Turning the tide on inequity through systematic equity action-analysis
A framework to support teams to meaningfully integrate equity across multiple settings
The authors of this article begin with a useful discussion about the relationship between power and health. They contend that across health research, policy and practice, there is a persistent tendency to minimize the structural drivers of health inequities and instead focus on more downstream conditions of daily life and individual behaviours. They observe that many efforts to advance health equity (a) do not engage with the full range of available expertise and knowledge, and (b) (mis)place the responsibility to address systemic injustice on others in the system, including on members of equity-denied groups.
To bridge the gap between good intentions to advance health equity and meaningful action, the authors offer the Systematic Equity Action-Analysis (SEA) framework (Figure 1, p. 4). They describe the framework as a versatile tool that is “grounded in relational theory and applied critical, anti-oppressive approaches in health science and practice” (p. 3). They recommend using a series of discussion questions (Figure 2, p. 6) to reveal how equity is or is not being integrated into programs, services, policies, engagement processes and more.
Intentional analysis with specific practice orientations needed for framework application
When applied, the framework facilitates users to move through four interconnected areas of analysis:
- Worldview – Participants discuss criticality: the values and assumptions that drive how the world works, how the world is portrayed, what is believed to be most important, and what is believed to be possible.
- Coherence – Participants discuss process: the alignment between the choices that are being made and what is known to cause inequities.
- Potential – Participants discuss agency, choice and the potential for taking meaningful equity action.
- Accountability – Participants reflect on “equity-advancing accountabilities” and the mechanisms in place to hold those responsible for a decision to account. They extend the initial discussion about world views and consider what is believed to be one’s responsibility to others.
The framework also encourages users to adopt specific practice orientations while engaging in discussion, including critically reflective dialogue, systems thinking, agency and humility. Importantly, the authors state that the use of this framework provides a concrete way for people to “explicitly recognize and interrupt their own entanglements in the intersecting systems of oppression and injustice that produce and uphold inequities” (p. 1).
Illustrative case examples
Readers will find the illustrative case examples of the SEA framework’s application (Tables 1 and 2, pp. 8–10) particularly useful. The featured examples analyze equity-centred practices in (a) global health research funding, (b) vaccine nationalism and global health responses, (c) transforming nursing curriculum, and (d) collaboratively building an equity framework.
Use this resource to
- Build individual and organizational capacity for health equity action through critical reflection and dialogue
- Consider power relationships and refine existing approaches related to public health programs, services, engagement or policy processes
- Identify opportunities to use yourself as an instrument of change and health equity action within larger public health systems
Alignment with NCCDH work
The NCCDH supports the public health community to act on interrelated structural, social and ecological determinants of health.
To do this, public health organizations need to build their capacity for health action. Further, the individuals who work within public health organizations need to be supported to develop the necessary competencies (knowledge, skills and attitudes) to address the structural and social determinants of health.
In response, the NCCDH has published several resources to support leadership and capacity for health equity, including a guide to tools for assessing organizational readiness, a values-to-action tool for public health teams, and a practice framework that names eight interrelated components. The NCCDH has also released documents and podcasts that facilitate dialogue and learning about redistributing power for health equity.
See related resources on leadership and capacity building for health equity.
Reference
Plamondon, K. M., Dixon, J., Brisbois, B., Pereira, R. C., Bisung, E., Elliott, S. J., Graham, I. D., Ndumbe-Eyoh, S., Nixon, S., & Shahram, S. (2023). Turning the tide on inequity through systematic equity action-analysis. BMC Public Health, 23, Article 890. https://doi.org/10.1186/s12889-023-15709-5
Tags: Leadership & capacity building, Document, Journal Article, Tool