska Native (AIAN) and Native Hawaiian/Pacific Islander (NHPI) infants experience nearly double the mortality rate of White infants.
Life expectancy statistics further illustrate these disparities. Based on 2022 data, life expectancy for Black people is approximately five years shorter than for White people (72.8 vs. 77.5), while AIAN people face an even wider gap of nearly ten years (67.9).
Chronic disease outcomes likewise show persistent inequities. Age-adjusted mortality rates for diabetes among NHPI (49.9 per 100,000), AIAN (47.7 per 100,000), and Black people (42.9 per 100,000) are roughly twice as high as rates for White people (21.3 per 100,000).
When analyzing these disparities, consider:
- Temporal trends (whether gaps are widening or narrowing)
- Geographic variations within your community
- Intersectionality of multiple factors (how race, income, and geography overlap)
Map existing resources and services
Once disparities are identified, mapping available resources helps pinpoint service gaps. The Health Resources and Services Availability Monitoring System (HeRAMS) offers one framework for this process. HeRAMS aims to ensure that core information on essential health resources and services is systematically shared and readily available to decision makers.
Community asset mapping provides another practical approach. This process involves creating a comprehensive inventory of services, identifying critical care gaps, and finding potential partners. First, identify your target population using multiple data sources. Then, create a list of necessary services for stabilization, including both formal and informal supports. Finally, match this list against currently available services, verifying accessibility, language support, and cost.
Ultimately, effective resource mapping reveals where service deserts exist and which populations face the greatest barriers to accessing care.
Set clear, measurable equity goals
Transforming identified gaps into actionable goals requires a structured approach. SMARTIE (Strategic, Measurable, Ambitious, Relevant, Time-bound, Inclusive, and Equitable) objectives provide an excellent framework. This approach builds on traditional SMART goals by explicitly incorporating inclusion and equity considerations.
When developing SMARTIE objectives, engage stakeholders and community members throughout the process. Collect data to establish baselines, prioritize needs based on gap analysis, and identify evidence-based practices for addressing disparities.
For example, instead of a general goal to “decrease breast cancer mortality,” a SMARTIE objective might state: “Decrease the rate of breast cancer mortality from 50 to 45 among African American women by June 2022”. This approach ensures goals are specific, measurable, and directly address identified inequities.
Obviously, tracking progress requires appropriate metrics. Consider incorporating measures related to structural drivers (resource distribution, power dynamics), community determinants (social-cultural environment, physical/built environment), and healthcare access.
Develop Your Health Equity Action Plan
With gaps identified and priorities established, creating a structured action plan becomes the cornerstone of your health equity efforts. A well-designed plan transforms aspirations into measurable progress toward health equity.
Choose evidence-based strategies
Selecting proven strategies increases your likelihood of success. For diabetes management, peer support and culturally tailored health education have shown clinically significant improvements in glycemic control. Meanwhile, screening and referral interventions have positively impacted blood pressure control among racial and ethnic minorities.
When choosing strategies, consider:
- Primary care integration approaches that implement universal depression screenings, which have reduced screening disparities across racial/ethnic groups
- Family-based interventions for childhood obesity prevention that focus on positive parenting and nutritional education
- Faith-based recruitment programs that effectively promote healthy eating behaviors and physical activity
Effective strategies often involve bringing care sites directly to communities, designing equitable telehealth programs, and investing in primary care.
Align actions with community needs
Authentic community alignment requires shifting from merely seeking feedback to genuine power-sharing. As evidence shows, “putting more power in the hands of more people, including those most impacted by structural inequities, results in systemic changes”.
Accordingly, health departments should determine effective communication approaches to engage diverse populations through a culturally-affirming lens. This involves reviewing existing community needs assessments to identify common health equity needs, successes, and barriers.
Beyond all else, create methods to share decision-making power with community members. This means prioritizing co-design principles and rooting work in community partnerships.
Assign roles and responsibilities
Establish a Health Equity Committee with representation from each department branch and at least one sponsor from the executive team. This committee should oversee implementation and annual revision of the plan.
Ensure accountability by documenting who is responsible for each activity in your plan. Additionally, create interdepartmental cohesion through alignment of various task forces and collaborations to facilitate coordinated engagement.
Create a timeline and budget
Develop realistic timelines for each activity with specific start and completion dates. For implementation, consider launching pilot programs before full-scale deployment.
