Implementing Systems-Level Change for Health Equity: A Partnership Summit

"The time to implement systems-­level change for health equity is now."

This report summarises the proceedings and recommendations of the inaugural Health Equity Initiative (HEI) Summit, which provided a forum to explore systemic issues and exchange ideas on action areas for building a culture of health and creating opportunities for better health among underserved and vulnerable populations. This includes communication about and advocating for health equity - topics that were explored in detail at the Summit's plenary sessions, roundtable discussions, and interactive consensus workshops. In addition to describing the Summit and its outcomes, this report points to several directions for future interventions and capacity building efforts.

The February 25-26 2016 Summit was convened in New York, NY, United States (US) by HEI, a nonprofit membership and member-driven organisation dedicated to building and sustaining a global community to advance health equity. The Summit offered more than 100 professionals, community leaders, and students across sectors and disciplines - public health, healthcare, urban planning, development, community - a forum to develop an agenda and related priorities for systems-level change using a participatory/consultative process. They had the chance to learn about and discuss the effects of social impact interventions on systems-level change for health equity and/or specific social determinants of health and to pledge new partnership-based endeavours moving forward.

The Summit explored 4 main themes: the role of urban design in promoting health equity; the importance of community and patient engagement to strengthen ownership and sustainability of all health equity-related interventions and results; the link between health equity and socio-economic development; and strategies to communicate about health equity and to engage different groups and stakeholders in the health equity movement. A number of topics emerged as relevant to all 4 themes and, more generally, to advancing health equity. These include:

• The need to foster understanding and defining of "health equity" in a way that is meaningful to each key stakeholder group; this may involve learning about the "language" of multiple sectors and establishing community­ and sector-specific priorities and definitions. "Finding the most effective communications approaches requires an understanding of each group. It is clear that capacity building and communications training are needed for the adoption of health equity into policy and practice."
• The strong interdependence of entrenched drivers and outcomes of poor health, poverty, and inequality as fundamental to interventions to promote health equity as well as to advance other social justice issues.
• The role of community and patient engagement not only in information dissemination, but also in the actual planning, implementation, and evaluation of health-equity­-driven interventions.
• The importance of participation in the urban planning process by professionals outside of design fields and communities themselves.
• Capacity building and training as a pre-requisite for action in areas such as advocacy and communication for policy and social change, cross­-sectoral collaborations and partnerships, community capacity to participate in intervention planning, and strategies for non-designers and communities to contribute to urban planning.
• The importance of health-equity-related efforts in fields outside health-related professions.

Other topics included discussions on engaging youth on health equity issues as well as the work of HEI's Public Policy Member Committee on child mental health disparities as an example of the need for systems-level change. (This work involves utilising a community-driven research approach to online/digital screening assessments for mental health among children.) Overall, the work of the Summit confirmed that there is far more to health than health care, and that we need to enlist a wider range of allies in advancing health equity.

At a poster session, a common theme of all posters was the need to involve members of communities most affected by health inequity in the process of advocating for, establishing, implementing, and evaluating initiatives that will lead to healthier populations. Several strategies were on display, including:

• Working towards establishing and fostering opportunities for health policy leaders who can identify with the experiences of populations most adversely affected by health inequity.
• Exploring public-private partnerships that result in better health outcomes for vulnerable, disenfranchised populations.
• Using data-informed and community-driven approaches to understanding poor health outcomes among vulnerable populations and identifying the underlying causes of these poor health outcomes as they relate to social determinants of health.
• Encouraging multisectoral collaborations and partnerships in which communities mobilise for action and pool resources together to advance health equity.
• The importance of a community-specific definition of health equity that takes into account the unique priorities and social determinants of health that may be relevant to a specific community and therefore inform action for health equity impact.

Key conclusions and/or recommendations from the Summit are summarised beginning on page 22, as well as in the reports of each plenary and roundtable session and consensus workshop. For example: "The chief points arising from the work of the Summit appear to validate the importance of a new concept of 'community', one that is composed not only of community residents but also all the stakeholders who live, work, and operate in a given geographical area....This includes all kinds of businesses, institutions, municipal services, policymakers, government services....For this, we need to build capacity and willingness for understanding health equity as of benefit to all. For this, we need to reconnect to the values that motivate our work and lives as well as our vision for the kind of world we want to leave to our children and grandchildren. We need to create appropriate forums to discuss perspectives on difficult issues such as poverty, race, and social discrimination, and how these impinge on health, social, and organizational outcomes. Finally, we need to remember that the concept of 'equal opportunity' is what has inspired or shaped many political agendas, civil and human rights movements, founding legislations, and international declarations across issues and centuries."