Health Equity: How specific will we get?

Niiobli Armah IV

April 4, 2017

We (the field) have done a tremendous amount of work in the last decade to usher Health Equity into the wider public health and advocacy discourse. There has been no other time when we had this much capacity to ease the burden on communities and better serve all residents, specifically those living in high opportunity areas. We have more advocates, champions, and partners than ever before, all holding the banner of Equity as we march forward. The question I have been asking myself lately is just how specific will we get?

By now, most organizations and institutions understand intellectually the reality of historic, structural, and institutional barriers that some communities face. Hundreds of professionals in our field have sat in trainings contemplating the plight of urban, rural and indigenous groups and discussed the question how do we accelerate change. In order for us to make true impact, the next phase of this work will require us to push people and institutions beyond intellectual discourse and into full engagement.  While population level outcomes can take decades to achieve, we have to publicly ask ourselves what will we do in the meantime to ensure those changes are on track to becoming a reality? What specific actions will we take as individuals and as organizations?

The initial step we must take is an internal audit of what is in place.  Assuming that all organizations engage in regular training opportunities, who is responsible for ensuring the training is translated into strong internal policy? Furthermore, we must ensure that the training opportunities have been developed to address the bias that we know is deeply embedded in our systems.  In a field where we focus on changing systems and policies, it is easy to forget that policies are written by people. If the people developing the policy have not been properly trained and lack the necessary community context, then a lack of equity in the policies will persist. This strong emphasis on training is due in part to the very few formalized opportunities in academic and institutional settings for practical health equity training. Most opportunities occur at biannual meetings and/or conferences.  Routine engagement around this topic should become a norm to ensure individuals and institutions are developing competency.

Second, we should all be adapting our outreach strategies to align with the needs of the broader field. This includes asking questions about how are we building capacity with our partners? What would an inventory of our partners, core allies and engagement efforts tell us?  Regardless of the answer, we know we can all grow here. It’s interesting, the number one reason individuals and organizations collaborate successfully is because of personal relationships. This tells us that if we want to achieve all the outcomes we are working towards then we must take two key actions. First, we must go deeper in our existing networks and better understand our mutual goals. Second, we must widen our networks to reach beyond the usual suspects.

Last, is the notion of proximity. Recently, this term has been used amongst advocates and organizers when referring to the relative distance of the advocate to the cause or people they are advocating for (or simply speaking on). Proximity is important because it allows for contextualization of circumstances. There is vast amount of data to prove that disparities exist, but understanding the environmental context is important in grounding your efforts.  I urge caution here to ensure we are not encouraging proximity for the sake of speculation but rather participation. This means we should not limit advocates to only support the causes they have proximity to. We should instead encourage advocates to become allies for diverse causes and to gain proximity through knowledge, trainings, and most importantly authentic engagement. Visiting and speaking with individuals who live in the communities where the need is high, will only strengthen our ability to advocate and become a strong ally of theirs.

There are many experts and strategies that can be sought out to respond to the items raised above, however the absence of asking the right questions is the absence of an equity strategy. It’s easy to be moved and mystified by the inequities in our society but action is what’s needed. So how specific can or will you be with yours?

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