Regarding budget allocation, healthcare institutions should weigh the comparative impact of investments. For instance, Boston Medical Center leaders noted that “a $1 million equity-care investment in 10,000 prenatal visits can lift entire communities” compared to the same amount spent on ten surgeries.
Track progress with key indicators and regularly evaluate outcomes. Henceforth, be prepared to adjust strategies based on feedback and emerging data.
Implement, Monitor, and Adjust
Image Source: https://pixabay.com/
Implement, Monitor, and Adjust
Bringing a health equity plan to life requires thoughtful implementation and continuous refinement. After developing your action framework, the focus shifts to execution, measurement, and adaptation.
Launch pilot programs or initiatives
Starting with pilot programs allows testing of equity-focused approaches before full-scale implementation. The National Institutes of Health exemplifies this approach through its Communities Advancing Research Equity for Health (CARE for Health) initiative, investing approximately $30 million over fiscal years 2024-2025. This pilot leverages existing clinical research networks to establish infrastructure at select primary care sites.
Typically, successful pilots prioritize community involvement. Throughout implementation, participating clinical sites should select research studies based on health issues affecting and prioritized by their communities. This approach ensures interventions address actual community needs rather than presumed priorities.
The National Committee for Quality Assurance (NCQA) demonstrated similar principles with its Health Equity Accreditation Plus pilot, which helped organizations establish processes for identifying both social risk factors in communities and individual social needs.
Track progress with key indicators
Effective monitoring requires clear metrics to measure advancement toward health equity. Agencies can utilize these indicators to explore improvement opportunities and track progress. Since achieving health equity demands a long-term approach, incorporate these measures into organizational and community plans beyond individual projects.
Alongside traditional metrics, consider implementing the Health Equity Monitor database, which contains disaggregated data for over 30 reproductive, maternal, newborn and child health indicators from surveys conducted across 115 countries. Data disaggregation, particularly for racial/ethnic groups, proves essential for identifying hidden disparities.
Adjust strategies based on feedback and data
Health equity work requires flexibility as priorities evolve. Routinely revisit and scale up plans while identifying data gaps to inform subsequent efforts. CDC’s Communities in Context program exemplifies this principle by piloting a public health monitoring framework to track structural drivers of inequities, enabling communities to identify improvement areas.
Continuous community engagement remains vital throughout implementation. The process relies on collaboration across affected populations and stakeholders, requiring strong health information systems, analytical expertise, and political will for remedial action. Prior to finalizing adjustments, consider input from those most affected by structural inequities, as putting more power in their hands often results in systemic changes.
Conclusion
Creating an effective health equity plan requires commitment, data-driven decisions, and authentic community engagement. Throughout this guide, we have explored how health equity differs fundamentally from equality, requiring tailored approaches rather than uniform solutions. Health disparities persist across racial, ethnic, and geographic lines despite overall improvements in healthcare, therefore making equity-focused work essential.
The journey toward health equity begins with thorough assessment of your community’s health landscape. Collecting comprehensive demographic data, identifying social determinants of health, and gathering qualitative insights through surveys and focus groups establish a solid foundation for action. These assessments reveal where disparities exist and which populations face the greatest barriers to care.
After identifying gaps, setting SMARTIE objectives transforms abstract goals into measurable targets. Evidence-based strategies such as peer support programs, culturally tailored health education, and community-based interventions provide proven pathways toward reducing disparities. Undoubtedly, successful implementation depends on shifting power dynamics to include those most affected by inequities.
Health equity work never truly ends. Pilot programs allow testing of new approaches before full-scale implementation, while ongoing monitoring with appropriate metrics helps track progress. Organizations must remain flexible, adjusting strategies based on community feedback and emerging data.
Remember that health equity represents both a process and an outcome. The ultimate goal extends beyond improving statistics to creating communities where everyone has fair opportunities to achieve optimal health. Persistent attention to equity concerns, coupled with authentic community partnerships, will gradually reduce systemic barriers that have historically prevented certain populations from thriving.
Your health equity journey may seem challenging, but each step toward reducing disparities brings us closer to a healthcare system that truly serves everyone. Start where you are, use the data available, engage your community authentically, and commit to continuous improvement. The path to health equity requires patience and persistence, yet offers profound benefits for individuals, communities, and society as a whole.
Show facts
