A Practitioner's Guide for Advancing Health Equity: Community Strategies for Preventing Chronic Disease

A Practitioner's Guide for Advancing Health Equity is a resource for public health practitioners working to advance health equity through community health interventions. While health disparities can be addressed at multiple levels, this guide focuses on policy, systems, and environmental improvements designed to improve the places where people live, learn, work, and play. The guide recommends that health practitioners engage the community, identify needs, conduct analyses, and develop partnerships as well as implement and evaluate the evidence-based interventions. The guides are from the United States (US)-based Centers for Disease Control and Prevention (CDC).
 
To achieve changes in policy, infrastructure, practice, and more, the guide recommends a series of communication-related strategies that help to identify and make changes:

• Be deliberate in recruiting and building staff skills to advance health equity.
• Track and capture health equity efforts in training and performance plans.
• Establish multi-sector collaborations and relationships with diverse communities.
• Undertake participatory institutional evaluations to learn about and improve organisational capacity.
• Make meaningful community engagement a priority to "harness the skills and talents of a community’s most important resource: its people.
  • Understand the historical context before developing your engagement strategy.
  • Build community relationships early on.
  • Assess and address organisational barriers to community engagement.
  • Select engagement techniques appropriate for your context.
• Develop partnerships and coalitions to advance health equity.
  • Include partners working with population groups that experience health inequities.
  • Establish mechanisms to ensure that new voices and perspectives are added.
  • Develop a common language among partners from different sectors and backgrounds.
  • Acknowledge and manage partner boundary and territory issues, and recognise and address power dynamics in a partnership.
• Gain a comprehensive understanding of the health inequities that exist through research or a study of the existing data relevant to your community, and use appropriate tools to identify health inequities.
  • Engage community members and partners in data collection interpretation.
• Establish participatory processes to identify and address implementation challenges.
• Assess the community context before developing messaging around health equity.
• Highlight solutions when framing your messages around health equity.
• Ensure that health equity messages are appropriately disseminated.
• Build the team - successful efforts depend on bringing a diverse set of partners to the table early, consistently, and authentically.
• Foster dialogue on health equity concerns within the community.
• Train staff and partners on equity issues regarding active living strategies [PDF format].

 
A Practitioner’s Guide to Advancing Health Equity also showcases programmes making changes at the policy, infrastructure, and policy levels and lessons learned in the field. They include:

1. Mapping our Voices for Equality (MOVE) uses the media to promote health equity in Seattle and King County (Washington State, US) by developing with the community more than 100 digital stories on health equity and features a local map that shows the impact of place on health.
2. In order to reach populations experiencing obesity and tobacco-related health inequities, the Boston Public Heath Commission (BPHC - Massachusetts, US) developed evaluation questions that helped gauge their impact on health inequities.
3. Smoke-free air protections work better when behaviour change has been primed. In Birmingham, Alabama (US) the health department and the Health Action Partnership conducted community needs surveys, overlaid them with geographic information systems to track rates of smoking, conducted evaluation interviews in identified areas, and then found key organisations and community champions to increase awareness about the benefits of smoke-free environments. One hundred neighbourhood association presidents were trained/educated along with pastors to spread the word, and a culturally appropriate radio soap opera aired on stations with largely African American audiences. The increased awareness contributed to greater success when smoke-free protections were put in place.
4. A strategy to bring about farmer’s markets in Georgia (US)’s rural food "deserts" sought to help struggling farmers as well as consumers who had no access to fresh foods. Once the markets were set up, innovative tactics such as performances by high school bands were held to attract patrons.
5. To improve access to school playgrounds as a community resource for active lifestyles, Latino Health Access engaged parents in Santa Ana (California, US) in parent focus groups to identify programming needs that included walking audits around the school, skill building, and a driver safety educational initiative.

 
The guide includes four user-friendly appendices that can help practitioners to understand and then identify health disparities. It includes considerations for the selection of strategies, design and implementation, and a health equity checklist for consideration during the strategy development process.