Heath equity occurs when society actively removes barriers that disproportionately affect the health status of particular individuals and groups within a society. HEAL (Health Equity Advancement Lab) promotes health equity through community engaged public health research and practice, with a particular emphasis on communities in the state of Iowa who experience inequities.
- Provide technical assistance for community engaged research for community and academic partners
- Build capacity within the University of Iowa for conducting community and behavioral health research using a Community Based Participatory Research (CBPR) approach
- Support equitable and sustainable partnerships between community and academic partners at the University of Iowa.
Definition: The process by which individuals, communities, organizations, institutions, and societies develop abilities to perform functions, solve problems and set and achieve objectives.
3 Levels (Hawe 1997):
- Capacity to execute the components of an intervention
- Capacity to continue the intervention once the supporting institution is no longer involved
- Capacity to identify and intervention upon other health issues
Example approaches (Crisp 2000):
- Involving community leaders
- Organizational collaboration
- Staff training
- Reorient established services for other problems
Hawe, P., Noort, M., King, L., & Jordens, C. (1997). Multiplying health gains: the critical role of capacity-building within health promotion programs. Health policy, 39(1), 29-42.
Crisp, B. R., Swerissen, H., & Duckett, S. J. (2000). Four approaches to capacity building in health: consequences for measurement and accountability. Health promotion international, 15(2), 99-107.
Definition: Maintaining partnerships and health benefits of a program over time.
- How to ensure sustainability in your public health project or program
- Work to obtain buy-in and support from key decision-makers and community members
- Develop and maintain adequate leadership, communication, and funding
- Continuous evaluation and re-rvaluation to serve the evolving needs of the community and partnership
- How does sustainability promote health equity
- Meaningful change in health status, especially among marginalized populations
- Not just a single intervention, but rather sustainable collaboration and structural change to improve health for all
Centers for Disease Control and Prevention. A Sustainability Planning Guide for Healthy Communities.
Rifkin, S. B. (2003). A framework linking community empowerment and health equity: it is a matter of CHOICE. Journal of health, population and nutrition, 168-180.
Definition: Incorporates a lifelong commitment to self-evaluation and self-critique, to redressing power imbalances, and to developing mutually beneficial and respectful partnerships with diverse communities.
Self-Evaluation and Self-Critique (California Health Advocates, 2007):
- Examine and recognize our personal assumptions and beliefs, (i.e., understanding what you assume from others based on their culture). What do you expect them to be like based on the way they look, based on where they say they are from, etc.
- Be aware of our assumptions and be aware of how they might impact us as we work with others, because misunderstandings, false assumptions, and lack of communication can arise.
- Recognize that we play the role of student and must learn about the culture and what is culturally appropriate from those who live that culture.
Redressing Power Imbalances (Siroka, 2011).
- Ask whether or not we see individuals and community groups as the teachers and experts on their culture and community life. By doing so, we can empower the individuals and community groups and help create a sense of ownership in decision making.
- View ourselves as the student, we must learn about the culture from those who live that culture. However, we are also partners who have access to resources and knowledge. We should be able to contribute to the conversation, provide advice or input based on our knowledge, and share resources.
Create Mutually Beneficial relationships (California Health Advocates, 2007; State of South Wales, Department of Education and Training, 2010)
- Focus on the needs of those you are working with (client-focused approach).
- Empower community to direct the project and have a sense of ownership
- Examine similarities and differences between our own and the community’s priorities, goals, and abilities
- Exchange of resources and knowledge
Cultural Humility vs. Cultural Competence (Alameda County of Public Health Department, n.d.):
- Cultural humility does not require us to be competent in others’ cultures.
- We do not have master a list of different cultural health beliefs and behaviors.
- It challenges us to be self-critical, recognize our cultures and our assumptions of others.
- It challenges us to play the role of student and learn from those within the culture we are working with.
- It involves developing a respectful partnership with diverse individuals and communities. Creating relationships that benefit all involved and empower those we are working with.
Alameda County of Public Health Department. (n.d.). Public Health 101 Module II: Cultural Competency and Cultural Humility. [PDF document] Retrieved from http://www.acphd.org/media/133120/modii_slides_cultural_competency.pdf.
California Health Advocates. (2007). Are you practicing cultural humility? – The key to success in cultural competence. Retrieved from http://www.cahealthadvocates.org/news/disparities/2007/are-you.html
Siroka, A. (2011). Cultural humility. [PDF document]. Retrieved from http://www.courts.ca.gov/partners/documents/2011SRL4gHandout.pdf
State of South Wales, Department of Education and Training. (2010). CHCICS406A: Support client self-management. Retrieved from https://my.northcoast.tafensw.edu.au/thedepot/LearningToolboxes/CIV%20Youth%20Work%20Online%202010/04chcics406a/activities/topic01act01.htm
Definition: An approach to problem solving by viewing “problems” as parts of an overall system rather than reacting to specific parts, outcomes or events in isolation.
What is it? Having a strong emphasis on the study of relationships working across organizational boundaries, and understanding that individual health is influenced by more than just individual behavior.
Health issues or behaviors do not exist in a vacuum; there are many outside factors influencing individual behavior. Systems thinking has a strong emphasis on the study of relationships, specialized studies, working across organization boundaries, and the use of mixed methodologies (Leischow, 2006). By using an interdisciplinary way of thinking we can better understand health issues.
Key model that can be used to think systematically in impacting healthy equity is the Social Ecological Model
- Individual level
- Biological and personal histories
- Factors such as age, education, income
- Attitudes, beliefs, and behaviors of an individual and how those affect individual health
- Intrapersonal Level
- A person’s relationships, partners, family, ect.
