COVID-19 acted as a magnifying glass to expose health disparities that existed long before the pandemic. This heightened awareness has increased focus and efforts to tackle health inequity.
Healthcare organizations can work toward the overarching goal of addressing health inequities by aligning their ecosystems and incorporating a Health Equity solutions lens. Below, explore examples of community-based solutions that have the potential to address health disparities.
Community Engagement
Community Engagement is a key component to health equity transformation. Without meaningful engagement, changes to programs and policies will exacerbate existing inequities. Community Engagement can be broad or narrow, but it should always be flexible enough to account for the various needs and vulnerabilities of people in each community.
Community can be defined by geographic proximity, common identities (e.g. race, gender, sexual orientation, faith), shared experience, mutual influence, or a commitment to meeting a need. Regardless of how community is defined, it is essential to understand and address existing power dynamics in any engagement process.
To be truly equitable, engagement must shift power to the community and include multiple opportunities for discussion of priorities and issues. Moreover, the engagement process should be open and transparent and built on trust. This will help to reduce conflict and improve communication between communities and government agencies. This will support collaboration, and allow for innovation to develop and be tested.
Community Health Assessment
Communities seeking to develop community-based solutions that promote health equity must be guided by the principles of a culture of health. To do that, they must have access to a diverse set of data. Querying standard demographic sources typically yields data only down to the county level, leaving out many at-risk individuals.
To gain such a comprehensive picture, they need a community health assessment (CHNA). A CHNA is required by law for hospitals to maintain their tax-exempt status, and it prompts them to examine local conditions that can lead to inequitable outcomes. These include structural policies and practices that impose unequal opportunities, whether intentional or unintentional. These inequalities often stem from bias, discrimination, or other factors that disproportionately affect a group.
Community Health Planning
Community health planning is a way to address community-level issues that contribute to health inequities. Typically, these efforts include providing education and support services to help residents adopt healthy behaviors. They also work to remove barriers to care, such as by promoting preventive and maintenance healthcare, providing access to affordable medical, dental, and mental health services; insurance enrollment assistance; language and transportation support; and other resources.
Achieving health equity requires a partnership among multiple industries and communities. The AAMC says that healthcare organizations should make health equity a leader-driven priority, develop structures and processes to support it, and take specific actions that address the social determinants of health.
However, a large gap exists between what is known about effective community solutions and the knowledge available to those trying to implement them. A limited number of effective programs and individualized interventions have been identified through experimental methods of evaluation, such as randomized controlled trials, but the majority of what is known about community solutions comes from qualitative and descriptive studies.
Community Health Education
Community health education initiatives teach people how to recognize signs of poor health and access essential services, including affordable medical care, dental care, and mental healthcare; insurance (Medicare and Medicaid enrollment); translation, interpretation and transportation services; and housing, food and jobs. These interventions reduce the need for costly emergency room visits and hospitalizations.
Community leaders often work to advance other desired community outcomes while addressing health inequities, such as improving high school graduation rates or increasing the number of affordable housing units. Identifying these types of partnerships and examining how their strategies contribute to health equity can provide valuable insight into effective community solutions.
During the COVID-19 pandemic, ARCHE supported community-based organizations by convening regional networking meetings for partners that included faith-based and tribal groups, local governments, public health departments and community health centers to share communication, messaging, resources and tools. These collaborations helped ensure that community-driven messages, coordination and trusted messengers were shared widely and were informed by health equity perspectives and approaches.
