Using Health Equity Indicators to Guide Community Health Improvement in U.S. Territories and Freely Associated States

ASTHO’s definition of health equity lays the foundation for our external work: "Health equity is when everyone has a fair and just opportunity to be as healthy as possible in a society that values each member equally through focused and ongoing efforts to address avoidable inequities and historical and contemporary injustices and eliminate disparities in health and healthcare." Consider the various definitions of health equity within and among island areas. Achieving health equity requires building a shared understanding of concepts and language to help advance efforts and collaborative action to improve health and well-being for all.

Step One in Action:

• Build the concept of health equity within public health agencies.
• Engage island areas public health partners to help facilitate discussions.
• Engage the community.

Reframe the issues to resonate with community members, partners, and other island areas collaborators.

Step Two in Action:

• Focus on health equity rather than health disparities.
• Frame health equity as achievable.
• Communicate to address stigma.
• Meet the community where they are.
• Communicate health equity as a "we" issue.
• Build island areas public health agency staff capacity to understand health equity.

Agencies can measure health equity by exploring existing health indicators and developing new ones. Before developing new indicators, use a health equity lens to explore equity within existing datasets and across indicators of health status, social determinants of health, and other community-level factors that influence health and well-being.

Step Three in Action:

• Identify what is important to measure.
• Select existing indicators and measures. Refer to pages 11-12 in the guide for examples of how to apply a health equity lens to existing health indicators.
• Develop new indicators and measures. See pages 11-12 in the guide in the guide for examples of health equity indicators that could be tailored to an island jurisdiction context. Although these are examples and not tied to any existing data sources, they could be adapted to highlight specific populations or communities and/or stratified by multiple factors (e.g., gender, geography, employment status, economic status).

This step builds on a shared understanding of health equity and how to apply a health equity lens to existing and new indicators. Use this step for employing storytelling and data to explore a public health issue or priority.

Step Four in Action:

• Identify a public health issue or priority.
• Review potential indicators and data sources to explore that issue. See Appendix B, Table 1 in the guide.
• Consider all the indicators you currently measure. From those indicators, identify a small set (two to four) to explore the issue (e.g., rates of depression among youth, geography, gender, age).
• Stratify the data using a health equity lens.
• Organize results in an infographic, brief data report, or data profiles. When possible, use stories to describe what you found and when sharing the results with community partners, organizations, and other sectors.
• Engage community partners in interpreting findings.
• Use results to inform programs, practices, and policies within the public health agency as well as the development of new health equity indicators.

Achieving health equity requires a long-term approach. Look beyond the project and program level and incorporate health equity indicators into organizational and community plans.

Step Five in Action:

• Establish long-term vision and commitment.
• Incorporate health equity within the quality improvement structure.
• Monitor progress towards health equity indicators.

In this stage, focus on maintaining and building momentum. Be flexible as you revisit and scale up plans to measure health equity, as the issues will change over time.

Step Six in Action:

• Consider challenges in measuring health equity.
• Seek out resources, tools, and training to enhance the skills of the workforce to bolster efforts to incorporate health equity into all grant-related work, from development to monitoring.
• Leverage workforce capacity strategies and practices to promote the integration of health equity.
• Identify data gaps and include lacking data points on health assessments to inform subsequent health equity efforts.
• Revisit and scale up health equity efforts.
• Continually engage with the community to explore additional priorities or public health issues.
• Increase the skills of the workforce to incorporate health equity into their work, from program planning, design, and implementation to monitoring and evaluation.
• Identify gaps and consider new data collection methods to explore root causes and key drivers of inequities.
• Utilize root cause and key driver data findings to inform public health practice.