- Community Level
- Schools, workplaces, neighborhoods, ect
- Places where there is interaction that may affect health
- Schools, workplaces, neighborhoods, ect
- Societal Level
- Include social and cultural norms
- Health, economic, educational, social policies that influence health
Social Justice Foundation
Definition: Improving the social determinants of health that impact health negatively so that all individuals are given an equal opportunity to achieve excellent health.
Social Justice can be shown in a graphic that has social and physical environmental factors such as housing, community, and infrastructure on a platform. This platform has a steep drop off that represents a person falling ill or losing their health. Prevention efforts and a person’s capacity to access preventative measures for disease and illness can be a blocker or a barrier protecting a person from plunging into illness. An additional buffer to further consequences of ill health come in access to and quality of secondary prevention efforts if primary efforts fail to prevent illness. An underlying buffer to all of these factors is the equability of quality, cost, and access to medical services and treatments. By providing equitable access to prevention efforts to all people, social justice in health can be achieved.
Using a Social Justice approach means considering upstream causes in health disparities (school, stores, employment, and ect.) and in downstream traditional public health interventions (screening, insurance, and ect.). Understanding that health is determined by factors beyond individual control and that these factors are unequally distributed across populations is the foundation of Health Equity and Social Justice.
Reciprocity and Accountability
Definition: We value partnership in which all parties are responsible for their own actions and mutually held to a high standard in order to achieve shared goals and objectives.
What is reciprocity and accountability?
Reciprocity is an approach to research that focuses on shared goals and responsibility of the research project. It is a “co-learning and empowering process that facilitates the reciprocal transfer of knowledge, skills, capacity, and power.”
Accountability is the commitment to providing justification for or information about decisions that are made. Types of accountability include financial (i.e. budgeting), performance (i.e. resource allocation), political (i.e. transparent decision making).
Definition: A collaborative process between the community and researchers to strengthen the well-being of the community.
Barriers and Benefits
- Community Barrier – community seldom feel they receive benefits
- Researchers choose the topics without addressing the needs of the community
- Academic Barriers – academic researchers struggle to produce results quickly. Community members expect quick turn around of results but it is unrealistic for researchers to produce these results in so little time.
- Community Engaged Research is a small part of an academic researchers’ duties.
- A real world setting allows for more practical applications that will improve human health.
- A guide to help researchers create authentic community-engaged research. Creating a frame work can help researchers create authentic community –academic partnership
- Building a framework increase accountability & equality between the partners
- Internal Department Grants
Conclusion: An authentic community-engaged approach to research will produce programs and systems that are more likely to be sustainable and impactful, benefiting both community and academic scientists and help to increase health equity.
Dr. Barbara Baquero is an Assistant Professor in the Community and Behavioral Health Department in the University of Iowa’s College of Public Health. She graduated with her PhD and MPH in Health Promotion from University of California San Diego and received her BA in Clinical Psychology from the Universidad Rafael Urdaneta in Maracaibo, Venezuela. Dr. Baquero’s conducts research guided by CBPR principles and the social-ecological framework. Her work focuses on identifying, understanding, implementing, and evaluating interventions in obesity and chronic disease prevention and control through the study of social, cultural, and structural factors. Much of her efforts work to reduce and eliminating health disparities for Latino immigrants in the US.
Dr. Paul Gilbert is an Assistant Professor in the Community and Behavioral Health Department in the University of Iowa’s College of Public Health. Dr. Gilbert graduated with his PhD from the UNC Gillings School of Public Health in Health Behavior, his ScM in Health and Social Behavior from the Harvard School of Public Health, and his BA in French and Political Science from the University of Michigan. He uses participatory, action-oriented principles in his research to advance the fields of health equity and alcohol-related disparities using mixed-methods study designs.
Dr. Jason Daniel-Ulloa is a Clinical Assistant Professor in the Community and Behavioral Health Department in the University of Iowa’s College of Public Health. He graduated with his PhD in Health Behavior Science, his MPH, and his BA in Psychology from the University of California San Diego. Dr. Daniel-Ulloa uses community engaged research approaches by establishing partnerships with local community members and organizations to decrease health disparities. One of his areas of focus is STD research with current work being done through the UI Mobile Clinic in cancer prevention and HPV vaccination. Additional research interests include healthy masculinity among Latino men and decreasing gender-based violence.
Dr. Briana Woods-Jaeger is an Assistant Professor at the Children’s Mercy Hospital in Kansas City, Missouri. Dr. Woods-Jaeger received her PhD and MS in Clinical Child Psychology from the University of Washington and her BA in Psychology from Duke University. Her research interests include providing psychological services for children and adolescents exposed to trauma as well as studying the behavioral, mental, social, and physical needs of both caregivers and children exposed to trauma and early adversity. Using comprehensive prevention and intervention approaches, she targets multiple risks, assets, and processes surrounding developing, implementing, and evaluating evidence-based research.
Becky Bucklin is a Research Assistant at the University of Iowa’s College of Public Health. She received her MPH from the University of Iowa College of Public Health in Community Behavioral Health and her BS in Nutrition and Wellness from Bradley University. Her work focuses on managing CBPR projects to increase physical activity and promote healthy retail for underserved populations.
The Science of Health Equity
April 17th, 9 AM -1:30 PM
College of Public Health Building (CPHB)
Event is free to public and all University affiliates
To find out more information check out our page at: (insert link)