Equity is “’The absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically.’ Equity encompasses both health equity and racial equity and includes both processes and outcomes. It is widely acknowledged that addressing equity is a critical goal of aligning across sectors and, ultimately, critical for improving community well-being.”²⁵

“We have major health inequities that are actually the result of racism, so any kind of platform that’s adopted has to start with that fundamental premise. It can’t be an add on or a ‘nice to have,’ it literally has to be what the whole initiative is built on.”

– Public Health Representative, CA

Key Takeaways

Equity includes both health equity and racial equity. Without racial equity, there can be no health equity.
Equity is both a process and an outcome. In other words, in order to produce equitable health outcomes, it is important to work equitably.
Within MSCs, equity can be incorporated into communication and activities among partners and community members in order to produce more equitable mindsets and practices.
Research participants had generally positive perceptions of their MSC’s progress toward advancing equity.

According to the World Health Organization, equity is “the absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other dimensions of inequality (e.g. sex, gender, ethnicity, disability, or sexual orientation). Health is a fundamental human right. Health equity is achieved when everyone can attain their full potential for health and well-being.”²⁶ This definition is more than just a technical understanding of a popular concept—it is an expression of hope for a future in which people are able to live healthy lives regardless of their birth circumstances. Equity is also at the heart of PHIL’s work with multisector collaboratives, as we are fundamentally interested in how systems can change to prevent systemic marginalization and inequitable outcomes.

Equity is both a fundamental process and a outcome within many MSCs, such as Accountable Communities of/for Health (ACHs). Due to both longstanding and ever-changing systems of discrimination, equity may never truly be “achieved.” Instead, equity must continually be monitored and advanced by providing and improving health services, eliminating upstream causes of poor health outcomes, and empowering community members to take control of their health.

As a process, equity requires MSCs to think carefully about how they do their work. The how determines whether or not MSCs will actually be able to advance equity as an outcome. When we took a closer look at how six MSCs that participated in our Aligning Systems for Health Deep Dive Study advance equity, we learned that:

Improving equity will take time, dedicated focus, and resource investments. Inequities have existed for generations and been reinforced through multiple systems.^{27, 28} Sustained collective action across sectors will be needed to shift the conditions that create inequities.²⁹ The deep dive study showed that many ACHs keep equity as a central focus across all their work.

Processes lead to outcomes, meaning that building equity into ACH processes will produce more equitable outcomes.^30,31 MSCs coordinate, influence, and contribute to the work of countless individuals, organizations, tribes, and others making them well positioned to build equitable processes into their aligning efforts.^32,33 Throughout the deep dive study, we saw MSCs implementing processes to increase representation, balance power dynamics, and ensure collaborative decision making. They did this by reserving time for public comment at board meetings; offering educational materials in multiple languages; hiring racially, ethnically, and linguistically diverse staff; offering multiple options for how people could participate in meetings (e.g., phone, web, in-person); rotating in-person meeting locations; holding meetings outside of working hours; using participatory budgeting practices; providing community representatives compensation for participation; and ensuring that community representatives had opportunities to engage in governance through community-led committees or designated seats of governingboards. These types of procedural arrangements are the building blocks for equitable systems-level outcomes.

Equity education creates ripple effects across sectors. Equity can be more readily advanced if people have a clear understanding of the definition and can visualize or see what it looks like in action.³⁴ When PHIL spoke with MSC participants during the deep dive study, we observed that people who had received education specifically on equity appeared to be more comfortable speaking about it and had a better understanding of how MSC efforts could improve equity in their community. When MSCs offer equity education, it can influence partner organizations to develop and implement health equity policies, fair hiring practices, and community advisory councils; to focus on equity, diversity, and inclusion in their own work; and to ensure decision-making bodies are representative of the communities served by the organization. Deep dive MSCs provided equity education by hosting equity book clubs, conducting equity assessments with partner organizations, and integrating equity measures into their work.

Survey Findings

91% of respondents agreed that their MSC applies principles of equity, diversity, & inclusion throughout its work (n=467).
95% of respondents agreed that improving health equity is an important outcome of their MSC (n=450).
90% of respondents agreed that their MSC is effectively promoting equity across our community (n=451).

“20% of that contract you only earn if you participate in equity work. That includes coming to the trainings, that includes writing an equity commitment statement in your project plan, that includes…a commitment to an internal equity goal that they’re sort of working towards improvement on. In that way, I think one of the things that makes a big difference in how we’re implementing stuff is that we are really trying to embed equity deeply at the center of all of our work with partners and make it not only a driving expectation, but something that people are on the hook for.”

– ACH Staff, WA

Perceptions of Equity

MSC participants had mixed feelings about their MSC’s ability to incorporate equity into their work. Perceptions of commitments to equity varied by different local contexts and participant backgrounds. We found that:

Not every MSC was seen as equally effective at incorporating equity into their work.
Participants from MSCs with public funding tended to have better perceptions of equity being incorporated into the work.
People from tribal communities and nations tended to have better perceptions of MSC progress toward equity, while people who worked in public health tended to have worse perceptions.

The Influence of Equity

When people believed their MSC was advancing equity, they also believed the MSC was doing better with its ability to create collective action and its ability to build shared purpose.

“When people believed their MSC was advancing equity, they also believed the MSC was doing better with its ability to create collective action and its ability to build shared purpose.”

– Public Health Representative, WA

Related Resources

Advancing Equity with Multisector Collaboration, a Population Health Innovation Lab (PHIL) research brief (2023)
Advancing Equity: Adapting to Local Context and Confronting Power Dynamics. Lessons Learned from Accountable Communities of/for Health, a Population Health Innovation Lab (PHIL) report (2022)
Advancing Equity: Adapting to Local Context and Confronting Power Dynamics, a Population Health Innovation Lab (PHIL) web discussion (2022)
Developing a Framework To Measure the Health Equity Impact of Accountable Communities For Health, a Funders Forum on Accountable Health report
Keeping the Focus on Equity with ACHs, a Population Health Innovation Lab (PHIL) research presentation (2021)

View all references for the Data Walk.