Centering Equity in Community Health Partnerships

In collaborating with seasoned community health practitioners over the last year, it has become clear that many of us in this field are considering the same questions when it comes to the future of community health: What is the role of place-based programs in supporting community partners during the pandemic? How can the field of community health more effectively advance racial justice? And, simply, what’s next?

In this period marked by uncertainty and instability, The BUILD Health Challenge® (BUILD) sought out insights from leaders in public health, health care systems, and philanthropy to better understand and take action on these issues. BUILD partnered with social change nonprofit Equal Measure to explore the trends and changes in community health, asking the following:

• What are the big trends or changes in the community health field with the potential to create healthier and more equitable communities? Where are these trends emerging?
• What are the accelerants of and impediments to these trends and changes right now?
• What changes do you believe will sustain?

Conversations helped to show that the field has increasingly embraced 4 approaches critical to community health:

• Pursuing systems change;
• Addressing upstream factors;
• Building effective and sustainable cross-sector partnerships; and
• Centering equity.

These approaches are detailed in “Journeying Toward Healthier Communities: A Report on Trends in the Field,”¹ published by BUILD to help inform community health leaders’ thinking, strategies, and actions in 2022 and beyond. BUILD also created a companion guide² with discussion questions to help leaders continue their exploration into field trends.

Spurred by widening inequities resulting from the pandemic and a growing racial justice movement, public health agencies are heeding calls from their community members to lead with equity in their organizations. But how do public health agencies shift from commitment to action in their effort to foster greater equity in their communities?

Reflecting on BUILD’s own equity journey has surfaced useful insights into how to understand, strategize, and operationalize equity, especially in establishing successful community partnerships for better health. Leaders of public health agencies can play a critical role in this process by first engaging in deep reflections on the power and privilege inherent in their roles and organizations. As one interviewee in public health quoted in BUILD’s field trends report said, “You cannot do equity for real if you are not in a relationship with community [and] with a balance of power.”

Questions to Guide Discussions of Equity

BUILD’s companion guide to its field trends report provides discussion questions on the emergent themes identified by community health leaders, including centering equity. These questions can serve as a starting point for public health agency leaders seeking more intentional and authentic community engagement, especially in developing partnerships. Regardless of the type of partnership—whether related to behavioral health, housing, food access, or another community health priority—it can be undertaken more effectively with an understanding of how power and privilege influence equitable outcomes.

BUILD offers the following 3 questions to begin and/or deepen your thinking on centering equity in community health partnerships, with considerations specific to public health agencies:

1. In what ways is your partnership holding power? How can you share or build power with those most affected by issues in your community? It is essential that public health agencies acknowledge the influence they hold in relation to the communities they serve. Failing to share power with those who have lived experience, those who are most impacted by an issue, or those who are disenfranchised, for example, can exacerbate imbalances in power between stakeholders. Health departments and other community-based public health organizations, in particular, can endeavor to mitigate such imbalances by ensuring that the design process and decisions related to an issue are made with the inclusion and approval of those who will be most affected.
2. What resources and time do you need to ensure all partners understand issues of racism, inequity, and power imbalance—and their implications for your efforts? These issues surround us and are baked into the organizations, systems, and policies in our communities. To try and address them, public health agencies must embed equity in terms of mindsets, practices, and policies at all levels among staff and leaders. To do so requires collaborating with their community partners to fully understand issues related to equity and how to address them. While there is no one “playbook” for addressing racism, inequity, and power imbalances, there are best practices, lived experiences, and examples to help one take action and create a path forward. Doing so requires ample time and resources that encourage open dialogue, conversation, and transparency between partners—as they begin a shared journey to center equity in their efforts.
3. What is being left unspoken or unaccounted for in your conversations about equity? Conversations about equity can be particularly complex because they require the acknowledgment of power imbalances, historical and/or ongoing discrimination, as well as social and racial injustices. Recognizing that advancing equity is difficult and time-consuming work requires intentionality on the part of participants. Public health leaders may want to consider positioning their team and organization as supportive of local efforts with a focus on relationships as the grounding for challenging conversations. Starting with trust in the form of proven partnerships can ultimately help shed light on the “unspoken” challenges the community faces and strengthen and improve collaborative programmatic efforts over time.

Making the Commitment to Equity

As these questions and considerations illustrate, centering equity is an ongoing and evolving process for public health agencies, as well as all leaders and organizations across sectors. It is not a one-time activity or something that can be “solved” in a day. What you can be sure of it that there is always more work to be done in creating partnerships rooted in equity, but investing in time, resources, and relationship building can yield significant gains for community health practitioners. Centering equity in community health is an opportunity for growth, with more fulfilling partnerships within reach for those who make the effort.