Ending health disparities means addressing its social determinants or attacking the problem at its roots where people live, work, and play. This means changing the conditions in communities of color that affect their health. This approach also requires changing the systems that impact these conditions. Five coinciding capacities are essential for beginning the process of changing communities and systems:
- Understanding of the connection between health disparities and social justice;
- Ability of community stakeholders, including leaders, residents, advocates, funders, and others (“community stakeholders”) to select and develop a scalable and sustainable change strategy that strengthens community, increases access to resources and opportunities for producing health, and addresses inequities;
- Ability of community stakeholders to monitor, evaluate, learn, and improve their work;
- Aptitude of people working in different sectors, including transportation, education, housing, health care, environmental protection, food production, and economic development—conditions that determine health—to collaborate, problem-solve, and implement change strategies;
- Commitment and skills in mobilizing, organizing, and engaging communities affected by health disparities to plan and take collective action.
It takes expertise and time to intentionally build these capacities. They do not develop overnight, and they do not come naturally to people. Just because you bring together well-intentioned people who are passionate about their communities does not mean that they will naturally collaborate with one another or that they understand the connection between health disparities and social justice. Funders, implementers, community leaders, and others have to assemble a set of tools from different disciplines—from public policy to community development—in order to build these capacities. More important, there needs to be an infrastructure or some sort of organized entity—whether at the local, state, regional, or national level—to build and sustain a community’s capacity to deploy the tools, learn from the work, and become better at it.1
Understanding the connection between health disparities and social justice: To help community stakeholders understand the connection between health disparities and social justice, public awareness or education campaigns can be useful. These campaigns can help people follow the story, which should combine the use of data and personal experiences. An example is how the lack of state investment in early childhood education, for instance, contributes to children, who live in low-income communities and often communities of color, falling behind in elementary school, which puts them further behind in high school. Without high school graduation, they are unable to secure jobs with decent salaries that would allow them to purchase a home located in an area with accessible fresh, healthy food and safe recreational space. The root of the disparities is not poor eating habits, but the lack of quality education from a young age.
An effective change strategy: The connection between health disparities and social justice also means that developing programs and providing more direct services is not sufficient. Community stakeholders must develop the skills to ask the right questions and use data to analyze and demonstrate the problem and inform the solution.2 A scalable and sustainable strategy means changes in policies and systems that have the potential to impact the lives of many people. Also, the efforts that are part of the strategy must be aligned with one another. For example, an initiative to change policies to ensure healthy school lunches should be connected to programs that teach children and their parents about eating healthy food; that, in turn, should be connected to programs that help farmers grow and distribute their produce as well as to economic development efforts to attract grocery stores and other businesses to the area to increase access to fresh food and to create jobs.
Monitoring, evaluation, and learning: Besides using data to analyze and demonstrate the problem and inform the solution, community stakeholders should be able to monitor, evaluate, and learn from the strategy’s implementation and results. This means designing an evaluation and feedback loop that appropriately monitors results at the community, systems, and population levels as well as provides recommendations for improving the change strategies. This requires changing the culture of community collaborations to address health disparities to not only use data to learn about their community condition, but to use data for strategy improvement and other decision-making processes. Organizations and community collaborations also need to develop the skills and internal processes (or habits) for collecting, analyzing, reporting, and using data for decision making.
Cross-sector collaboration: No single individual or organization can tackle the problem of health disparities, however. It requires a group of people with relevant expertise from different disciplines to examine the problem from different angles, and to develop and implement a solution. Their collaboration requires careful planning, coordination, and execution because, while they may share the common goal of ending disparities, they naturally have self-serving agendas as well as different—and perhaps conflicting—ways of analyzing the problem. There are two important steps to ensure that the collaboration is successful: 1) establish a coordinating entity that has the knowledge and skills to engage the different stakeholders, and 2) be clear about what the “end” is, for which the collaboration is a “means.”3
Community mobilization and engagement: Community engagement is necessary to build public will for change. This task requires 1) knowledge about how communities are organized to support their members, which is based on their cultural values and traditions; 2) skills in bringing people from different racial, ethnic, and cultural groups together to work on a common goal; and 3) solutions that are respectful of and responsive to people’s cultures.4,5 Similar to collaboration, this requires a thoughtful and intentional strategy that allows participants to see their commonalities and not just differences. More important, it does not pit one group of people with “fewer disparities” against another group of people with “more disparities,” but instead, works together toward creating an inclusive community that cares for all its members.
