Health equity is gaining prominence in public conversations about community well-being. While not a new concept in the field, it is invigorating to see health equity as an integral part of seminal work and papers, including the recent study of the association between income and life expectancy by Chetty et al., and the inclusion of residential segregation as a measure in this year’s County Health Rankings. Health equity is also one of six Essential Practices for creating meaningful and sustained change in communities at the center of Active Living By Design (ALBD)’s new Community Action Model.
Perhaps even more encouraging is how this growing attention and energy around health equity is leading to more in-depth consideration of the multiple factors that influence equity, as well as how the interconnectedness of these factors shapes the health and longevity of people in communities. The study by Chetty et al. delved into these factors and found that unemployment and income equality had weak associations with longevity, while education, population density and local policies to support health appear to contribute to improved longevity even for poor residents. These findings help explain why “one-size-fits all” approaches, and those that do not authentically address multiple factors, fail to create or sustain positive community change.
Every community has its own culture and assets on which to build. These can direct efforts to achieve health equity by addressing the avoidable and unjust social, economic and environmental conditions that lead to health inequities. ALBD considers Community Context to include the residents, location, history, policies, systems and resources and the interplay of these factors. Those various factors have a unique influence on health in each community and must be understood and accounted for at every stage of the healthy community change process. This includes the selection of strategies and the order in which those strategies are implemented. To support this process, ALBD helps communities tailor their approaches using the Community Action Model as a guide through community change.
ALBD developed the original Community Action Model more than a decade ago. As the healthy community field has matured, we realized that we needed to more intentionally address key elements, including health equity, to help ensure that community transformation efforts are tailored to and sustainable within communities. We know that the nuanced differences between communities and the people that live within them can determine whether a farmers’ market thrives, a park is utilized, or whether a child who grows up in poverty has equal access to preventive health care.
In our journey towards health equity, we follow the lead of community residents and leaders. We ask questions and seek to understand their perspectives in order to ensure that they are not unduly stereotyped or seen solely as a “poor” community or categorized based only on their ethnicity or another single factor. We support them by sharing success stories, evidenced-informed strategies and lessons learned, and we trust their judgement in deciding and directing their own course. This requires us to be intentional and curious. It also requires us to advocate for the time and resources it takes to develop mutually supportive relationships and achieve sustainable, positive change that improves access to healthy living opportunities for all people.