For nearly every indicator of well-being, Black Americans experience the poorest outcomes compared to other racial and ethnic groups, especially when compared to White Americans. Long before the COVID-19 pandemic, Black Americans have consistently endured the greatest disease burden across the lifespan, from poorer maternal health and infant deaths, to higher chronic disease rates and lower life expectancy. These outcomes are directly linked to both intentional and unconscious racial bias in our institutions.
Trending Toward Equity
With equity as a growing concern, major health funders and public health agencies have increasingly prioritized the social determinants of health through grantmaking and other funding mechanisms. Social determinants of health include factors beyond the health care system such as criminal justice, economics, education, food systems, housing, and transportation. Funders now typically urge (or require) participating grantees to adopt equity approaches in their attempts to improve community health.
Community Engagement: A Key to Equitable Processes
Regardless of what specific issues community initiatives focus on, an equitable approach must address who is included when setting priorities and making decisions, how they are engaged, and for what purpose. Ideally, those who are most impacted by poor health outcomes are encouraged, accommodated, and fairly compensated to participate in assessment, planning, implementation, and evaluation. An equitable approach is inclusive, mindful of longstanding racial inequities, and shifts power to people who have too often been excluded from these processes.
The following resources can help practitioners and community leaders ensure that community change processes are equitable and therefore more likely to result in equitable outcomes:
- Community Engagement — TYTHEdesign’s Community Engagement Almanac is a “tactical guide for supporting productive and equitable conversations with community-based stakeholders.” Designed for local organizers of community change initiatives, the Almanac helps coordinators clarify the purpose and benefits of community engagement; offers tips for critical decision making; and provides mini-guides on accessibility, equity, facilitation, virtual and physically-distant gatherings, as well as ensuring that community engagement processes are equitable, inclusive, and accessible. The Almanac also frames key elements of the community engagement spectrum, including outreach, consultation, collaboration, and shared leadership.
- Community Planning — The Planner’s Playbook, a resource recently developed by ChangeLab Solutions, helps local planners and policy-makers use a “community-centered approach to improving health and equity.” The Playbook addresses structural inequity and the potential for official planning documents, policies, and government staff to reinforce existing patterns of marginalization, despite their good intentions. Another ChangeLab resource, Long Range Planning for Health, Equity and Prosperity, provides guidance for aligning health equity policies across local government departments, and incorporating equity in long-range planning, community engagement, investment, and evaluation processes. Additional resources for insights and equity strategies related to land use and zoning practices include Four Shifts to Heal Communities (Prevention Institute) and Equitable Development Toolkit: Inclusionary Zoning (PolicyLink).
- Food Systems — Racial Equity Tools for Food Systems Planning (University of Wisconsin) is a facilitation guide and process for assessing racial equity in the food system. The tool provides a helpful perspective on the historic roots of racist land-based policies that are part our legacy today. This process can help planners “normalize conversations about racial difference [and] ask critical questions about who is or is not served by plans.”
- Racial Equity in Government — Produced for the national Government Alliance on Race and Equity, the Racial Equity Toolkit helps local government officials “integrate explicit consideration of racial equity in decisions, including policies, practices, programs, and budgets.” The Toolkit guides local leaders and staff through a sequence of steps and questions, with prompts related to process, impact, data, community engagement, communications, and accountability.
- Transportation — Take it from our colleague and street-level researcher/urban planner, Charles T. Brown, that equity cannot be achieved without a better understanding of residents’ needs, root causes of inequality, and intentionally building fairness into systems and institutions. 12 Strategies for Centering and Prioritizing Equity in Transportation, a tool included in the ITE Journal, offers practical advice for inclusive engagement processes and communications strategies. Mr. Brown reminds us that equity work “requires more than a desktop exercise or activity”—it also requires intentionality and “finding comfort while being uncomfortable.”