Equity, Participation, and Power: Achieving Health Justice Through Deep Democracy

Exploring how health equity is addressed in accountable communities of/for health (ACHs)

OBJECTIVE

To explore how Accountable Communities of/for Health (ACHs), a type of health-focused multisector collaborative, are developing strategies to address health equity with diverse partners.

DATA SOURCES AND STUDY SETTING

Interview and focus group participants were recruited from a purposive sample of 22 ACH participant organizations in Washington (n = 9 ACHs) and California (n = 13 ACH).

STUDY DESIGN

Interview and focus group data were thematized using constant comparison analysis.

DATA COLLECTION

Interviews were conducted to learn how each ACH's system context, collaboration processes, and goals influence its progress toward health equity. Focus groups were conducted to gain a deeper understanding of how local context and power dynamics influence an ACH's ability to make progress toward health equity. There were 22 focus group participants and 65 interview participants.

PRINCIPAL FINDINGS

Results indicate that ACHs advance health equity across the social-ecological spectrum of health with approaches targeting the individual, community, and societal levels. Specific approaches used by ACHs to collaboratively address health equity include providing equity education to participating organizations and community groups; including diverse community voices in collaborative decision-making; changing practices in their participant's daily operations; improving existing services and developing new services; and actively promoting a culture of keeping equity at the center of ACH efforts.

CONCLUSIONS

This study identifies strategies for advancing health equity in multisector collaboratives. ACHs in Washington and California are devoting resources to ensure health equity is central to their work. The numerous approaches ACHs use to advance health equity are important to ensure everyone can reach their full health potential. While current literature argues that multisector health initiatives are integral for advancing health equity, there is a lack of research on how these initiatives advance equity in practice. Thus, this paper provides generalizable strategies that can be further investigated to optimize progress toward health equity.